Key Considerations for Vaccine Rollout in Care Homes

Professor Farhad Huwez, a specialist Geriatrician, provides his insight on how he believes the coming months of the vaccine campaign should be delivered.

As of Monday 15th February, the UK Government reached its milestone of offering vaccines to their top priority groups – totalling 15 million people. With care home staff and older and clinically vulnerable residents among those prioritised, recent weeks have been a time of anticipation and relief for families with loved ones liv- ing and working in residential care.
But while relief and celebration are undoubtedly necessary amid a third lockdown, the pandemic is a long way from over.
Figures, while positive, paint an unclear picture and caution is essential to progressing with vaccine rollout. While 15 million people have been offered the vaccine, we know not everyone has taken it up.

The policy-shift in early January to delay the second dose of vaccines by up to 12 weeks has now been ‘vindicated’ according to the WHO, but still leaves uncertainty as fewer than 600,000 people are ‘fully’ vaccinated having received both doses.

So, how can we ensure the ongoing success of roll-out? How do we encourage as many elderly and vulnerable people, and those working with them, to get vaccinated?

COMMUNICATION AND CONSENT

Properly communicating the importance of vaccines to residents, and employees, is essential. Taking time to understand the concerns of both parties, explain risks and answer questions about the vaccine are important to alleviating anxieties.

If a care home resident is able and has the capacity to make a decision about vaccination, they can do so by giving informed consent, the same as any medical procedure. That decision is theirs to make and must be respected.

But many care home residents may have dementia or other conditions that reduce capacity to consent. In these cases, vaccines could be offered based on ‘best interest’ under the principles of the Mental Health Capacity Act. This will be decided by the key care providers, considering the individual’s previous wishes, attitudes, beliefs and any other factors.

For employees, Matt Hancock recently urged key workers to come forward for the vaccine after revealing that take up amongst care workers has been particularly low, with a third still not having had their first jab.

Care workers should also be aware that while mandatory vaccination is not currently legal, employers have a duty to ensure a safe working environment. For those working with vulnerable people, it could be argued that requiring staff to be vaccinated and disciplining them if they continually refuse, is reasonable because of the high-risk nature of the work.

Leadership amongst care home staff will be critical here – ensuring directors and management are vaccinated will set a positive example.

BARRIERS TO ACCESSING OR TAKING UP THE VACCINE

Concerns about the vaccine are particularly prevalent amongst communities of certain faiths and ethnicities, with worryingly low take-up amongst Black and Asian communities. Paying specific attention to understanding and allaying these concerns will be an important step for continued vaccine roll out and, where possible, care providers and residential homes should collaborate with community and faith leaders to dispel worries or mistruths.

THE SECOND DOSE

With the vaccines currently available in the UK, patients receive two injections. While the immunity provided in the first dose could be nearly 60%, it is critical to get both doses, as the second boosts effectiveness and provides longer lasting immunity.

Older people and their carers should be reassured that all available vaccines seem to work well in older people and those with pre-existing health conditions. There are remaining questions over effectiveness against new strains, but vaccines still offer a higher level of protection against more severe cases of Covid-19.

VACCINES ARE NOT A SILVER BULLET

Transmission of Covid-19 is still possible even with increasing numbers of people vaccinated, and the possibility of new strains threatens the programme if transmission of the virus is not reduced globally. Therefore, additional measures are equally as important as they have been for the last year.

Care homes should not relax and must retain the appointed leads responsible for ensuring accountability when it comes to reducing risk; overseeing prevention and control measures, PPE supplies, training, testing, access to medical care and control of visitors. The mainstays of infection prevention and control in care facilities are still physical distancing, hand and respiratory hygiene and appropriate use of PPE. These measures remain paramount to reducing opportunities for trans- mission.

Care homes still have a critical role to play in containing the spread of Covid-19, and we must all remain vigilant to protect our communities.

Professor Farhad Huwez is a certified Consultant General Physician and Geriatrician, Professor of Geriatrics at New Vision University, Georgia, and Programme Leader of the Care of the Elderly Diploma MSc provided by online learning specialists, Learna (www.learna.ac.uk)

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