coronavirus

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

Key resources

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.

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

Vaccine storage: information on handling of the Pfizer BioNtech vaccine is available from the Specialist Pharmacy Service (SPS)

Vaccine preparation is detailed in this video produced by Pfizer.

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

Given the current epidemiology of the disease and increasing availability of new 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.

There are currently three vaccines approved by the MHRA for use in the UK against COVID-19:

Changes to scheduling and leaving a longer gap between the first and second dose

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. Please see Regulatory approval of Pfizer BioNTech vaccine for COVID-19 for more information.

The second dose of the AstraZeneca vaccine may be given between 4 to 12 weeks following the first dose. Please see Regulatory approval of COVID-19 AstraZeneca vaccine for more information.

Please see: COVID-19: the Green Book, chapter 14a, COVID-19 vaccination: information for healthcare practitioners and the links in our key resources section above.

There is a useful video on the Public Health Wales site which also helps to clarify this. Please see this along with their resources for health and social care professionals.

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 now given temporary authorisation 174 to three vaccines; Pfizer-BioNTech, AstraZeneca are being rolled out as part of the COVID-19 vaccine programme; a third vaccine from Moderna will be added as soon as vaccine supplies become available. Given the current rapid increase in COVID-19 cases, it is essential we roll out vaccine at speed to protect those most vulnerable.

There is good evidence of short-term vaccine efficacy from the first dose of both vaccines. As a result the advice from the JCVI is that vaccinating a greater number of people (at least initially) with a single dose will prevent more deaths and hospitalisations than vaccinating a smaller number of people with two doses.

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 that people have consented to two doses within a short time scale. Does the change to scheduling invalidate that consent?

Just as with any change to planned treatment, a change to the schedule for vaccine doses for an individual recipient does not invalidate the earlier consent, providing people are given the explanation for this.

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. The RCN and NMC would support local decisions to continue with planned second dose administration at 3-4 weeks where it is appropriate.

Members who are concerned about their own clinical situation/circumstances should discuss this with their employer and/or GP.

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

The Green Book advice is to give two doses of the same vaccine wherever possible. There is no data on the interchangeability between the two vaccines, however, 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 clear in the Green Book, in the guidance for health care professionals (which includes the national protocols), and in the Patient Group Direction templates.

There is work ongoing to assess the potential interchangeability of the vaccines so this guidance may be amended further as evidence becomes available.

If you have concerns, raise these with your line manager and if they are not resolved, contact RCN Direct on 0345 772 6100.

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.

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 14) 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. Read our PPE guide here.

Will I be protected from infection after having the COVID-19 vaccine, and how quickly?

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 vaccines in the current programme have been authorised given evidence that they will help prevent severe disease in significant numbers of people.

As with most vaccines, it will generally take 10 to 14 days for people to build any kind of immunity from the vaccine and no vaccine will ever provide complete protection.

It is still unknown if COVID-19 vaccination will stop people from catching or passing on the SARS-CoV2 virus.

We do not yet know how long the current vaccines will give protection for as there is limited data on this.

It is really important that everyone who has had the vaccine still follows the guideline on social distancing, testing and self isolation where necessary. This applies to the workplace and at home.

The COVID-19 vaccine will not affect testing for COVID-19 infection. For further information see COVID-19 vaccination: information for healthcare practitioners and Public Health Wales resources for health and social care professionals.

Please see the RCOG guidance on COVID-19 vaccines, pregnancy and breastfeeding FAQs. 

There is insufficient evidence to recommend routine use of COVID-19 vaccines during pregnancy, although there are no specific safety concerns or harm to pregnancy. There is also no known risk associated with giving non-live vaccines during pregnancy and neither vaccine would lead to infection in either the woman or the unborn child. The JCVI advises that either vaccine should be considered where the risk of exposure infection is high and cannot be avoided, or where the woman has underlying conditions that put them at very high risk of serious complications of COVID-19.

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

Those who are trying to become pregnant do not need to avoid pregnancy after vaccination.

There is no known risk associated with giving non-live vaccines whilst breastfeeding.

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.

Under regulation 7 of the Control of Substances Hazardous to Health Regulations 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. 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 recommends taking up vaccination as best practice. However, we recognise that some members might choose not to be vaccinated. If you have medical concerns about the vaccine, please see our section on refusal below.

Members who are concerned about their own clinical situation/circumstances should discuss this with their employer and/or GP.

How do I get the vaccine? Can agency workers or students get the vaccine?

The Priority groups for coronavirus (COVID-19) vaccination is published by the JCVI and covers frontline health and social care workers who provide care to vulnerable people. This includes those working in hospice care and those 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.

What should I do if I have not been included in the list to be vaccinated?

The Green book chapter for COVID-19 vaccination says that staff working in care homes for older adults should be included in the first Priority Group for receiving a COVID-19 vaccination. This includes temporary and agency workers as well as permanent employees working in these settings. All other frontline health and social care workers should then be included in Priority Group 2 to receive the vaccine. This group should include students, temporary staff such as agency or bank workers, and those working in independent or voluntary healthcare providers.

The order that the NHS will vaccinate everyone in each Priority Group may vary, so you may need to wait for details of when and where you will receive your vaccination. NHS Trusts have compiled details of how many of their workers are eligible to receive the vaccination, as have many independent workplaces such as care homes, hospices and independent hospitals and clinics. We expect that most members will have their vaccination arranged through their workplace or employer in this way, but it is possible that some members may be given a letter by their employer or agency to take to a GP.

If you believe that you have not been included in the list of workers to be vaccinated as part of Priority Group 1 or 2 then you should raise this issue with your employer/agency in the first instance. If this does not resolve the issue you should contact RCN Direct on 0345 7726100.

Do I need to have the flu vaccine before I have the COVID-19 vaccine?

The guidance in the Green Book chapter for COVID-19 vaccination recommends there is a seven day gap between administration for the flu vaccine and the COVID-19 vaccine. The RCN would recommend staff have both these vaccines as soon as they are able to help protect them, their families and patients.

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 vaccine information.

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.

The RCN recommends taking up vaccination as best practice. However, we recognise that some members might choose not to be vaccinated and the questions and answers below are for their assistance.

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

No-one can be forced to have medical treatment - including vaccines - and the UK governments are not making it mandatory for health and social care workers to be vaccinated against COVID-19. However, there may be consequences for you at work if you have not been vaccinated and your employer can show that you present a risk to patients or clients as a result.

Can my employer dismiss me if I am not vaccinated?

If your employer considers that you present an unacceptable risk of infection to patients because you have refused the vaccine, in some circumstances they may even be able to dismiss you under the heading of ‘some other substantial reason.’ For the dismissal to be fair, the employer would have to act reasonably and consult with you before making a final decision. For example, they would need to:

  • provide you with their reasons for their requirement that you are vaccinated
  • give you the opportunity to state your concerns, and
  • consider other alternatives.

This risk assessment could include consideration of whether you could be redeployed to a place where you did not present an unacceptable risk or whether any risks could be reasonably mitigated through testing and PPE.

If your employer is taking action against you for refusing to be vaccinated, call us on 0345 7726100.

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

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 to your religion and belief, you may have a claim for discrimination under the Equality Act 2010. Your employer would need to show that they had tried to accommodate you. Your employer may and try and defend their actions on the basis that they had good reason for the decision, and it is proportionate. This is known as “objective justification”.

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. Your employer would need to show that they had made reasonable adjustments in all the ways suggested above. Your employer may and try and defend their actions on the basis that they had good reason for the decision, and it is proportionate. This is known as “objective justification”.

Other medical issues 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.

Conception, pregnancy and breastfeeding: Please see the RCOG guidance on COVID-19 vaccines, pregnancy and breastfeeding and our section on vaccination and pregnancy above.

Serious allergy: Anyone with a previous history of allergic reactions to the ingredients of the Pfizer BioNtech vaccine should not receive it, but those with any other allergies such as a food allergy can now have that vaccine. See this guidance for more

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 on 0345 7726100 for advice and support.

Does it make a difference if I work in the NHS or for an independent sector employer?

Your employer will need to undertake a risk assessment that will consider both the risk you present and steps that can be taken to mitigate these risks. For example, these steps may include:

  • considering redeployment to a lower risk area
  • a continued requirement for COVID-19 testing, and
  • the wearing of PPE

It is important to recognise that smaller independent employers may not have the capacity to implement measures that larger employers can offer. The ongoing provision of PPE and testing for staff who refuse the vaccine will add additional financial outlays for the employer which may not be considered a reasonable adjustment in the long-term.

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

Under the NMC Code all registered nurses have a duty to preserve safety. You must take all reasonable precautions necessary to avoid any potential health risks to others. Whilst receiving the vaccine will not be mandatory, you must work with your employer to mitigate the risks if you have not been vaccinated. It is difficult to predict what this might mean as the pandemic enters new stages, but it could include redeployment to areas with less vulnerable patients, regular testing and the ongoing use of PPE even when other staff are not required to make use of those precautions. Provided that you cooperate with your employer to avoid exposing others to risk, you should be deemed compliant with the 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?

You will be paid statutory sick pay, but your employer may try to argue that any discretionary element of your sick pay could 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, you should contact us for assistance and a claim for unlawful deduction of wages may be considered. Call us on 0345 7726100.

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.

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.

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Page last updated - 14/01/2021