1. Position
The RACGP:
- supports mandatory COVID-19 vaccination for healthcare workers
- proposes this requirement includes general practitioners (GPs), practice nurses, reception staff and other members of the practice team undertaking patient facing roles as appropriate
- highlights the potential benefits of widespread vaccination amongst healthcare workers, including:
- protection of healthcare workers, who by nature of their work and interaction with the community are at greater risk of contracting COVID-19
- reduced transmission of COVID-19 from healthcare workers to patients and other team members
- reducing disruption to health services when healthcare workers are infected with COVID-19
- considers that vaccination of healthcare workers supports the medical profession’s duty of care and builds vaccine confidence in the community.
2. Definition
For the purposes of this position statement ‘vaccination’ refers to receiving a full course of an approved COVID-19 vaccination in Australia, including:
- AstraZeneca (Vaxzevria)
- Pfizer (Comirnaty)
- Moderna (Spikevax).
3. Background
The National Plan to transition Australia’s National COVID-19 Response will see lockdowns eased and opening up of interstate and international borders at a time where there will likely be virus circulating in the community and a proportion of the population unvaccinated. The healthcare system will inevitably be challenged as restrictions ease, even with high vaccination numbers. Vaccination against COVID-19 of all healthcare workers will go some way to readying the system and sustaining the workforce now and into the future.
Immunisation is a safe and effective way to prevent serious disease and GPs and their teams have a key role in vaccine delivery and acceptance in the community.1
Healthcare workers, by nature of their work and interaction with the community, are at greater risk of exposure to, and contraction of, COVID-19. Across Australia, thousands of healthcare workers and support staff have been diagnosed with COVID-19, of which a majority of cases were likely acquired in the workplace.2
The RACGP believes all healthcare workers, including GPs and members of the general practice team, should be vaccinated for their own protection, for the protection of patients, and for the protection of Australia’s healthcare system more broadly.
4. Discussion
4.1 Current application of mandatory vaccinations
4.1.1 Australia
Australia’s National Cabinet has mandated COVID-19 vaccinations for all residential aged care workers as a condition of working in a residential aged care facility. 3
Some State and Territory governments have issued public health orders mandating COVID-19 vaccines for all healthcare workers to ensure the safety of patients and other workers. However, these orders often exclude GPs and general practice teams.
There is legislation and public health orders in place in some states and territories for other workers in specified occupations deemed to be high risk of COVID-19 transmission such as disability support, border and quarantine, aviation, and early childhood education. Current public health orders mandating COVID-19 vaccination for specified workers are listed on the FairWork Ombudsman webpage.
Public Health Orders have been in place since 2020 in most states and territories mandating influenza vaccination for all residential aged care workers, volunteers and visitors in response to recommendations by the Australian Health Protection Principal Committee (AHPPC).
4.1.2 Overseas4
Mandating COVID-19 vaccination for healthcare workers has been implemented internationally including in Italy and Hungary.
Care home workers in England will be required to have received a full schedule of COVID-19 vaccination by October. This requirement has not been extended at all National Health Service staff.
Canada requires all federal public servants and many other workers to be vaccinated against COVID-19.
The United States of America (USA) requires federal workers to provide proof of vaccination or face regular testing, mask mandates and travel restrictions. Some US states require state employees and those working in high-risk settings to be vaccinated against COVID-19.
4.2 Obligations for registered health practitioners
GPs and other registered health practitioners have responsibilities outlined by the Australian Health Practitioner Regulation Agency (Ahpra) and the National Boards to “to promote the health of communities and meet obligations with respect to disease prevention including vaccination, health screening and the reporting of notifiable diseases”.5
The Medical Board’s Good medical practice: a code of conduct for doctors in Australia states that “Good medical practice involves…. Making sure that you are immunised against relevant communicable diseases” (section 11.2.4).
4.3 Scope of application
The RACGP supports mandatory COVID-19 vaccination for all healthcare workers, including GPs, practice nurses, reception staff and other members of the practice team undertaking patient facing roles. We strongly encourage vaccination more broadly for all non-patient facing staff in all healthcare services.
A position on mandatory COVID-19 vaccination for other industries, is outside the remit of the RACGP and should be determined by federal, state and territory governments and other industry bodies. The RACGP supports having as many Australians vaccinated as possible and recommends industries considering mandating vaccination for workers do this collaboratively and in line with workplace health and safety legislation.
The RACGP recognises employers are well positioned to support COVID-19 vaccination uptake among their employees. Types of support employers can offer include education on the benefits of vaccination, facilitating easy and convenient access to vaccinations and minimising any financial or times costs associated with getting vaccinated.
4.4 Exemptions
The ATAGI clinical guidance on COVID-19 vaccine in Australia in 2021 outlines contraindications for COVID-19 vaccination. Healthcare workers who have any condition which contraindicates vaccination should be exempt from mandatory vaccination.
Exemptions due to medical contraindications or natural immunity can be recorded on the Australian Immunisation Register which displays on an individual’s Immunisation History Statement. Eligible medical practitioners, including GPs, can record an individual’s exemption by completing the Australian Immunisation Register (AIR) - immunisation medical exemption form (IM011).
4.5 Supports for healthcare workers who cannot receive a COVID-19 vaccination
Where a healthcare worker is medically exempt from mandatory vaccination the worker should be supported to maintain their own health and safety and the safety of patients. Supportive actions will need to be taken on a case-by-case basis noting the current community transmission of COVID-19 in their area, access to personal protective equipment and the person’s ability to transition to different modes of practice such as consulting via telehealth or non-patient facing work.
- Danchin M, Biezen R, Manski-Nankervis JA, Kaufman J, Leask J. Preparing the public for COVID-19 vaccines: How can general practitioners build vaccine confidence and optimise uptake for themselves and their patients. Australian journal of general practice. 2020;49(10):625.
- Victorian Department of Health (DH). Victorian healthcare worker (clinical and non-clinical) COVID-19 data. Victoria, Australia: DH, 2021. [Accessed 25 August 2021].
- Commonwealth Department of Health (DoH). Residential aged care workers. Canberra, Australia: DoH, 2021. [Accessed 25 August 2021]
- Cwikowska P, Mackos D, Mumcuoglu O. Factbox: Countries making COVID-19 vaccines mandatory. Reuters. 17 August 2021. [Accessed 25 August 2021].
- Australian Health Practitioner Regulation Agency (Ahpra) and the National Boards. Position statement - Registered health practitioners and students and COVID-19 vaccination. Melbourne, Australia: Ahpra and National Boards, 2021. [Accessed 25 August 2021].