It has been a traumatic and testing year for the health and care workforce globally. In recognition of their contribution and struggles during the pandemic response, WHO has designated 2021 as the International Year of Health and Care Workers. This campaign highlights the need for investment in health workforce readiness, education, and learning to manage the COVID-19 pandemic, to maintain health services, and to prepare for vaccine roll-outs. A call for action on behalf of the health-care workforce is welcome. What must also be considered is a governmental duty to sufficiently protect the health-care workforce, be that protection from infection, protection of mental health, or legal protection. Governments should be asking themselves whether they are fulfilling this duty of care.
Amid the strain the pandemic is placing on health systems, the health-care workforce is experiencing serious harms to their physical and mental wellbeing while trying to deliver quality care. These issues are not limited to clinicians and nursing staff, but affect everyone working to improve health in their community, including in care homes, pharmacies, and residential centres. International data are scarce, but according to Amnesty International, more than 7000 health workers worldwide had died from COVID-19 by September, 2020. Although health and care workers represent less than 3% of the population in most countries, they make up 14% of the COVID-19 cases reported to WHO. These statistics are sobering, but statistics alone cannot tell the full story of a workforce that feels a palpable sense of anger. Nor can they illustrate the sorrow and mental burden of health and care workers who see colleagues, friends, and family suffer from the virus while making personal sacrifices to deliver the best care they possibly can.
Health and care workers should be prioritised for vaccination. However, there are several concerns. There are uncertainties, such as that surrounding the effect of vaccination on transmission, and in some countries the health-care workforce is being given vaccines for which efficacy data have not been published. In the UK, the government has decided to extend the gap between doses to 12 weeks. According to the BBC, this approach has been questioned by the British Medical Association in a letter to Chris Whitty, the government's chief medical adviser, warning that “the absence of any international support for the UK's approach is a cause of deep concern and risks undermining public and the profession's trust in the vaccination programme“. Efficacy and vaccine effectiveness might also differ in light of the new variants circulating. There are concerning reports in some places of wariness among health and care workers to take COVID-19 vaccines, although it is unclear why.
Vaccination is not the limit of government duty to the health and care workforce. Other immediate concerns should be addressed to ensure their safety. It is a serious issue that obtaining personal protective equipment (PPE) of an appropriate standard remains a problem a full year into the pandemic, with recent calls in the UK to update PPE guidelines to better tackle more transmissible variants going unheeded. A recent survey for National Nurses United in the USA suggests that 80% of nurses report reusing at least one type of single-use PPE.
The best way to protect health and care workers in the long term is to address the substantial shortfall in the workforce worldwide. Shortages have put huge pressure on staff during the pandemic and hampered responses. There were not enough health and care workers before COVID-19, with an estimated 18 million person shortfall, mostly in low-income and middle-income countries. Governments can build countless emergency hospitals and buy thousands of ventilators, but without the workforce to operate them, they are useless. WHO estimates that 40 million new jobs in health and social care are required to meet the Sustainable Development Goals. A vast number of trained vaccination workers are also needed now and for the foreseeable future. Governments must put in place long-term spending plans that invest sensibly in the training and employment of health and care workers to meet these needs.
The social contract between health-care workers and the public is at risk if the health workforce cannot be properly protected and the duty of care to them fulfilled. The lack of sufficient protections given to health and care staff during the pandemic makes it impossible to properly respond to COVID-19 and makes the sector a far less appealing one to work in, jeopardising its long-term security. A health-care system cannot function by relying solely on the good nature of its workforce and their sense of duty in the face of extreme adversity.
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Published: 30 January 2021
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- Gender, race, and health workers in the COVID-19 pandemic
- The Editors1 correctly highlighted the situation the health workforce is in, and how it is facing “serious harms to their physical and mental wellbeing while trying to deliver quality care” during the COVID-19 pandemic. Considering the health workforce as a homogeneous group misses the reality of who is affected within this group and the necessary solutions.
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