UK COVID-19 Update: Mandatory NHS Jabs Considered, 'Exciting' Antibody Treatment Results

Tim Locke

June 16, 2021

Editor's note, 16 June 2021: This article was updated with new information from the Commons.

These are the UK coronavirus stories you need to know about today.

Mandatory Jabs

The Guardian reported there are plans for COVID-19 vaccination to be made compulsory for care home staff looking after elderly people in England, and ministers are considering extending this to NHS staff.

England's Health Secretary confirmed the plan in the Commons: "After careful consultation we've decided to take this proposal forward to protect residents."

He continued: "We will be taking forward the measures to ensure the mandation as a condition of deployment for staff in care homes and we will consult on the same approach in the NHS in order to save lives and protect patients from disease."

The BMA said earlier that "compulsion is a blunt instrument that carries its own risks" and "would raise new ethical and legal implications".

Danny Mortimer, chief executive of NHS Employers, said: "Any announcement to make the vaccination mandatory for social care workers will also impact on NHS staff, especially those who provide health care in social care settings.  Our members will continue to place an emphasis on education and communication with their staff, something which remains crucially important even where the Government insists on mandatory vaccination. 

"We will also work closely with our trade union colleagues to address the concerns of their members and to ensure that the implementation of any decision is handled sensitively going forward."

Commenting via the Science Media Centre, Dominic Wilkinson, professor of medical ethics, University of Oxford, said: "There is a strong ethical case that care home workers (and NHS staff) who have not had the COVID vaccine should be redeployed to areas other than frontline care.

"It would be ethical to make COVID vaccination (in the absence of a medical exemption) a condition of employment in the same way that hepatitis B vaccination is currently for some health professionals.

"If vaccines are made mandatory for health care and care home workers, they should be able to choose from available vaccines. Every effort possible should be made to address any concerns that they have about the vaccines."

What do you think?

No Jabs for Kids Yet

The Telegraph reported that ministers will be advised against a vaccination programme for children until more risk data becomes available. The JCVI could issue a statement this week, the paper said.

International Trade Secretary Liz Truss told the BBC: "It is my understanding that they are not recommending the vaccination of under-18s and we will be saying more in due course about that."

Earlier this month, the MHRA approved the Pfizer/BioNTech vaccine for use in 12-15 year olds.

Doctors' Distress

A new BMA poll of almost 2000 doctors found that the concepts of moral distress and moral injury were new to many medics, but over three-quarters (78.4%) of respondents stated that moral distress resonated with their experiences at work.

Over half of doctors cited "insufficient staffing to suitably treat all patients" as one of the leading causes of their moral distress.

Mental fatigue was the second most common reason.

'Hopeless' Hancock

Former Downing Street adviser Dominic Cummings has released WhatsApp messages he says show Prime Minister Boris Johnson describing Health Secretary Matt Hancock as "totally....hopeless".

The PM also seems to describe the first wave PPE situation "a disaster".

Mr Cummings had previously told a committee of MPs that Mr Hancock should have been fired for lying but had not previously submitted evidence to back up his claims.

Downing Street didn't deny the messages were genuine but said the PM has full confidence in Mr Hancock.

'Exciting' Antibody Treatment Results

Oxford University's RECOVERY trial demonstrated that Regeneron's investigational antibody combination reduces the risk of death when given to patients hospitalised with severe COVID-19 who have not mounted a natural antibody response of their own.

In the trial, published as a preprint, 9785 patients hospitalised with COVID-19 were randomly allocated to receive usual care plus the antibody combination treatment (casirivimab 4g with imdevimab 4g by intravenous infusion) or usual care alone.

Among patients who were seronegative at baseline, the antibody combination significantly reduced the primary outcome of 28-day mortality by one-fifth compared with usual care alone (24% of patients in the antibody combination group died vs 30% of patients in the usual care group; rate ratio 0·80; 95% confidence interval 0·70–0·91; p=0·001). Thus, for every 100 such patients treated with the antibody combination, there would be six fewer deaths.

Joint Chief Investigator, Sir Peter Horby, said: "These results are very exciting. The hope was that by giving a combination of antibodies targeting the SARS-CoV-2 virus we would be able to reduce the worst manifestations of COVID-19. There was, however, great uncertainty about the value of antiviral therapies in late-stage COVID-19 disease. It is wonderful to learn that even in advanced COVID-19 disease, targeting the virus can reduce mortality in patients who have failed to mount an antibody response of their own."

Needle Fears

COVID-19 vaccine hesitancy could be reduced by 10% if people's needle anxiety was treated, according to Oxford research involving 15,014 adults published in Psychological Medicine.

Study lead, Professor Daniel Freeman, said: "For people with injection phobia the sight, say, of a hypodermic needle will prompt an initial increase in heart rate and blood pressure. This may be swiftly followed by a sudden decline in both. When that happens, some people faint. The COVID-19 vaccination programme means that almost everyone has had – or will soon have – to face the needle. People may certainly think twice about joining a queue for a vaccine if they fear that they might topple to the ground."

NHS England opened vaccine booking to 21 and 22-year-olds today.

Care Concerns

A report from the Commons Public Accounts Committee highlights the pandemic’s "devastating impact on the care sector" and says the sector "is not properly funded, lacks transparency and urgently needs reform".

Meanwhile, an Association of Directors of Adult Social Services (Adass) survey of more than 90 directors found:

  • 69% are seeing more people referred for support from the community

  • 68% are seeing more people with mental health issues

  • 67% are seeing more people seeking support due to a breakdown in carer arrangements

Commenting, Dr Andrew Goddard, president of the Royal College of Physicians, said the results of the survey "are further evidence that the government needs to take action on social care immediately".

The Department of Health and Social Care said the Health and Care Bill will introduce plans to develop and support improved adult social care oversight across England.

More News

  • University of Sheffield research published in Resuscitation found 31% suspected COVID-19 admission patients had DNACPR decisions recorded before or on their day of admission during the first wave. In March, the Care Quality Commission expressed "serious concerns" that individuals' human rights may have been breached in more than 500 pandemic DNACPR decisions.

  • Referrals for children and young people with eating disorders has almost tripled during lockdown, according to Royal College of Psychiatrists in Scotland freedom of information request figures. The College blamed an emphasis on virtual appointments, loss of support structures, staffing shortages, and reduced access to community services.

  • Office for National Statistics (ONS) data for England show that after adjusting for age, 'more-disabled' people were more than three times as likely to die from causes involving COVID-19 than non-disabled people. 'Less-disabled' people were almost twice as likely to die from causes involving COVID-19 than non-disabled people. 

See more global coronavirus updates in Medscape’s Coronavirus Resource Centre.

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