Patient receiving COVID-19 vaccine

COVID-19 and vaccination FAQs

 

The information below has been compiled by RCN advisers in public health, infection control, and employment relations. We'll be updating it as the situation develops - so please do check back often.

Looking for something different? Try our COVID-19 FAQs

The RCN actively encourages its members to take up the COVID-19 vaccine. The NMC Code requires nurses to take measures to protect their patients and the public as well as to protect themselves against serious illness as a professional responsibility.

The vaccine reduces the individual’s risk of severe illness, it will also reduce the chance of you contracting the infection and thereby passing infection to others who are more vulnerable to serious disease.

Alongside PPE and social distancing, vaccination is a measure to reduce the risk. Employers should take all reasonable steps to support the vaccination of at risk staff. The RCN believes that this includes employers allowing these staff reasonable paid time away from work to attend vaccination appointments.

Under regulation 7 of the Control of Substances Hazardous to Health Regulations (COSHH) 2002, employers are required to assess the risk to staff of occupational exposure to hazardous substances (including biological agents and pathogens) and take measures to control and reduce the risk of exposure. Under regulation 3 of the COSHH Regulations employers have a duty to risk assess and put in place control measures to extend to those who may be affected by the work carried out by the employer, this includes taking all reasonable steps to ensure agency and bank staff are protected, vaccinated and provided with PPE.

The RCN recommends taking up vaccination as best practice. However, we recognise that some members might choose not to be vaccinated. Please see our section on refusal below.

How do I get the vaccine (NHS, agency, students and those outside the NHS)?

Any staff who have not been offered the vaccine should contact their employer to find out how to go about getting it in the first instances. In England, frontline staff who have not had the COVID-19 vaccine can call 119 or book online.

The Priority groups for coronavirus (COVID-19) vaccination is published by the JCVI. It includes all:

  • frontline health and social care workers who provide care to vulnerable people wherever they are employed

including those who are:

  • employed independently to provide care to vulnerable people
  • working in hospice care
  • working temporarily in the COVID-19 vaccination programme who provide face-to-face clinical care.

The Green Book chapter for COVID-19 vaccination provides more detail and recommends that temporary staff such as bank or agency workers, including those working in the COVID-19 vaccination programme, students, trainees and volunteers who are working with patients in the NHS or in an independent or voluntary setting, must also be included.

The vaccine programme for health and care staff is being rolled out through organisations those staff at high risk of acquiring infection, at high individual risk of developing serious disease, or at risk of transmitting infection to multiple vulnerable persons or other staff in a health care environment, are considered of higher priority for vaccination than those at lower risk. This prioritisation should be taken into account during vaccine deployment.

Can internationally recruited nurses get the vaccine?

Yes, internationally recruited nurses working in the NHS will be offered a COVID-19 vaccine and will not need a GP/NHS number.

Giving other vaccines alongside the COVID-19 vaccine

The guidance in the Green Book chapter for COVID-19 vaccination recommends there is a seven day gap between administration of all other vaccines and the COVID-19 vaccine.  

I am hesitant about being vaccinated and I am worried about what will happen at my work if I refuse it. What should I do?

Make sure you find out about the vaccine, talk to colleagues and read the information in the Green Book and other reputable vaccine resources, for example see the external links below and the RCN's clinical resources

You should also find out what your employer expects from you in relation to the vaccine. Check whether your employment contract has any terms about vaccination and check the local policy.

You should speak to your manager and/or your HR department to find out if there are other arrangements (like redeployment) that can be utilised if your employer only wants vaccinated staff to work in your area. Ask whether testing and PPE will mitigate the risk sufficiently for you to continue to work in your usual area. See our section below for more information on refusal.

What to expect after vaccination

The COVID-19 vaccines are safe and effective, but as with any medicine they can cause side effects. These are mostly mild and short lived and while not everyone will get them they are not uncommon. People should be advised that they may get side effects and reassured that these are to be expected. Anyone who becomes very unwell should call 111 or their GP.

Please see 'What to expect after your COVID-19 vaccination' for more detailed information and printable leaflets in a range of languages. Contact us if your employer is taking any formal action against you due to sickness absence in relation to the vaccine. You can also see our COVID-19 and time off guidance.

It is really important that people return for the second dose of vaccine

Reporting and monitoring of adverse events after vaccination

All medicines adverse events are monitored by the Medicines and Health Care Products Regulatory Agency (MHRA) and there is a dedicated Coronavirus Yellow Card reporting site.

Any member of the public or health professional can submit suspected side effects through the Yellow Card scheme. The MHRA also publish a Coronavirus COVID-19 vaccine adverse reactions report detailing the adverse events to date reported from the vaccine programme roll out.

What if I am worried about an allergic reaction?

As with any vaccine there is a small risk of serious allergy and anaphylaxis but this is very rare, please see Contraindications and special considerations: the Green Book, chapter 6.

For the COVID-19 vaccines:

  • As for any vaccine, anyone with a previous history of allergic reaction to the ingredients in the COVID-19 vaccines, should not receive it.
  • Individuals with a history of immediate onset-anaphylaxis to multiple classes of drugs or an unexplained anaphylaxis should not be vaccinated with the Pfizer BioNTech vaccine. The AstraZeneca vaccine can be used as an alternative (if not otherwise contraindicated).
  • Those with allergies to a specific drug or vaccine, food or insect stings can safely have the vaccine.
  • All recipients of the Pfizer BioNTech or Moderna vaccines should be kept for observation and monitored for a minimum of 15 minutes as a precaution. This is due to severe adverse reactions seen in the initial roll out, not because of specific ongoing concerns.
  • As with administration of any vaccine, facilities need to be available for the management of anaphylaxis and vaccinators need to be appropriately trained.

See this guidance for more information along with the Green Book, chapter 14a.

Reporting and monitoring of adverse events after vaccination

All medicines adverse events are monitored by the Medicines and Health Care Products Regulatory Agency (MHRA) and there is a dedicated Coronavirus Yellow Card reporting site.

Any member of the public or health professional can submit suspected side effects through the Yellow Card scheme. The MHRA also publish a Coronavirus COVID-19 vaccine adverse reactions report detailing the adverse events to date reported from the vaccine programme roll out.

The Royal College of Nursing recommends that everyone accepts a COVID-19 vaccine when they are offered it. We know that Black, Asian and Minority Ethnic (BAME) communities are amongst the group that are at higher risk of becoming critically ill and dying as a result of contracting COVID-19, there are however some understandable concerns about vaccination from some communities. Vaccination is a vital step in protecting already vulnerable communities from further harm. 

Tailored local implementation to promote good vaccine coverage in BAME communities is an important factor within a vaccine programme. Such programmes should aim to build trust and confidence in the vaccine as well as tackle misinformation.

Employer's duties

Employers are responsible for undertaking staff risk assessments to identify individuals at higher risk of contracting the virus and/or experiencing serious illness if they do. These risk assessments include factors such as ethnic background, and should be used as the basis for prioritising access to vaccines for staff. It is essential that all staff including those from BAME backgrounds have access to the vaccine as soon as they are offered it. Please see our individual risk assessment guidance for more information.

What is the evidence to show the vaccine is safe for BAME communities?

The Public Assessment Reports from the MHRA contain all the scientific information about the trials and information on trial participants.

There is no evidence either of the vaccines will work differently in different ethnic groups.

Further Information

British Red Cross video encouraging everyone to join the conversation around vaccines.

Colleagues from University Hospitals Birmingham share their experiences of the COVID-19 vaccine, to encourage others to have the vaccine: 

Information from the British Islamic Medical Association on COVID-19 vaccines which addresses many of the myths.  

Are there any resources to help with community languages?

Please see our section on leaflets and resources for help with accessing a range of materials, leaflets and videos in different languages.

Please see the RCN position statement on changes to the COVID-19 vaccination programme.

As a general principle, the RCN support the decisions of the Joint Committee on Vaccination and Immunisation (JCVI) as the independent expert group responsible for advising the UK vaccination and immunisation programme.

The decisions must be taken by independent experts and on the basis of all the available evidence and such decisions must be taken without pressure from government or other pressure groups. There must be detailed responses when concerns are raised and other solutions proposed.  

General changes to the vaccine programme: how do I keep up to date?

Given the current epidemiology of the disease availability of new vaccines and constantly emerging information on the vaccines, it is inevitable that the programme will change. Vaccines need to be rolled out at speed as soon as they become available to help stop serious disease from COVID-19.

The rapid changes to the programme underline the necessity for all clinicians involved in the vaccination programme to keep track of the most up to date published guidance, to be found in the Green Book: Immunisation against infectious disease which provides the UK immunisation policy and is informed by JCVI.

The vaccines available in the UK for use against COVID-19, including the authorisation detail from the Department for Health and Social Care (DHSC) and the Medicines and Healthcare Products regulatory Agency (MHRA) are below:

I am concerned about the risk of giving a second dose with a different vaccine

For the majority of COVID-19 vaccines, 2 doses are required.

The Green Book advice is to give two doses of the same vaccine wherever possible. Studies are looking at potential for completing the course with different vaccine brands. There is however no specific data on the interchangeability between the two vaccines' effectiveness. Depending on the individual risk or concern that someone may not be able to return, it may be pragmatic to give the second dose with the locally available vaccine - but this would be an individual clinical risk assessment.

This guidance is in the Green Book, in the guidance for health care professionals (which includes the national protocols), and in the Patient Group Direction templates.

As further information and evidence becomes available, it will be included in these resources.

Conception and fertility

There is absolutely no evidence, and no theoretical reason, that any of the vaccines can affect the fertility of women or men. Everyone is advised to have the vaccine as soon as they are eligible. Those who are trying to become pregnant do not need to avoid pregnancy after vaccination.

The British Fertility Society COVID-19 vaccines and fertility FAQs.

Joint statement from the RCOG and the RCM which provides confirmation that there is no evidence to suggest that COVID-19 vaccines will affect fertility.

Pregnancy

There is currently no evidence that the COVID-19 vaccination causes any problem with pregnancy. There is now data from United States showing that pregnant women have been vaccinated, mainly with mRNA vaccines, Pfizer-BioNTech and Moderna, without any safety concerns.

Based on this data, the Joint Committee on Vaccination and Immunisation (JCVI) advises that it’s preferable for pregnant women in the UK to be offered the Pfizer-BioNTech or Moderna vaccines where available. There is no evidence to suggest that other vaccines are unsafe for pregnant women, but more research is needed. 

The advice, in the Green Book, chapter 14a on COVID-19  is that pregnant women should discuss the risks and benefits of vaccination with their midwife or clinician. 

This letter from NHSE/I JCVI announcement regarding COVID-19 vaccination during pregnancy and next steps details the booking system and practical application of this.

If a woman finds out she is pregnant after she has started a course of vaccine, the course can be completed during pregnancy using the same vaccine product (unless contraindicated). Alternatively, vaccination should be offered as soon as possible after pregnancy.

Where pregnant women have already started their vaccine course with the Astra Zeneca vaccine the second dose should be given with the same product where possible.

The JCVI does not advise routine pregnancy testing before receipt of a COVID-19 vaccine.

Breastfeeding

There is no known risk associated with giving non-live vaccines whilst breastfeeding. JCVI advises that breastfeeding women may be offered any suitable COVID-19 vaccine.

Further information

Guidance from the RCOG on COVID-19 vaccines, pregnancy and breastfeeding and Coronavirus infection and pregnancy. 

The RCM has also produced information on COVID-19 vaccines. Merged information sheet and decision aid tool (RCOG, RCM, MacDonald obstetric medicine society and UK teratology information service.

The British Society for Immunology video COVID-19 vaccine Q&A: fertility, pregnancy and breastfeeding.

Under regulation 7 of the Control of Substances Hazardous to Health Regulations (COSHH) 2002, employers are required to assess the risk to staff of occupational exposure to hazardous substances (including biological agents and pathogens) and take measures to control and reduce the risk of exposure.

Under regulation 3 of the COSHH Regulations employers have a duty to risk assess and put in place control measures to extend to those who may be affected by the work carried out by the employer. This includes taking all reasonable steps to ensure agency and bank staff are protected, vaccinated and provided with PPE.

The RCN recommends taking up vaccination as best practice and also recognise that there may be consequences for members at work if they have not been vaccinated. Staff need to be able to make this decision in a supportive environment with the right information, encouragement and clear explanation of the benefit and value of the vaccine. If you choose not to be vaccinated for medical reasons, vaccine concerns or religious beliefs, your employer still has ethical considerations and responsibilities for you.

In their guidance to the COSHH regulations, the Health and Safety Executive (HSE) point out that immunisation should be seen only as a useful supplement to reinforce physical and procedural control measures, not as the sole protective measure.

The HSE advise that employees may not wish to take up the offer of immunisation, or they may not respond to a vaccine and will, therefore, not be immune. If so, employers should consider the effectiveness of the other controls and consider whether any additional controls should be implemented to allow them to work safely. In practice this will mean the continued provision of respiratory and other protective equipment, effective ventilation and where the risk of harm remains high, or potentially redeployment. 

If you are considering refusing the vaccine, please see our section on refusal.

Find resources and guidance around COVID-19 vaccination delivery on our public health pages. See also:

Further information and education materials

Regulation

Wales

Scotland

Northern Ireland

See 'Get involved in vaccine delivery' on our COVID-19 vaccination page.

I’m currently ill with COVID-19, can I get the vaccine?

People currently unwell and experiencing COVID-19 symptoms should not receive COVID-19 vaccine until they have recovered. This is to avoid wrongly attributing any new symptom or the progression of symptoms to the vaccine (and to prevent infecting anyone else in the vaccination centre). 

As deterioration in some people with COVID-19 can occur up to two weeks after infection, ideally vaccination should be deferred until they have recovered and around four weeks after onset of symptoms or four weeks from the first positive test in those who are asymptomatic. 

See COVID-19 vaccination: information for healthcare practitioners and the ‘Green Book’ chapter COVID-19: the green book, chapter 14a.

Do people who have already had COVID-19 get vaccinated?

Yes, they should get vaccinated. 

There is no evidence of any safety concerns from vaccinating individuals with a past history of COVID-19 infection, or with detectable COVID-19 antibody so people who have had COVID-19 disease (whether confirmed or suspected) can still receive COVID-19 vaccine.

It is not known how long antibodies made in response to natural infection persist. If individuals do have antibodies following natural infection, receiving COVID-19 vaccine would be expected to boost any pre-existing antibodies.

See COVID-19 vaccination: information for healthcare practitioners and the ‘Green Book’ chapter COVID-19: the green book, chapter 14a.

Vaccines and many medicines are routinely given outside the manufacturer licence. There are instances with the wider routine UK vaccine programme where the schedule and dose recommendations differ to those from the individual vaccine manufacturer’s product information. This occurs as new evidence on disease epidemiology or vaccine effectiveness becomes available or on occasion for operational reasons.

Where there are differences to the manufacturer guidance and national policy, it is the Green Book guidance that takes precedence, as detailed as a basic vaccination principle. See Immunisation procedures: the Green Book, chapter 4.

The national Patient Group Direction (PGD) templates and national protocol templates are updated and available here. While these are developed for England, they are shared across the UK for authorisation in the devolved administrations.

Vaccine administration outside the existing PGD or protocol will need a Patient Specific Direction (PSD) or individual prescription.

Members with concerns about their registration can be reassured that the NMC will support those who follow the national protocol or the PGD even where the process diverges from manufacturers’ instructions. If any patient brings a compensation claim, the state indemnity schemes will cover our members. Read more about indemnity in our guide COVID-19 and indemnity: what you need to know.

There is no evidence as to the interchangeability of the different COVID-19 vaccines, although studies are underway. Wherever possible the first and second dose should be the same vaccine.

Where an individual started the schedule and then attends for vaccination at a site where the same vaccine is not available, for example, if the individual received their first dose abroad, or where the first product received is unknown, it is reasonable, in these circumstances, to offer one dose of the locally available product to complete the schedule.

Advice on vaccine interchangeability and what to use where people have been vaccinated overseas see the PHE ‘Guidance for health care practitioners’ appendix 1.

Can internationally recruited nurses get the vaccine?

Yes, internationally recruited nurses working in the NHS will be offered a COVID-19 vaccine and will not need a GP/NHS number.

Please also see the NHS Employers guide for international nurses during COVID-19.

The rationale for dose schedule changes are detailed in the JCVI statement and the four UK Chief Medical Officers’ letter. The WHO have acknowledged the recommended dosing interval but also that countries have to make more flexible schedules to meet specific epidemiological situations.

 

  • The second dose of the Pfizer-BioNTech vaccine may be given between 3 to 12 weeks following the first dose.
  • The second dose of the AstraZeneca vaccine may be given between 4 to 12 weeks following the first dose.
  • The second dose of the Moderna vaccine may be given between 4 to 12 weeks following the first dose.

Please see: COVID-19: the Green Book, chapter 14a, COVID-19 vaccination: information for healthcare practitioners and the links in our external resources section. Where there are differences between the manufacturer guidance and national policy, the basic vaccination principle is that the Green Book guidance takes precedence; see chapter 4 of the Green Book.

The video on the Public Health Wales site helps to clarify the rationale for the scheduling. Additional resources along with FAQs are also available from Public Health Wales

Regulatory approval of Pfizer BioNTech vaccine for COVID-19
Regulatory approval of COVID-19 AstraZeneca vaccine 

Why have these changes been made? Will the vaccine still be effective?

The vaccine programme needs to change to reflect the specific public health situation we are managing with COVID-19 disease. The MHRA have given temporary authorisation 174 to three vaccines; Pfizer-BioNTech, AstraZeneca and Moderna. Given the current situation and increasing global uncertainty with different variants, it remains essential we roll out vaccine at speed to protect the population. The JCVI recommendation is that vaccinating a greater number of people (at least initially) with a single dose, will prevent more death and hospitalisations than vaccinating a smaller number of people with two doses.

There is increasingly good evidence of short-term vaccine efficacy from the first dose of both vaccines.

The second dose is still important to provide longer lasting protection and is expected to be as or more effective when delivered at an interval of 12 weeks from the first dose.

The programme details may change further as the epidemiology of the disease also changes.

I am concerned about consent where there is a change to the schedule or the vaccine given for the second dose. Does the change to scheduling  or vaccine invalidate that consent?

Just as with any change to planned treatment, a change to the schedule for vaccine doses or the vaccine for an individual recipient does not invalidate the earlier consent, providing people are given the explanation for this and they are given the information in order to consent for the second dose.

Consent for administration of any vaccine is required before each dose. As such, people need to be advised at each appointment; what vaccine they are going to get, the reasons for receiving it and have any concerns addressed - this would include if there have been changes to the original planned care, just as you would expect for any care pathway.

See the links in the key resources section above for the Green Book and other useful sources of information. Also see the leaflets for health care staff and the public from Public Health England.

Wherever possible, members should be encouraged to explain to patients the rationale for the changes, i.e. that more people can get the vaccine as quickly as possible and that the first vaccine dose will provide immediate short-term protection.

Members may decide on an individual clinical basis that they need to vaccinate people as per the original plans.

Should people who have already had COVID-19 or are suffering from ‘Long Covid’ get vaccinated?

Yes, if they are in a priority group identified by Join Committee on Vaccination and Immunisation (JCVI). This has been considered by the Medicines and Healthcare products Regulatory Agency (MHRA) in authorising the vaccines for use. Having prolonged COVID-19 symptoms is not a contraindication to receiving COVID-19 vaccine. If people are seriously debilitated, still under active investigation, or have evidence of recent deterioration, deferral of vaccination may be considered to avoid incorrect attribution of any change in the person’s underlying condition to the vaccine. See COVID-19 vaccination: information for healthcare practitioners and the ‘Green Book’ chapter COVID-19: the green book, chapter 14a.

If you are experiencing difficulties at work as a result of time off due to COVID-19 please see our COVID-19 and time off guidance. If you are subject to formal absence management, speak to your RCN steward for support or contact us.

What PPE is required for administering an immunisation including the COVID-19 vaccine?

Immunisers are advised on the infection prevention and control precautions and appropriate PPE for immunisation within the UK infection prevention and control guidance document (see page 17) i.e. wear an FRSM mask on a sessional basis, and risk assess the need for eye protection.

Gloves and aprons are not routinely required unless there is an additional risk of exposure to blood or body fluid contamination/broken skin. This risk is generally very low. If gloves and aprons are worn they are single use and must be removed and changed in between each patient. Hand hygiene must be rigorously applied between each vaccination episode and patient/person contact.

The WHO Framework for decision-making: implementation of mass vaccination campaigns in the context of COVID-19: interim guidance, 22 May 2020 has similar guidance.

I have had the vaccine. Do I still need to wear PPE at work?

All vaccinated staff should still follow current COVID-19 guidelines on PPE and social distancing where appropriate.

Please also see our sections on returning to work, protection from future infection along with our PPE guide.

Will I be protected from infection after having the COVID-19 vaccine?

The aim of the COVID-19 vaccine programme is to protect people from severe disease as a result of infection with the SARS-CoV-2 virus. The initial aim of the programme based on the evidence from the vaccine trials was to protect the most vulnerable first therefore helping prevent severe disease in significant numbers of people with an impact on reducing mortality and pressure on hospital admissions.

As with most vaccines, it will generally take 2- 3 weeks for people to develop antibodies and build immunity to SARS-CoV-2 infection and COVID-19 disease. To achieve maximum effect It is essential that people have the full course, for most COVID vaccines this is two doses initially.

No vaccine will ever provide complete 100% protection.

There is increasing evidence that the COVID-19 vaccines are helping to stop severe infection and in transmitting the SARS-CoV2 virus.

We do not yet know how long the current vaccines will give protection. As relatively new vaccines there is limited data on this so far, although this is increasing all the time.

Assessment of immunity with or without antibodies is not a reliable predictor of immunity from infection. Other factors such as T cells are also important in the overall efficacy of vaccines.

All individuals respond differently to vaccines; people’s age and any underlying conditions will affect their overall immune response. Having a high overall uptake across the population will help build community or herd immunity and help reduce transmission of infection. 

Inevitably with a novel pathogen such as SARS-CoV-2, vaccine efficacy could be less effective against new variants of the virus, which the vaccines were not originally developed for and this is also being closely monitored by public health agencies and researchers. It is therefore imperative that people have 2 doses, if required, to offer the highest level of protection against variants. 

Data are emerging all the time on the impact of the vaccine programme overall. The PHE vaccine surveillance reports show the overall monitoring and analysis of the vaccines against infections, hospitalisations and deaths as well as on transmission but obviously these data are still limited due to the relatively short time the programme has been running.

There is ongoing work looking at booster doses of modified vaccines which will affect these variants and enhance the overall efficacy for individuals into the future. 

The RCN aligns itself to JCVI guidance and is working closely with the NHS and public health agencies on both the vaccine efficacy data and the logistics of the roll out of the vaccine programme.

Please also see our section on returning to work after having the vaccine within this guide.

For more information on record keeping, please see Immunisation services and large-scale vaccination delivery during COVID-19 and the Top tips section. This also covers the role of administrative staff.

The RCN strongly recommends all members have the vaccination as soon as they are able to. It is considered to be best practice to protect you, your patients and clients, as well as friends and family. The vaccine reduces the individual’s risk of severe illness, it will also reduce the chance of you contracting the infection and thereby passing infection to others who are more vulnerable to serious disease. It is important that nursing staff also have up to date information so they are able to advise patients and the public to have the vaccines.

Some members however, might decide not to be vaccinated for a variety of reasons. The questions and answers below are intended to provide further information and assistance. Please also see our section on refusal and medical grounds within this guide.

As a health and social care worker do I have to have the vaccine?

The RCN do not support staff being mandated to have the vaccine (please see the RCN position statement). While no-one can be forced to have medical treatment, including vaccines, the government, in England, has announced the intention to make it mandatory for staff in care homes for older adults to be vaccinated against COVID-19 (see the RCN response to the consultation). The government are intending to further consult to extend this to all health and care staff. 

The RCN believe that vaccination is a key pillar of the overall infection prevention and control strategy, and vaccination will help protect you from serious disease and help protect you from transmitting infection to others. Staff who are not vaccinated may also present a risk to patients or clients as a result. We do not believe however, that mandating staff to get the vaccines is the right approach to achieve maximum uptake.

Employers will need to review risk assessments and consider redeploying staff in some settings to a lower risk environment if they choose not to be vaccinated.

If your employer is taking action against you for refusing to be vaccinated, contact us.

Can a prospective employer demand that I have the vaccination as part of my conditions of employment? 

Some organisations are introducing these conditions as part of their employment contracts. The RCN do not believe that this is the right approach to improve uptake and we recognise this could impact on workforce morale as well as recruitment and retention.

The RCN do not support staff being mandated to have the vaccine. However, the government, in England, has announced the intention to make it mandatory for staff in care homes for older adults to be vaccinated against COVID-19 and are intending to further consult to extend this to all health and care staff. 

The RCN will continue to work with employers and resist attempts by organisations to amend existing terms and conditions requiring staff to have the vaccine. The RCN recognises however, there may be consequences for members at work, if they have not been vaccinated, and their employer deems that vaccination is necessary (due to the health & safety risks present in the workplace).
Staff need to be able to make this decision in a supportive environment with the right information, encouragement and clear explanation of the benefit and value of the vaccine. It is imperative that all organisations make it easy for their staff to get vaccinated. This collaborative approach works well and improves vaccine uptake.

If your employer is taking action against you for refusing to be vaccinated, contact us.

Can my employer dismiss me if I am not vaccinated?

As set out in the ACAS guide on working safely during coronavirus, if your employer believes your reason for refusing the vaccination is unreasonable, this could result in disciplinary action on the basis you have failed to follow a reasonable management instruction. This will depend on the vaccination policy in place at your workplace and whether vaccination is a necessity to do your job.

If your employer is considering or is taking, action against you for refusing to be vaccinated, contact us

Could I be breaching the NMC Code of conduct if I decline to be vaccinated?

Under the NMC code all registered nurses midwives and nursing associates have a professional responsibility to preserve safety and to take all reasonable precautions necessary to avoid any potential health risks to themselves or others. Whilst receiving the vaccine will not be mandatory, you must work with your employer to mitigate any risks if you have not been vaccinated. 

This could include redeployment to areas with less vulnerable patients, regular testing and continuing to protect yourself with ongoing use of PPE, even when other staff are not required to make use of those precautions. Provided that you co-operate with your employer to avoid exposing others to risk, you should be deemed compliant with the NMC code.

I declined the vaccine and I have fallen ill with COVID-19. My employer says that I will not receive full sick pay. What can I do?

Check your sick pay entitlements as set out in your contract of employment. You should be paid statutory sick pay, but your employer may try to argue that any additional element of your sick pay should be withheld. The RCN position is that uptake of the vaccine is voluntary and should not be connected with any sick pay. You should check your employment contract to determine what sick pay is owed to you contractually.

If you are unable to resolve the issue, contact us. A claim for unlawful deduction of wages and/or discrimination may be considered.

What about RCN support?

If you intend to refuse a vaccine on medical grounds please see our section on this. If your refusal leads to a dispute with your employer, please contact us for advice and support.

Under regulation 7 of the Control of Substances Hazardous to Health Regulations (COSHH) 2002, employers must ensure the exposure of employees to substances (including biological agents and pathogens) hazardous to health is either prevented, or where not reasonably practicable, adequately controlled. 

Under regulation 6 of the COSHH Regulations an employer shall not carry out work which is liable to expose any employees to any substance hazardous to health unless it has:

(a) made a suitable and sufficient assessment of the risk created by that work to the health of those employees and of the steps that need to be taken to meet the requirements of the Regulations; and (b)implemented the steps referred to in sub-paragraph (a)

This includes taking all reasonable steps to ensure all staff are protected and provided with PPE.

The RCN recommends taking up vaccination as best practice and we also recognise there may be consequences for members at work if they have not been vaccinated. The RCN do not however, support staff being mandated to have the vaccine. Staff need to be able to make this decision in a supportive environment with the right information, encouragement and clear explanation of the benefit and value of the vaccine. The vaccines also need to be made easily accessible to staff during the working day.

If an RCN member chooses not to be vaccinated due to medical risks, vaccine concerns or religious beliefs, employers must consider those concerns within the workplace. (see below for our section on  Refusal to be vaccinated: religious and medical grounds (including pregnancy). 

In their guidance to the COSHH regulations, the Health and Safety Executive (HSE) point out that immunisation should be seen only as a useful supplement to reinforce physical and procedural control measures, not as the sole protective measure. 

The HSE advise that employees may not wish to take up the offer of immunisation, or they may not respond to a vaccine and will, therefore, not be immune. Employers need to still consider the effectiveness of the other controls and consider whether any additional controls should be implemented to allow them to work safely.  In practice this will mean the continued provision of respiratory and other protective equipment, effective ventilation and, where the risk of harm remains high, potentially redeployment. 

What if I am refusing vaccination because of my religion and belief?

If you do not wish to have the vaccine because of a protected characteristic for example: pregnancy, age, religious belief or disability, and your employer persists with disciplinary action, you may have a discrimination complaint in accordance with the Equality Act 2010. Please be mindful of the time limit to present discrimination claims (3 months less 1 day from the date of the alleged discrimination).

Other medical issues may give rise to a recommendation that you do not receive a vaccine. Your GP may make such a recommendation, or national guidance may be in place.  See our section below on medical issues and contact us if you need support or further advice.

Please also see the NHS England guidance on supporting COVID-19 vaccine uptake during Ramadan.

What if I am refusing the vaccination because of a medical issue?

If you are subjected to a detriment as a result of your decision not to receive a vaccine, or even dismissed and the reason for your refusal is related your disability, you may have a claim for discrimination under the Equality Act 2010. If you are disabled your employer is obliged to make reasonable adjustments if a provision, criterion, or practice places you at a substantial disadvantage in comparison with persons who are not disabled. Your employer may try to justify their actions on the basis that they had a legitimate reason for its decision, and it is proportionate. 

Contact us if you need support or further advice.

What about the risk to conception, pregnancy and breastfeeding?

What if I have a serious allergy?

Please see our section on allergies above.

What about GP and RCN support?

If you intend to refuse a vaccine on medical grounds you may require a GP report to support this. As with any medical information, your medical reason for refusal should be treated in strictest confidence by your employer, following occupational health guidance.

If you refuse a vaccine on medical grounds and this leads to a dispute with your employer, please contact us for advice and support.

Can I return to work after having the vaccine?

Yes, you should be able to work as long as you feel well. If your arm is particularly sore, you may find heavy lifting difficult. If you feel unwell or very tired you should rest and avoid operating machinery or driving. 

The vaccine cannot give you COVID-19 infection, and two doses will reduce your chance of becoming seriously ill. 

Should I return to work after having the vaccine if I am clinically vulnerable, pregnant or have been shielding?

No vaccine will give 100% protection and it is really important that you continue to follow the guidance in your workplace, including wearing the correct personal protective equipment and taking part in any screening programmes. 

Everyone who has had the vaccine must continue to follow the guideline on social distancing, testing, shielding and self-isolation where necessary. This applies to the workplace and at home.

Public Health England have updated their guidance on shielding and protecting people who are clinically extremely vulnerable from COVID-19 to reflect this and confirm that anyone who has had the vaccination should continue to follow shielding advice. 

If you have not received official guidance to shield, but you are currently off work or working from home following a risk assessment, then your employer should conduct a further risk assessment before requiring you to return to your place of work. This remains the case whether you have received your first or second dose of the vaccination or whether your employer is asking you to return for any other reason. 

If you are pregnant and working from home, then your employer must carry out or review a pregnancy risk assessment before considering any return to the workplace.  A risk assessment must also be carried out if you have recently become pregnant.  Government guidance on pregnancy and work should still be followed.

If your employer is requiring you to return to your place of work and you do not believe an appropriate risk assessment has taken place then you should contact us.

All medicines, including vaccines, are highly regulated – and that is no different for the approved COVID-19 vaccine. There number of enablers have made this possible:
  1. The different phases of the clinical trial were delivered to overlap instead of running sequentially which sped up the clinical process.
  2. There was a rolling assessment of the vaccine trial data as soon as it became available so that experts at the MHRA and JCVI could review it as soon as possible, ask questions along the way and request extra information as needed – as opposed to the usual process which would mean getting all information at the end of a trial.
  3. Clinical trials managed to recruit people very quickly as a global effort meant thousands of people were willing to volunteer.

The trials and evidence show the vaccines to be safe and effective. These are being followed up with ongoing surveillance and monitoring to analyse the safety and ongoing effectiveness of the vaccines. The PHE COVID-19 vaccine surveillance strategy describes the process for how this will be implemented.

It is inevitable that the programme will adapt as more evidence becomes available. This will be analysed by the JCVI and MHRA and be published in the COVID-19: the green book, chapter 14a. Everyone should make sure they always look at the most up to date version and access it on line. For more information see the other sections on this page, particularly the one on 'Blood clots and COVID-19 vaccination'  relating to the AstraZeneca vaccine and 'Allergies'.

Please also see the MHRA information on the process for vaccine authorisation and ongoing surveillance and the Oxford Vaccine Group useful information and resources for all COVID-19 vaccines.

You can also read our blog which helps to explain how vaccines have been tested. 

I am extremely clinically vulnerable. What will having the vaccine mean?

It is still unknown if COVID-19 vaccination will stop people from catching or passing on the SARS-CoV2 virus. It is really important that everyone who has had the vaccine still follows the guidelines on social distancing, testing, shielding and self isolation where necessary. This applies to the workplace and at home.

Public Health England have updated their guidance on shielding and protecting people who are clinically extremely vulnerable from COVID-19 to reflect this and confirm that anyone who has had the vaccination should continue to follow shielding advice. 

Please also see our section on returning to work after having the vaccine above.

Vaccination with COVID-19 vaccines in children is not routinely recommended given the lack of data on the safety or efficacy in children. The COVID-19: the green book, chapter 14a gives more detailed information. There are some studies underway to test the safety of giving COVID-19 vaccines to children.

The RCPCH have issued advice on the use of the vaccines in children who are vulnerable and/or shielding: Message for paediatricians on children and young people and the COVID-19 vaccination programme | RCPCH.

Communication materials in different languages

Please see our section on leaflets and resources for help with accessing a range of materials, leaflets and videos in different languages.

The PHE Migrant Health Guide, a free online resource for primary healthcare professionals to help them support their migrant patients. The information includes guidance on health topics, entitlements to an interpreter, information on data sharing and clarifies migrants’ entitlements to NHS services, among other resources. There is a section specifically on immunisation.The PHE animation Keeping up to date with vaccinations for migrants and the NHSE / PHE resources on reducing health inequalities in vaccine uptake may also be helpful.

Doctors of the World have produced an animation on how to register with a GP and Book a Vaccine. As well as the English version, you can access the animation in other languages by visiting Doctors of the World

Learning disabilities

The Challenging Behaviour Foundation

National Development Team for Inclusion (NDTi)
guidance on reasonable adjustments

Is the vaccine vegan/vegetarian friendly?

There is no material of fetal or animal origin, including eggs, in the current vaccines. All ingredients are published in healthcare information on the MHRA’s website. Please also see:

PHE Guide to the use of human and animal products in vaccines discusses this in greater detail for all vaccines, not just those for COVID-19.

COVID-19 vaccination

Clinical information, guidance and relevant RCN positions on the UK COVID-19 vaccine programmes.

Our COVID FAQs

Find out how to protect yourself, what you should expect from your employer and what to do if you have concerns.

Our guidance on PPE

Read this alongside your local infection prevention and control policy.

Page last updated - 16/07/2021