Table 1

’Intervention ladder’ adapted for mandatory vaccination of FHCWs from most to least coercive

PolicyConsequences of vaccine refusal*
Forced vaccinationForcible vaccination using chemical or physical restraint, if required.
Compulsion/penaltiesFines or imprisonment; termination of employment; cancellation of professional registration.
Professional restrictions/conditionsEmployment suspended; enforced leave; loss of salary for days not worked; admitting rights suspended; conditions imposed on professional registration preventing front-line healthcare work.
RedeploymentRedeployment to non-clinical duties, working from home. Restriction on direct clinical work with elderly, vulnerable, immunocompromised patients.
Loss of incentivesNo access to employee privileges, such as additional paid leave; no access to restricted areas of the health service such as tea rooms or health club; no professional registration fee discount.
Nudging/libertarian paternalismOpt-out policies, such as requiring FHCWs to sign a declinature statement explaining why they are refusing COVID-19 vaccination; reporting vaccination rates across different teams and highlighting underperforming teams to increase rates, making it harder for underperforming teams to say it is not possible to increase rates.
PersuasionEducation campaigns or professional development activities offered (but not mandated) to persuade FHCWs to reconsider.
No interventionNo intervention if FHCW refuses or declines vaccination.
  • *Does not apply to exemption on approved medical grounds.

  • FHCW, front-line healthcare worker.