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Spoonful of honey or a gallon of vinegar? A conditional COVID-19 vaccination policy for front-line healthcare workers
  1. Owen M Bradfield1,
  2. Alberto Giubilini2,3
  1. 1 Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
  2. 2 Oxford Uehiro Centre for Practical Ethics & Wellcome Centre for Ethics and the Humanities, University of Oxford, Oxford, UK
  3. 3 University of Oxford, Oxford, UK
  1. Correspondence to Dr Owen M Bradfield, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia; o.bradfield{at}


Seven COVID-19 vaccines are now being distributed and administered around the world (figure correct at the time of submission), with more on the horizon. It is widely accepted that healthcare workers should have high priority. However, questions have been raised about what we ought to do if members of priority groups refuse vaccination. Using the case of influenza vaccination as a comparison, we know that coercive approaches to vaccination uptake effectively increase vaccination rates among healthcare workers and reduce patient morbidity if properly implemented. Using the principle of least restrictive alternative, we have developed an intervention ladder for COVID-19 vaccination policies among healthcare workers. We argue that healthcare workers refusing vaccination without a medical reason should be temporarily redeployed and, if their refusal persists after the redeployment period, eventually suspended, in order to reduce the risk to their colleagues and patients. This ‘conditional’ policy is a compromise between entirely voluntary or entirely mandatory policies for healthcare workers, and is consistent with healthcare workers’ established professional, legal and ethical obligations to their patients and to society at large.

  • COVID-19
  • health workforce
  • public health ethics
  • clinical ethics
  • right to refuse treatment

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  • Contributors OMB developed the concept for the article with consultation and expansion from AG. OMB performed the scoping and primary drafting while AG provided substantial revisions and expansion of concepts. Both OMB and AG approved the final version of the manuscript.

  • Funding OMB was supported by a Melbourne Research Scholarship and is also a recipient of a 2020 Fulbright Future Scholarship sponsored by The Kinghorn Foundation. AG was supported by an AHRC/UKRI grant (AH/V006819/1).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.