31 jan 2022
As a Consultant in Infectious Diseases and Internal Medicine in an NHS Hospital, I have been on the front-line throughout the COVID-19 pandemic. I have chosen not to be vaccinated against Covid as I am sufficiently protected by natural immunity following infection and repeated re-exposure.
The growing evidence base indicates that a Covid vaccination for someone in my position will not alter the possibility that I will infect a patient I am caring for. It is also of vital importance that we robustly defend the right to personal autonomy as the default position. In order to countenance trespassing the right to personal autonomy, there must be excellent reasons and excellent evidence for its necessity. Mandating these vaccines, whether for healthcare workers or the general public, is counterproductive and will only fuel distrust in government and the medical profession.
Where there is risk, there must be consent or patients will cease to trust us. I asked a patient of mine with Covid, who was certainly at risk and would have benefited from a vaccine, why he didn’t have the vaccine. He told me: “I don’t understand the ins and outs. All I do know is that the Government is not being honest with me.” Tragically, he died a few days later. I have also seen vaccine side effects. Although infrequent, they are a reality poorly covered in the media and not appropriately discussed in order to gain consent. I cared for a young woman whose risk of severe illness was tiny, but developed severe myocarditis following vaccination. She said to me: “Nobody told me this was a possibility.”
My decision not to be vaccinated was not easy. Although it is now reported the Government intends to U-turn, at the time I took the decision I stood to lose my job and career on April 1st 2022 if I did not comply. But this issue is too important. It involves matters that that should give all of us pause to consider and debate.
As a healthcare worker, it is very important not to put my patients at unnecessary risk, particularly as many of them are especially vulnerable. Conversely, it is also true that any expectation placed on a healthcare worker must be necessary, safe, effective and reasonable. In order to satisfy these criteria there should be robust evidence to support it.
For the purposes of clarity, COVID-19 in those who are at risk and have not been previously infected can be so severe that the risk-benefit calculation is strongly in favour of having a vaccination. But care should be individualised, and this calculation may be different for people who are younger and at lower risk.
In my case, the natural immunity acquired from previous illness significantly reduces my chances of further infection and the evidence also indicates that a vaccination would not materially change this. Some of the best evidence for this is data from very large cohorts published by the Centers for Disease Control and Prevention (CDC) in America.
In mostly Delta infections, natural immunity provides robust protection against infection and hospitalisation, and vaccination in addition to previous infection makes no significant difference to this.
While vaccination against Covid has been shown to be effective at reducing severe disease and death, we know that it does not prevent acquisition of infection (particularly with the current variants), nor does it prevent transmission. A large study from Oxford suggests vaccination against the Delta variant has no significant effect on transmission 12 weeks after vaccination compared to an unvaccinated person. If someone does get infected, having had a vaccine previously does not appear to alter how likely they are to pass it on. And it now looks like the vaccines’ protection against Omicron is even worse than for the Delta variant.
Why not be vaccinated anyway, even if it might help a bit? This is where we must consider the safety of the intervention. These vaccines have now been given to a lot of people, so we now have some experience in adults. However, nobody has been followed up for more than two years, and there have been significant side-effects detected, particularly with regard to myopericarditis (with mRNA vaccines like Pfizer and Moderna) and thrombotic disease (with viral vector vaccines like AstraZeneca). As a result, many countries have restricted the use of one or more of the vaccines in younger people. It is difficult to make a good estimation of the long-term risks of the vaccines given that they are new and documentation and collation of side effects has been patchy. So, questions remain.
My conclusion is that there simply isn’t the evidence that being vaccinated will significantly reduce the risk that I will pass on COVID-19 to patients, particularly when I am protected by previous infection. Testing healthcare workers for the virus is the best precaution to be taken to protect patients from infection rather than relying on these vaccines. Furthermore, I am not convinced that the safety of the vaccines has been sufficiently demonstrated to warrant forcing me to have one. As a doctor, I believe that personal autonomy in matters of health is fundamental and so I will defend that right for myself, as well as others.
The wider concern is that coercion, particularly where there are still unknowns, fosters increasing mistrust in healthcare and vaccination, a fertile ground for conspiracy and misinformation. We should seek to persuade people based on evidence, not force them – and vaccine passports and certificates are clearly forms of coercion. Fuelling distrust in vaccines will cost lives and it is crucial that we do not do this. The potential long-term damage could be enormous and we lose the trust of patients at great peril to public health moving forward.
Dr. Simon M. Fox is a Consultant in Infectious Diseases and Internal Medicine in an NHS Hospital. Watch him speak about his decision to Julia Hartley-Brewer on talkRADIO here and also on GB News here.
By Simon M Fox / 31 January 2022
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