Subsequent to our writing of this blog entry for publication, the UK government announced it was reconsidering its decision to enforce an NHS England vaccine mandate. Steps are already underway to formalise this decision in parliament as we speak, but this suggests the mandate is unlikely to progress any further. We note that the vaccine mandate has already been enforced for three months in social care settings and has led to staff shortages (approximately 40,000 new vacancies now exist in that setting as a result) and that due to this change in direction there is likely to be some confusion surrounding this in our profession and amongst the public. For these reasons, we have decided to continue to publish this entry to explain why a COVID vaccine mandate may be an ineffective strategy in health and social care settings and what may be more helpful instead to help staff navigate vaccine hesitancy in the context of the ongoing pandemic. [Update added on 02.02.2022]
We are a group of psychology professionals working in an acute NHS Trust in England. Core to our role is to seek to understand and empathise, and to challenge stigma, racism and discrimination wherever we encounter it. We write to raise the issue of the impact of mandated COVID vaccines upon staff working within the health and social care systems of the NHS in England.
Supporting, promoting and encouraging uptake of the vaccination programme for healthcare staff to protect themselves, patients and colleagues is important; however there should remain some choice in this decision.
There is a wider socio-political context to vaccine hesitancy which has not been acknowledged by our professional bodies, government, or most of the media. The mandating of Covid vaccines for NHS workers in England is a highly political act and will disproportionally affect People of the Global Majority*.
We write this statement to oppose the mandatory vaccination of NHS workers.
In doing so, we aim to promote understanding of and to stand in solidarity with our colleagues who have declined the vaccine and now face losing their careers. We call on our elected representatives in government and on our professional bodies to take a stand against yet another example of structural racism.
Several studies have examined reasons for SARS-CoV-2 vaccine hesitancy in People of the Global Majority. To summarise, these include:
These influences intersect with other factors, including socio-economic status and access to resources. More broadly, People of the Global Majority have a collective history of lack of autonomy over their own bodies and of their bodies being abused by people in power.
For all these reasons, it is entirely understandable that rates of vaccine acceptance are lower in People of the Global Majority (at the same time it should be noted that there is heterogeneity across groups).
Almost a year ago the Organisation for Economic Co-operation and Development (OECD) published guidance about how governments can enhance public trust in Covid-19 vaccination. This includes:
Social cohesion is undermined when citizens feel unfairly treated, and makes it less likely that people will “co-operate” [their words]; thus it seems reasonable to infer that the introduction of a vaccine mandate in one sector (NHS and social care staff in England) that discriminates against People of the Global Majority is likely to impact negatively on the trust the wider community has in government, and make it less likely that some of this community will consider vaccination themselves.
Indeed, an unpublished survey by researchers at the London School of Economics and Political Science found that policies such as mandatory vaccination would, in some people, fuel distrust and further reduce the likelihood of them accepting the vaccine3.
Dr Hans Kluge, the Europe Director of the World Health Organisation recently stated that mandating vaccines should only be used as “an absolute last resort”, stressing the importance of engaging with the community first.
Instead of demonstrating any understanding of factors that influence decision-making and behaviour, politicians and the media simply talk about the burden on hospitals caused by “selfish” unvaccinated people, and about “anti-vaxxers”. Such talk from influential sources risks exacerbating stigma and overt racism towards People of the Global Majority.
The impact of mandatory vaccination on individuals and the NHS in England will be great. For individuals who decline the vaccine, the impact of a loss of career cannot be overstated. For an already-stretched NHS with many thousands of unfilled vacancies, the impact on patient care of fewer staff will be significant and cause reductions in services. This will disproportionately, once again, affect People of the Global Majority and will widen existing health inequalities.
An NHS that has shown itself to be hostile towards People of the Global Majority through the implementation of this mandate will face even great difficulty recruiting in future. Service users will, understandably, be even more likely to regard healthcare services as untrustworthy and racist.
These effects will be exacerbated by the speed at which the policy is being implemented at a time of intense pressure on the NHS. Many NHS managers and colleagues in England are describing the distress they feel in having to implement this policy and under such a tight deadline when they are already experiencing heightened levels of stress and pressure.
What’s the alternative to mandatory vaccination?
As outlined in the recent guidance from the British Psychological Society (BPS)5, the COM-B model of behaviour is drawn upon to outline the positive influences that may increase vaccine uptake among the population. In addition, six key principles are highlighted to optimise messaging, access and uptake of the vaccination.
Trust is a key principle here and one that may be more helpfully adopted if there were to be an extension of the timeframes for the mandated vaccine. Trusted members of a community and wider staff support are essential to dispel misinformation, whilst also decreasing potential stigma of ambivalence or reluctance to get vaccinated.
We are also aware that some of our colleagues and other appropriately trained professionals are helping individuals and groups in the NHS who are ambivalent about vaccination to work through this in a way that respects their individual autonomy. This support work has increased in the last few months.
However, these interventions take time and working with trusted community members in marginalised communities is important and helpful to address widening health inequalities that are likely to emerge due to this vaccine mandate.
Time is needed to ensure that the communication channels and messengers are appropriate, and to prevent a close-down on the discussion and decision-making process, within the NHS workforce and beyond.
*Please note: We use the term People of the Global Majority throughout this article as it is more factually accurate than Black, Asian and Minority Ethnic people. Minoritised ethnic and racial groups make up the majority of the global population (approximately 87-90% according to 2019 UN report estimates: https://population.un.org/wpp/Publications/Files/WPP2019_Highlights.pdf) and the former term also allows self-definition independent of white supremacist hierarchies of race and ethnicity
What happens after the momentum of a social movement has peaked? In any movement cycle, there will be periods of engaged activism, and periods when those involved can pause and reflect on progress made, lessons learned, and re-inspire each other. On 26th October, PSC's Anti-Racism Working Group hosted an event to reflect on our collective journey against racism. We shared stories and ideas to inspire us, bring hope, spread awareness and create joy.
The Hope and Solidarity event was an open, inclusive, relaxed session with attendees from across the UK and different PSC groups. The event hoped to create a space to come together to hear about anti-racism work that has gone well in order to be inspired and increase motivation and momentum to more longer-term sustainable anti-racism work. We hoped too it would join together people to form a network or coalition of like-minded people engaged in anti-racism work. Finally, we hoped to create a space to reflect on where we are now (individually and collectively) in relation to anti-racism energy and activity.
After opening to 'The Revolution Will not be Televised' by Gil Scott-Heron, we began looking at the movement cycle. We considered how after the uprising and peak of the anti-racism movement in Spring 2020, we were now in a contraction and evolution phases, hence the need for learning and reflection.
Before the event, we invited people to share creative pieces that have brought inspiration and joy. These were collated and can be accessed here. During the event, we shared a compilation of some of the artwork, poems, videos, songs and other media that have brought inspiration along this journey of resistance, and you can watch this below.
Before going into breakout groups, we started with a reflection on dynamics within conversations and how whiteness can operate unconsciously, and the importance of making it conscious and thinking about who’s talking and what’s being centred in conversations.
We also acknowledged the importance of being mindful that these conversations can feel challenging, and how the challenges are different for people racialised in different ways. We intended to help make the spaces as safe as possible, especially for people racialised as people of colour, and also a brave space, where we can share our thoughts from a place of awareness.
With this in mind, we explored several questions in break-out groups including:
Finally we ended by asking participants to fill in a mentimeter on what has stayed with you / inspired you / take away? (see below).
Some points that PSC's Anti-Racism Working Group took away were:
We hope that this event helped us all to learn from each other and build momentum in our collective endeavours against racism.
In a series of guest blog posts by Harry Leitch, Integrated Care Systems will be explained, and key concerns highlighted. The question will then be asked, what do these changes mean for communities?
"Although seen by the media as suggesting the role of the private sector will be reduced, the proposed legislation, if passed, will enact the current government’s wish to further fragment, destabilise and privatise our NHS." - Keep Our NHS Public
During a pandemic that has revealed the necessity of universal, comprehensive and equitable healthcare, a top-down reorganisation of the NHS is underway. In accordance with proposals from the 2019 Long Term Plan, NHS England (NHSE) is transforming the NHS into Integrated Care Systems (ICS).
For Keep Our NHS Public (KONP) and other campaign groups, these moves represent a severe threat to the NHS and a failure to achieve the increased and sustained funding required. Key concerns include use of a population health perspective, lack of regulation and increase presence of private companies within the NHS.
When the Professional is Political and Personal: Queer Psychologists reflect on debating gender identity within the profession
During the month of Pride, four queer psychologists (from a larger working group discussing and challenging transphobia within the profession) reflect personally on the felt impact of transphobia and cis-privilege. Pseudonyms have been used throughout.
Understanding and accepting gender diversity as a natural state of being is crucial in protecting the wellbeing and lives of trans and non-binary people.
If you were to write two lists of characteristics headed ‘male’ and ‘female’ (and I would encourage you to do this briefly), we often find these characteristics fall into two extremes. Males are supposedly ‘dominant’, ‘loud’, ‘strong’, ‘rugged’; females by contrast something like ‘passive’, ‘quiet’, ‘sensitive’, ‘warm’, ‘pretty’, ‘small’. We may then ask ourselves, do we fit either of those binaries? Perhaps more importantly, do we know anyone that does?
Probably not. However, these stereotypes have the effect that many of us often feel that we are ‘failing’ at our gender. Failing to a woman may mean not feeling attractive enough, petite enough, being unable to carry a child. Men similarly may feel they are not athletic enough, successful enough or they may encounter these feelings through experiencing infertility. Feeling that we do not fit the mould of our gender expectations is not the preserve of people who attend gender clinics and affects most of us at some point. Gender issues exist on a spectrum. And like other issues of intersectionality (race, age, ability), individuals who are unable to entirely fit the cis, white, able-bodied mould are likely to find themselves excluded by mainstream society in one way or another.
by Elena Zeniou, PSC member
In the landscape of Covid19, we are discovering a world that is not fit for our needs. How we socialise, travel, work, celebrate, grieve - all require extra layers of planning and thinking about uncomfortable questions.
Do we hug when we meet? Do we shake hands? Will you be offended if we don’t? Or if we do? How do I travel safely? How often do I change masks? Will my job understand that I’m finding this really tough? Will they make adjustments? Do I ask the person next to me to put their mask on? Would they be offended? Do I just avoid seeing people altogether?
Consider the above questions, and perhaps add to the list what comes to mind right now. Do you plan for these questions because you should have been immune to the virus but you aren’t? Or would you say that because of the virus our world set-up no longer allows for us to be safe, comfortable,and able to do things as in non-pandemic times? We’ve designed a world that allows us to be functional without a pandemic on the loose. Whereas before we would be free and able to navigate through our social interactions and daily activities, we are now limited, needing adjustments.
Open letter to the Secretary of State for Education and the Chief Regulator of Ofqual in response to the BTEC and A-Level exams crisis
Dear Rt Honorable Gavin Williamson CBE (Secretary of State for Education) and Sally Collier (Chief Regulator; Ofqual),
Psychologists for Social Change is a network of applied psychologists, researchers, academics, therapists and students who are interested in applying psychology to policy. We aim to generate social and political action towards a psychologically-healthier society. We felt compelled to write to you with regards to the BTEC and A-Level exam results in order to outline our concerns. We initially prepared to request a rapid revision of the application of the A-Level exam results algorithm. We are pleased to see that this process has been revised. However, our concerns about the impact of the use of the algorithm and subsequent U-turn remain.
Our concerns are as follows:
The algorithm used to award students’ A-Level grades was flawed in a way that benefited those with greater privilege and penalised those who were already disadvantaged. Data show that independent schools in England saw the greatest improvement of A* and A grades, up 4.7 percentage points. This is compared with an increase of just 1.7, 2 and 0.3 percentage points in England’s academies, comprehensives and colleges, respectively. This unfair advantage was conferred to private schools purely because the small cohort sizes meant the algorithm gave more weight to teacher predicted grades than historical data or prior student attainment. Thus, in private schools, teacher predictions were less likely to be downgraded and students who already held a privileged position in the education system were rewarded.
The following letter to the Taoiseach (Prime Minister of Ireland) and Minister for Equality and Integration was penned by Psychologists for Social Change Ireland. The letter calls for the end of the Direct Provision system for accommodating those seeking asylum in the Republic of Ireland. You can read more about this system, which has been heavily criticised by human rights groups here and here. The letter is a living document which has been covered in the Irish press. It has been signed by 150 applied and research psychologists to date.
Open letter to the Taoiseach Micheál Martin and Minister for Children, Disability, Equality and Integration Roderic O'Gorman
Dear Taoiseach and Minister,
We are a group of applied and research psychologists practising in Ireland who believe that direct provision must be promptly dismantled and replaced with a more humane and ethical alternative. We wish to express our solidarity with those seeking asylum on our shores.
Our nation has a responsibility to protect those who come to Ireland seeking refuge from persecution, famine and war. We observe that the direct provision system has barely met the basic physiological needs of these individuals and families, while causing untold psychological harm. We are concerned by the many systemic barriers which deny those living in direct provision the dignity of fully participating in Irish society. Bulelani Mfaco of the Movement of Asylum Seekers in Ireland has explained how this system “eats away at your humanity”. As a country we must do better.
By Aya Adra
I like to think of the summer of 2014, around the time I was finishing up the second year of my bachelor’s degree, as the period when I started becoming a social psychologist. For a couple of sticky, hot months in Beirut, sitting under a distinctly loud and largely useless fan, I listened to my professor share what seemed like mind-shattering theoretical and empirical knowledge on Tuesdays and Thursdays. Every bit of information that was sprung onto me felt like a revelation – the usual suspects of any Intro to Social Psych class; Milgram, Zimbardo, Asch, and their likes. Every theory, every finding, seemed to explain phenomena I had been witnessing and marvelling at for years. So much so that I went around spraying my newly found discoveries onto friends who were rather unenthused, and claiming with reverberating confidence that the world would be a better place if everyone were mandatorily exposed to social psychological knowledge. It truly felt like I, a biology student who had randomly taken this conveniently timed elective, had finally found the discipline that would equip me to fight for the world I wanted; a just world. On the last day of lectures, in between questions about the final exam’s format and informal feedback on the course, the professor asked us what we thought the main insight of social psychology was – what were we taking home with us, us liberal arts students from across disciplines who would go back to investing in whatever major we had signed up for? After a string of pseudo-sophisticated answers (one of which was very likely mine, although my motivated memory conveniently leaves that out today), the professor concluded the class with his own takeaway; “context matters.”
Challenging Lockdown Narratives in Leicester: 'Leaning in' to complexity with compassion when our community is shamed and divided
By PSC Leicester
Communities in Leicester are facing an extended lockdown following a ‘spike’ in cases of COVID-19. Public Health England are yet to find obvious reasons for this and emerging data from ‘backward contact tracing’ trials in Leicester indicate most were following stay at home guidance. The absence of a clear narrative, however, has resulted in widespread stories which ‘other’ and blame. We live in an age where unchecked soundbites or fragments of information spread quickly and carry immense power, often resulting in divisive rhetoric that damages community cohesion and obscures the bigger picture. It’s easy to fall into these traps. We must therefore continue to be curious about wider factors that are likely to have contributed.
Psychologists for Social Change have previously warned that the COVID-19 crisis has increased the visibility of existing social inequalities in our society and could further compound divisions in our communities. Tragically, we are experiencing this in Leicester today. Many of the speculative narratives focus on personal responsibility with even the Prime Minister bemoaning problems “getting people to understand what was necessary to do” in Leicester. This caricatures residents as either unintelligent or unable to speak English; the latter pointing unfairly to our Eastern European, Somali and Asian communities. There is no evidence that social distancing was understood any less here than in other parts of the country, and the reality is far more complex than that narrative implies. Blaming individuals in this way is unhelpful, shaming, feeds into nationalist rhetoric, and takes the focus away from a government who have been slow to act not just in Leicester but from the outset of the pandemic. It also obscures the more powerful and intersected systemic influences at play that people cannot change.
PSC is a network of people interested in applying psychology to generate social and political action. You don't have to be a member of PSC to contribute to the blog