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Can you insist that employees be vaccinated?

Thinking of introducing a policy relating to vaccinations?
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Can you insist that employees be vaccinated?

Can you insist that employees be vaccinated?

17 March 2020

Can we insist that our employees be vaccinated?

Our Workplace Advice Line recently received this question from a Workplace Assured subscriber.

Q Our company operates in the healthcare sector and we are thinking of introducing a policy relating to vaccinations. Can we insist that all employees be vaccinated?

A Workers whose job entails biological hazards include healthcare staff, employees at childcare centres, sewage workers and many others. For example, if a toddler about to fall ill with chickenpox unknowingly transmits the disease to a pregnant childcare worker who has not been immunised or previously infected, there is a small but significant risk to her unborn child.

Where employees face a serious risk of work-related infection with a preventable disease for which a safe and effective vaccine is available, vaccination is a vital element in protecting their health.

Where no vaccination is available, such as coronavirus, following government health guidance, developing business continuity plans that assess current and new hazards and risk management plans is essential.

While no vaccine is always 100% safe for everyone, the balance of risks and benefits is such that people’s failure to participate in vaccination programs can cause and perpetuate serious health risks for the population as a whole.

The issue has a high profile in some sectors. Employers of healthcare workers, for example, have a duty of care to ensure their employees are protected from vaccine-preventable diseases, and health care workers themselves have a duty to ensure they minimise the risk of passing a preventable disease to their clients, such as hospital patients. This is particularly important, considering that their clients may already be at an increased risk of serious illness or even death, due to compromised health status or immunosuppression.

For these reasons, most healthcare employers insist that their workforce be immunised. Healthcare facilities in Australia generally have policies requiring all healthcare workers (including students) to be immunised against or have evidence of immunity to certain vaccine-preventable diseases, in order to participate in clinical placement activities.

Working with children

Similar government policies apply in relation to people working with children. Like healthcare workers, they too have a duty of care towards others – the children they work with or care for. People working with children must be appropriately diligent in making sure they do not pass on vaccine-preventable diseases to the children in their care. State health departments provide lists of the diseases against which people working with children should be vaccinated, as well as other relevant information, including how to manage refusal.

Vaccination against some diseases attracts more controversy than others. In relation to influenza, for example, the 10th edition of the Australian Immunisation Handbook recommends influenza vaccination for all healthcare workers and staff (including students) at nursing homes and long-term care facilities. However, some studies have indicated that mandatory flu vaccination does not significantly reduce the risk, so the subject remains controversial, and some health care establishments have no punitive consequences for staff who refuse to participate.

Outside those industry sectors where infection control is a major issue, compulsory vaccination of employees is more fraught with dissent.

Some critics have argued that vaccination results in a false sense of security and tends to make workers less careful with regard to other means of infection control such as hand-washing and covering their mouth and nose when coughing or sneezing. Others have maintained they have religious reasons to refuse vaccination.

Managing the risk of infectious diseases

To manage biological risks, employers should follow the standard procedure for risk identification, assessment and control. This includes exploring the possibilities that workers could be infected (or could infect others) with vaccine-preventable diseases, and considering the likelihood and potential severity of the consequences.

If an employee’s refusal to participate in a vaccination program is believed, on reasonable grounds, to raise a serious health risk to anyone, including themselves, their workers and others, employers will need to assess the risk according to the particular circumstances of the work situation, taking into account how diseases are spread. Decisions regarding risk control should be based on such risk assessments. All relevant options for risk control should be considered, in addition to vaccination.

Strategies that may help reduce the risk where an employee refuses vaccination (or cannot be vaccinated for medical reasons) include reviewing work practices to ensure systems of work are best practice in terms of infection control, providing extra information, instruction, training and supervision, and using personal protective equipment. In some organisations, there may be scope for adjustments to work placements (eg in a childcare centre, allocating the care of the youngest infants to workers who have received the adult pertussis (whooping cough) booster).

If an employer believes that making vaccination a condition of employment is essential for effective risk control, legal advice may help to determine the legitimacy and any risks associated with such a policy.

The consistency of the policy with anti-discrimination legislation should also be taken into account before insisting that an employee be vaccinated. Depending on the circumstances, professional assistance may be advisable.

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