Planning for different groups of employees
Employees who can’t have the vaccine
Some individuals may be advised not to have the vaccine due to a medical condition, while others may be allergic or have trypanophobia (a fear of needles). These people could be protected by the disability provisions within the Equality Act 2010 if they refuse the vaccine.
It is possible that some allergic reactions could be protected as a disability but this should not be an issue if employees refuse the vaccine due to an allergy. Following the initial roll-out, the MHRA has advised that individuals with a history of anaphylaxis to food, an identified drug or vaccine, or an insect sting can still receive any COVID-19 vaccine, as long as they are not known to be allergic to any component of the vaccine.
For employees with a genuine medical reason that prevents vaccination, employers should take other steps with regards to health and safety, for example reinforcing their COVID-19 risk management, regular testing, facilitating remote working where possible, or considering a different role. In some cases, medical advice may need to be taken with the employee’s consent.
Employees who may be hesitant
‘Vaccine hesitancy’ is the term used to describe either a delay in taking vaccines, or a refusal to have them. It is a complex area with much scientific research considering the reasons behind it and the approaches to take.
There are NHS toolkits for healthcare workers and public health experts dealing with hesitancy. Encouraging people with a deeply established anti-vax stance to receive a vaccination is difficult. How best to manage this is a complex aspect of behavioural science and really falls to the state rather than individual employers. However, employers may find some of the overall research helpful in managing employees who are hesitant. Encouragement, engagement and education are key.
External medical advisors engaged to answer any questions and provide reassurance to employees may help. Trusted members of senior management may also be able to deliver the message as trust is a key aspect. False stories on social media need to be countered with evidenced-based messages. Social norms also influence behaviour so bringing attention to national media reports showing how many people have been vaccinated each day helps the feeling of a collective effort.
Employers should listen to any concerns employees have around vaccination with empathy and understanding, as with the many issues that people have been facing due to the pandemic (like illness, fear and anxiety, childcare issues and so on) – this is a period that needs very careful and sensitive management.
Line managers will likely be the first port of call for most employee concerns – hopefully the relationship they have with their team will be based on trust and the kind of environment that enables honest conversation. Managers also need to be briefed on the organisation’s vaccination policy and any awareness campaign around vaccinations, possible questions and concerns they could face from employees about the vaccine, and how to deal with them/refer to HR if necessary.
Pregnant or breastfeeding employees
Advice for those who are pregnant, breastfeeding or planning to get pregnant has changed since the vaccination programme started. There's no evidence the COVID-19 vaccines are unsafe. The JCVI advise that pregnant women should have the COVID-19 vaccine as soon as possible. Pregnant women are more at risk of severe COVID-19 disease and should not delay vaccination until after they have given birth.
Breastfeeding women can have the COVID-19 vaccine.
Women do not need to avoid pregnancy after vaccination. However, those who avoid vaccination because they are planning a pregnancy may be able to use this to assert sex or pregnancy discrimination if they are then treated less favourably or are later dismissed due to this refusal.
Ethnic minority groups
There has been some evidence that hesitancy about the vaccine has been disproportionately higher in ethnic minority groups. The government's scientific group for emergencies (SAGE) has warned of a risk that vaccine uptake could be lower among certain ethnic minority groups.
The additional effort to identify and encourage ethnic minority patients to take up COVID-19 vaccination is primarily down to the government and the NHS. Employers should not identify employees based on ethnicity and stereotype them based on their ethnicity as this would potentially be discriminatory treatment. Employers should distribute information equally to all employees. There is an NHS anti-disinformation drive and a national equalities board dealing with the disproportionate impact of the virus on ethnic minority communities.
Employers should consider any cases of hesitancy individually, offering support and directing to NHS and government advice where possible.
Employees who refuse the vaccine
Employees may refuse vaccines for many reasons, ranging from concerns about potential allergy, a phobia of needles or misplaced concerns about fertility. There is also misinformation around vaccines including disbelief about the rigorousness of the approval process, which could lead to concerns or refusal.
Whatever reason an employee has for refusing to be vaccinated, employers must consider each case individually, taking into account the issues outlined below. Some of the concerns people may have could reflect deeply held views or feelings of apprehension, and these are taking place against a backdrop of heightened levels of fear and anxiety due to the pandemic and the challenging circumstances many are experiencing.
Refusal due to philosophical belief
An employee with an anti-vaccination belief could argue it is a protected philosophical belief under the Equality Act 2010. This act protects some beliefs, such as climate change, or the use of only natural medicine, if deemed genuinely held and worthy of respect. The Grainger case law is an example. There has been some initial tribunal level case law which suggests that a fear of catching COVID-19 is not a protected philosophical belief. There are legal subtleties around whether the 'anti-vax' movement would be protected, but there is at least a possibility claims could be brought and lead to irrecoverable legal costs or compensation. If an employee seeks protection under philosophical belief, please seek legal advice.
Refusal due to religious belief
Some employees may refuse to be vaccinated on the basis of their religious beliefs. Religious beliefs do not have to be shared by everybody within that religion. For example, the belief of some Christians that a cross should be worn as a symbol of your faith does not have to be held by everyone. Therefore, an anti- vaccination belief could be held by some people of a certain faith and potentially be protected, even though others of the same faith are in favour of vaccination. Employers will have to take each case on its merits and listen to an employee’s reasons for refusing vaccination and if necessary, explore other COVID-19 secure ways of working.
Religious objections to vaccines are for a wide range of reasons depending upon the individual, the interpretation of their religion and the vaccine. Objections may be based on beliefs that the body should avoid certain chemicals, stem cell or animal derived products.
For example, although pork gelatine is historically used in some vaccines, which could lead to refusal on the grounds of religious belief for people of Muslim, Jewish or Hindu faith, the COVID-19 vaccines being used in the UK do not use pork gelatine. Other objections may relate to ethanol or host cell lines used in the production of some vaccines. The UK COVID-19 vaccine rollout is endorsed by the British Islamic Medical Association, Hindu Council UK, and the Board of Deputies of British Jews. Full information on the ingredients of the Oxford-Astrazeneca, Pfizer-BioNTech, Moderna and other vaccines can be found on their websites and patient information leaflets. This information can be used to discuss any objections based on religious beliefs.
Other religious groups with an objection to vaccines include religions that rely on faith healing including some Christian churches. Some Amish may be reluctant to vaccinate. Christian Scientists do not have a formal policy against vaccines but may believe that medical interventions including vaccines are unnecessary generally relying on prayer for healing. There has been an unsuccessful tribunal level case concerning dismissal for refusal to be vaccinated which had a religious element. The employee said taking any form of non-natural medication would go against her Rastafarian beliefs. However, there were issues in that case about when the religious objection to pharmaceutical medicines was raised. Employers should take each case individually and listen to any reasons for refusing vaccination and, where needed, consider other COVID-19 secure ways of working.
Detailed free information on vaccines and their ingredients can be obtained from the University of Oxford Vaccine Knowledge Project which aims to provide clear information to the public backed up with references to research. This information may help employees make informed decisions about vaccine issues.
Options if staff refuse vaccination
If staff refuse vaccination employers should seriously consider the employee’s reasons and any concerns they may have, and look to implement alternative solutions, while relevant. This could include hybrid working or continued working from home if possible, social distancing within the workplace, screens, the use of PPE and so on. The employer may be willing to consider changing the employee’s work responsibilities or role if this could enable them to work remotely or in a safer working environment. The position changes from month to month as virus rates, variations and severity of symptoms fluctuate.
Ultimately, if their return to the workplace could pose a threat to the wider workforce's health and safety, employers may consider not allowing unvaccinated employees to return to the workplace. This entails a legal risk for the employer. Indirectly pressurising employees to be vaccinated (such as with disciplinary action) are likely to result in claims and will be less successful, ultimately, than the encouragement approach of sharing educational factual information.
In some sectors though, such as health and care work, vaccination is of even greater importance so employers may consider a dismissal process as a last resort, especially if they are unable to find alternative work for individuals who refuse vaccination and other efforts at encouraging employees to be vaccinated are unsuccessful.