Mandatory vaccination of health workers would be ‘most intrusive step’ – regulator

Watchdog advises Nphet to take ‘progressive’ steps to encourage vaccine take-up

Mandatory vaccination of healthcare workers who refuse the Covid-19 vaccine may be considered in future but it would be the “most intrusive step”, a health regulatory report has warned.

The State’s health service watchdog, the Health Information and Quality Authority (Hiqa), has advised the National Public Health Emergency Team (Nphet) on developing a policy that follows “progressive” interventions to encourage healthcare workers who decline to take the vaccine.

Hiqa has recommended that policies are developed and enacted on the basis of an “intervention ladder” starting with evidence-based information and then one-to-one conversations with workers who refuse the vaccine, ongoing testing and additional personal protective equipment.

Possible redeployment to a lower risk area may then be considered. Mandatory vaccination would be “at the top of the ladder as the most intrusive step”, the regulator advises.


“The decision to step up the ladder should be influenced by the level of risk to patients from unvaccinated personnel posed by increased levels of community transmission,” said Hiqa.

The regulator recommended the need for specific guidance on what the steps on the ladder might be and who might be exempted.

“Additionally, such a measure may be perceived as being overly harsh on a workforce that have had a particularly traumatic year,” Hiqa says in the advice to Nphet.

“If all lesser restrictive measures have been exhausted and there is still low uptake, consideration may be given to mandatory vaccination in the future.”

The expert group expressed caution about “how far one should go to ensure high levels of vaccination and the potential creation of a negative work environment”.

Hiqa advised that a model of “encourage and support” should be followed on vaccination of healthcare workers “to ensure ongoing positive work environments”.


Commentary about the ethics of mandatory vaccination showed there was a risk of “a breakdown in trust” between staff and institutions if mandatory vaccination was implemented.

Dr Máirín Ryan, Hiqa’s deputy chief executive and director of health technology assessment, said it was encouraging all healthcare workers to be vaccinated “as soon as they are eligible”.

She said the regulator was advising Nphet that any policy about Covid-19 vaccination “should be built on a model of encouragement and support”.

Few countries have policies and guidance on unvaccinated healthcare workers. Hiqa found that only the UK had published guidance on the topic and only Italy had introduced a policy of mandatory Covid-19 vaccination for all healthcare workers.

“It is vital that vaccine policy considers issues around data collection, legality and ethics as well as the range of mitigation strategies available to protect those availing of and working in the health service,” said Dr Ryan.

In another area of guidance, Hiqa stuck with its view that people had six months of presumptive immunity from Covid-19 after being infected with the disease.

However, it told Nphet the body of evidence about immunity duration and protection from reinfection was “rapidly expanding” and advised that the data be continuously reviewed.

Hiqa also advised no change in the minimum age for the wearing of masks in a community setting. Face masks or coverings are not recommended for children under the age of 13.

Simon Carswell

Simon Carswell

Simon Carswell is News Editor of The Irish Times