The College responds to a DHSC consultation on revoking vaccination as a condition of deployment

The College of Optometrists agrees that vaccination is among the safest, most effective and evidence-based approaches to help protect people from infectious diseases. As such, we have always encouraged all health and social care workers in primary and secondary care, and their colleagues, to have all recommended vaccinations, unless they are medically exempt.

We believe that the over-whelming majority of optometrists and practice staff are already vaccinated, including with the booster (third dose). We are of the opinion that vaccine uptake will continue to be maximized where optometrists and practice staff are supported to make their own decisions, having been provided with clear, evidence-based information on the benefit and value of vaccinations. Indeed, enforcing vaccinations may actually result in the opposite response, and discourage people from coming forward.

Throughout the pandemic, hospital eye care services have been severely affected, which has resulted in patients not being treated; and now, we must continue addressing the significant backlog of patients in the system who are at risk of permanent sight loss. Whilst we would anticipate that only a very small number of optometrists will continue to be vaccine hesitant, employers would have been faced with complex challenges (including legal complexities) in dismissing unvaccinated staff. Re-deployment to other duties would not have been a feasible option for many optometrists, and the health system would have run the risk of losing essential workers from the eye health sector at a time when it is already under-resourced.

We therefore agree that revoking vaccination as a condition of deployment is the correct policy.

While the vast majority of healthcare workers, including optometrists and practice staff have had at least one dose of the Covid-19 vaccine, some that are eligible to be vaccinated may have not yet chosen to do so.

We recognise that some individuals have concerns about vaccination. Some of the common reasons for vaccine hesitancy include lack of access to appointments, doubts and misinformation about their mode of action, safety and efficacy^{4, 9, 10, 11, 12} and lack of support and reliable information from colleagues and other social groups^{9, 12}.

Evidence suggests that mandating vaccination may actually be counterproductive, as it may shut down the opportunity to discuss and dispel myths and increase knowledge, and may increase distrust in health and science information ^{6, 7, 8} Furthermore, those who are initially accepting of vaccinations may choose not to by objecting to the government mandating what they should do^{6, 7}.

Previous studies looking into maximising vaccine uptake suggest that providing accessible and flexible services, and regular reminders/recalls are most effective^{3, 4, 12, 13}. Evidence also suggests that good interactions between health professionals and educators to discuss concerns, explain evidence, and discuss the risks and benefits as part of an active listening and motivational interview approach are effective at reversing vaccine hesitancy^{3, 4, 12, 14}.

We therefore believe that 1-2-1 discussions with employers and line managers, and targeted information to dispel misinformation will be more effective in encouraging vaccine uptake, as well as time off being granted to attend vaccination appointments.

As the professional body for optometrists, the safety of patients, optometrists and their colleagues has always been the College’s priority. The pandemic has seriously affected the provision of eye care, and focused attention on the need to maintain stringent infection and prevention control measures, including access to recommended vaccinations, to protect patients and practice staff from harm.

Covid-19 vaccination is proving to be an important tool in managing the pandemic; however, it is not sufficient in itself. For example, regular lateral flow testing of front-line staff continues to be important, and we encourage all optometrists to undertake regular testing and to take appropriate action if they receive a positive result.

We believe that an over-emphasis on vaccination could result in a relaxing of infection control measures in healthcare settings (particularly in primary care) where workers may be given a false sense of security.

We recommend that the Department of Health and Social Care:

• continue to encourage all healthcare workers, including optometrists and colleagues who are vaccine-hesitant, to have the opportunity to fully understand the benefits of vaccinations, with risks explained proportionately, and given the autonomy to make an informed choice. Optometrists should be given time to discuss their concerns with their employer or occupational health team.
• ensure that optometrists and colleagues have priority and easy access to all vaccines as frontline healthcare workers. Employers should make having vaccinations as easy as possible; for example by enabling optometrists to attend an appointment within working hours, or at a time and location that suits their needs.
• provide employers with the support to undertake a risk assessment for those who are medically unable to be vaccinated, or remain hesitant about vaccines, and consider how to mitigate risks to patients and prioritise patient safety.
• continue to ensure that messaging around infection control measures and regular lateral flow testing is clear, and that they must continue to be practiced, regardless of whether optometrists have been vaccinated or not.

1. Coronavirus and vaccine hesitancy, Great Britain - Office for National Statistics (ons.gov.uk)
2. BAME community hesitancy in the UK for COVID-19 vaccine: suggested solutions | Postgraduate Medical Journal (bmj.com)
3. COVID-19 vaccine hesitancy – debunking the myths using a community engagement approach underpinned by NICE guidance | NICE
4. Covid-19 vaccination hesitancy | The BMJ
5. 2021-11-02-coronavirus-covid-19-infection-in-pregnancy-v14.1.pdf (rcog.org.uk)
6. Vaccine hesitancy: guidance and interventions (2019) K4D, Tull, K
7. Mandatory infant & childhood immunization: Rationales, issues and knowledge gaps (2018) Vaccine, MacDonald, N. et al
8. COVID-19 vaccination beliefs, attitudes, and behaviours among health and social care workers in the UK: a mixed-methods study (2021) medRxiv, Bell, S. et al (Not yet peer reviewed)
9. Vaccine hesitancy and healthcare providers - PubMed (nih.gov)
10. Vaccines | Free Full-Text | Healthcare Providers’ Vaccine Perceptions, Hesitancy, and Recommendation to Patients: A Systematic Review (mdpi.com)
11. Knowledge, attitudes, beliefs and behaviors of general practitioners/family physicians toward their own vaccination: A systematic review (nih.gov)
12. Increasing the coverage of influenza vaccination in healthcare workers: review of challenges and solutions - ScienceDirect
13. BNT162b2 vaccine uptake and effectiveness in UK healthcare workers – a single centre cohort study | Nature Communications
14. Using Best Practices to Address COVID-19 Vaccine Hesitancy: The Case for the Motivational Interviewing Approach - PubMed (nih.gov)

Submitted: February 2022