Five communities advocate that the vaccine be mandatory for health workers and nursing home workers

A health worker performs a covid-19 test on a user of a residence.Mònica Torres

Vaccination against covid is voluntary in Spain. The population is responding to the call to prick like few in the world, but the growth of infections in residences, which have multiplied by eight in two weeks, is beginning to worry both the Government and the autonomous communities. At least five of them claim, in one way or another, that inoculation be mandatory for professionals who care for vulnerable people - such as health workers and nursing home employees - as France has done. The Ministry of Health has always been against forcing vaccination, but it is in favor of tightening control measures in social health centers. Together with the communities,It is studying how to do it and it is proposed that workers in these centers who are not vaccinated have to undergo two weekly tests or even be forcibly transferred to positions where they are not in contact with the elderly.

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• Coronavirus surge in Spanish nursing homes fuels debate on mandatory vaccination for carers

The community that most clearly advocated mandatory vaccination was Galicia, whose Parliament even approved a law that included this possibility, although it was suspended by the Constitutional Court.

Its president, Alberto Núñez Feijóo, has admitted this Thursday that it is not legal, but has advocated for the obligation in certain sectors: “What is my opinion?

In certain cases in which a person's work is directly related to vulnerable people, to the sick, I believe that general public health should prevail over the individual decision to vaccinate or not ”.

Along these lines, the Junta de Andalucía has requested that the vaccination of health personnel and nursing home workers be mandatory, a request that is also supported by the sector's employers' association. Murcia is studying how to legally fit in that all essential workers who deal with vulnerable people have to be inoculated, including social health workers, doctors and nurses. Canary Islands Government sources have explained this Thursday that this community is also studying forcing public officials to be vaccinated. Its president, Ángel Víctor Torres, already referred to this issue last week, when he pointed out that certain officials - without specifying which ones - should receive the vaccine if their work is for the public.

This trend is joined by the General Deputy of Álava, Ramiro González, who has asked his legal services if there is legal protection for it.

"People who do not want to be vaccinated should not work in direct contact with those who are at risk, such as, for example, the elderly who are in residences," he said at a press conference given the increase in infections in these centers.

In Bizkaia and Álava, the number of nursing home staff who have rejected vaccines is between 5% and 6%.

Finally, the Cantabrian president, Miguel Ángel Revilla, asked in the conference of presidents last week that the punctures be mandatory not only for certain workers, but for the entire population.

Meanwhile, communities such as Catalonia, Castilla-La Mancha or the Basque Country reject this possibility.

Mandatory vaccination for toilets

Although almost all democracies in the world leave vaccination to the will of their citizens, some do force some workers to inoculate themselves. In Italy, the law that obliges health personnel to be vaccinated, including doctors, nurses and assistants, came into force in April. The regulations consider suspension of employment and salary as an extreme sanction, but the company, both public and private, must warn the professional beforehand and offer him the vaccine and other options such as changing his functions so that he does not work in contact with the public where possible . The law contemplates that the sanctions are in force as a maximum date until December 31. The regulations are being applied unevenly in the different regions, in which health competencies fall,But some, such as Veneto, have already sent the first suspension letters between July and August to 16 doctors and 200 nurses who have not been vaccinated and have not shown a reason for not doing so.

The most recent example is the French. Its Constitutional Court has endorsed this Thursday that all professionals in contact with vulnerable audiences, such as health workers, firefighters and emergency services, or workers in nursing homes receive the vaccine under pain of being suspended from employment and salary. According to the law, these employees have until September 15 to begin the vaccination schedule and until October 15 to complete it.

The difference with Spain is that in France there are a large number of anti-vaccines that are complicating the immunization plan. The Spanish Ministry of Health does not have specific data on how many health workers have been vaccinated, but department sources emphasize that the “vast majority” have done so, something that the autonomous communities consulted have ratified. A source from the ministry explains: “They were the first group and they responded fantastically. At the moment we are not having problems with outbreaks in hospitals ”. However, he acknowledges that the situation of nursing homes for the elderly does concern, where there is a higher percentage of workers who have rejected the puncture, although an official figure is not provided either.

The report on alerts from the Interterritorial Council of the National Health System (CISNS), the technical body that has prepared documents such as the traffic light of restrictions, is already studying how to tighten control measures in social health centers. These include doing two weekly PCR or antigen tests on uninoculated workers. Even the possibility of transferring them so that they are not in contact with the elderly. But they are still conversations that will have to go through the Public Health Commission and be approved by the CISNS itself, say sources in the presentation.

Last week, the General Council of Official Medical Associations discussed with the minister a campaign to raise awareness among health workers about vaccination. Although they assume that they are a minority who reject the injections, they consider it unaffordable. Its president, Tomás Cobo, explains to EL PAÍS that those who do not do so may be violating the code of ethics, since they put public health at risk. "In the cases that have contact with patients, it would be necessary to consider separating them and putting them in other tasks," he says.

Juan Pablo Horcajada, head of Infectious Diseases at the Hospital del Mar in Barcelona, ​​has the same opinion: “I believe that health personnel should be vaccinated on a mandatory basis.

The law does not work this way at the moment, but I think that people who do not want to be vaccinated should not visit patients, the elderly or immunosuppressed people because they can transmit the disease to them no matter how much they are protected, since it is a virus with which they do not protection measures always work 100% ”.

Legal debate

Federico de Montalvo, president of the Bioethics Committee of Spain, explains that compulsory vaccination has two aspects: legal and opportune. He believes that in Spain today it is not necessary, since the population is flocking to receive the vaccine. "The problem can come in the last stretch, when we lack a small percentage to achieve herd immunity," he emphasizes. Taking into account that there is no approved vaccine for children under 12 years of age (who make up 11% of the population), it will be impossible to reach it if practically everyone else is not vaccinated.

In the legal aspect, De Montalvo maintains that the European Court of Human Rights endorses mandatory vaccination in an epidemic situation such as the current one, since the benefit for the population compensates for the intrusion into the body of citizens that involves inoculating them with a drug, with the (minimal) risks that this entails. “The last Constitutional order [that suspended the Galician mandatory law] has left me very perplexed because it continues to insist that it does not have a fit in the General Health Law of 1986, when the Supreme Court has dictated that the necessary measures can be taken, and vaccination is classic in epidemics, "he says.

To take this measure, either to the entire population or to specific groups, the autonomies seek legal umbrellas. The Balearic Government Council approved in May a decree to modify the Balearic Public Health Law that contemplates the possibility of "subjecting to prophylactic measures" for the prevention of coronavirus, including mandatory vaccination, to certain unspecified groups. However, the Ministry of Health has not yet defined these groups (which would be health and social health workers) and insists that the percentage of vaccination among them is high and for the moment the possibility of forcing their immunization.

With information from

Silvia Ayuso, Lorena Pacho, María Sosa, Lucía Bohórquez, Guillermo Vega, Juan Navarro, Isabel Valdés, Sonia Vizoso, Jessica Mouzo, Eva Saiz, Pedro Gorospe

and

Ferran Bono

.