Can nursing home professionals be forced to be vaccinated by law?

One in six workers in health centres and nursing homes has not yet received a dose of the vaccine

4 min
Two women entering the residence where they live, in an archive image

MartorellIn January, a judge in Seville forced an 86-year-old disabled woman to be vaccinated against the coronavirus, despite her son's refusal. Also in Andalusia, but a decade earlier, the courts had ruled in favour of the regional government and ordered the forced vaccination against measles of some thirty children in the Albaicín neighbourhood to stop an outbreak of this highly contagious disease. The parents objected on religious grounds and, despite the fact that vaccination is voluntary in Spain, the magistrate protected the common good. The professor of the UB Observatory of Bioethics Fernando García López brings these two examples to the table as a result of the debate on whether to force-vaccinate the 16% of the staff of health centres and geriatric centres that have not yet been vaccinated, although they have been given preference.

"The figure is the average, but we have evidence that there are homes with 40% of unvaccinated staff", says Maria Jose Carcelen, a member of the Coordinator 5 + 1 and one of the spokespersons of the new Plataforma Estatal de Organizaciones de Familiares y Usuarias de Residencias (State Platform for Organizations of Relatives and Users of Nursing Homes). The organisation calls for a reversal of the "hotel and usurious" model of geriatric homes in order to increase the public management and administration of the centres. The latest outbreak of coronavirus, in fact, occurred in a nursing home in La Bisbal d'Empordà and caused two deaths. In this case, 54 of the 55 residents had completed the vaccination schedule in January, while of the 56 professionals, 46 were vaccinated and 10 were not.

Vaccination is voluntary in Spain, but the law on special public health measures is generic enough to open the debate. It empowers the government to apply all necessary measures, but does not go beyond that, and not even with the pandemic has the Spanish government wanted to open the debate, appealing above all to the traditional high coverage of vaccines, higher than in other countries in the region.

Constant hiring

The Health Department does not explain the reasons why the professionals on the front line against covid have not been vaccinated four and a half months after the start of the campaign. Andrés Rueda, president of Ascad, the association of directors of dependency centres, does mention them. He describes the anti-vaccine campaigners as "residual", but points to the reticence of pregnant women and breastfeeding mothers, who are concerned about possible side effects, despite the fact that there is no scientific evidence to question their safety. Above all, he stresses "the lack of agility" in vaccinating professionals hired for the first time and that is why he calls on the Department of Health to "get its act together" to schedule more and faster, despite the fact that it has managed to have sufficient stock of vaccines available and that professionals are a priority for the Department of Health, he defends. "Labour mobility is very high" due to the ravages of "pandemic fatigue" of the staff, "exhausted by so many hours of work for more than a year", explains Rueda.

The Secretary of Public Health, Josep Maria Argimon, closes the debate on the compulsory nature of vaccination with a concise "it cannot be done", an argument the unions also agree with. Garcia Lopez admits that it is a complicated issue because there is a "collision between individual rights and the common good", but says that in the field of bioethics "mandatory vaccination would be justified". He cites the "John Sutart-Miller principle", which limits individual liberties if they harm third parties. At Col-lectiu Ronda they admit that there is an unresolved internal debate among lawyers about whether the refusal to be vaccinated could be considered a "supervening ineptitude" and therefore be grounds for dismissal. Sources in the same office indicate that although company medical check-ups are voluntary, for certain sectors, such as forest firefighters, "it is essential to know the state of health of the professional". "Could this be regulated in this sense? There is a lot of uncertainty", say the same sources.

Rueda, however, while admitting that vaccination "cannot be forced", is in favour of it being "a requirement" to apply for a job: "In the same way that to join the Mossos d'Esquadra you have to achieve certain marks and have a certain physical condition, or level C of Catalan to be a civil servant, to work in a nursing home you can be considered vaccinated". This is an option shared by employers' organisations such as ACRA, the largest in the country, the president of which, Cinta Pascual, appeals to the "individual responsibility" of workers, but also regrets that Health has not done more "pedagogy" to "overcome fears", such as that of women who plan to become pregnant. In contrast, Josep Maria Yagüe, head of trade union action for the CCOO, questions its legitimacy.

In the easing of restrictions in geriatric homes, Health has relaxed the restrictions in the centres according to the reduction of mortality, income and positive cases due to the impact of the vaccine. Less than 5% of residents have not been vaccinated, but for Carcelén, of the platform of families, the most serious thing is that the department has removed from the protocol periodic screening with PCR in nursing homes and only provides tests for unvaccinated people every fifteen or thirty days, depending on the incidence of covid in the area. The platform, which has been presented virtually, brings together organizations from ten autonomous communities and calls for regional parliaments to investigate the high mortality in nursing homes, to increase inspections "without warning" to geriatric centres and increase the ratios of professional staff (from nurses to assistants) and investigate the "physical, emotional and psychological" aftermath caused by the ban on leaving the centres and the lack of contact with families. "There are residents who have lost fifteen kilos", said Carcelén in the presentation of the entity.