Responses to 3.11. Vaccination policies for people using and providing Long-Term Care


COVID-19 vaccination in Australia began in late February 2021 and in June 2021 in phase 1a of their national rollout strategy. Phase 1a includes quarantine and border workers, frontline health care workers, and aged care and disability care staff and residents. As of March 2, 2021, 41,907 doses have been given in Australia, which corresponds to 0.17 doses per 100 people (; Aged care staff are in the highest priority group (1a) for vaccinations, however rather than being vaccinated at work with residents, they have been asked to obtain their vaccinations through their GP or at a vaccination clinic. This means that rollout has been slow, and data is difficult to obtain on how many long-term care staff have been vaccinated (

From 17th September 2021, residential aged care workers must be vaccinated against Covid-19 as a condition of employment. By 7th September 2021, 39% of the population aged over 16 are fully vaccinated and 63.8% have had one dose. Among aged care workers, 85.7% had had at least one dose and 64.1% had been fully vaccinated (

Last updated: September 7th, 2021


On 26 December 2020 the Federal Ministry of Social Affairs, Health, Care and consumer protection published their COVID-19 vaccine prioritization recommendations. In the first phase, the highest priority group included residents and staff in care and nursing home, staff in health care sector with high risk of exposure and people aged 80 years and older. The second phase included people with existing illnesses (including dementia) and their closes contacts (especially of those living in residential care settings), domiciliary care workers, people aged 75 to 79 years. Since the end of December, 1,053,599 people have been vaccinated (appx. 275,000 of whom have received both doses). Starting March 2021, those 65 and older are eligible for vaccination, indicating successfully high rates of vaccination amongst the top two priority groups (

Currently there is only a recommendation to get vaccinated in place for care staff, but no obligation. An obligatory regulation is also not foreseen in the near future. However, there is a law (Epidemiegesetz 1950) that could make this possible.

It is possible, however, when hiring new staff, that employers ask for tighter tests in the hospital or care sector (e.g. for measles, hepatitis, not influenza). Only in one region (Styria) there are some legal possibilities to oblige staff to have specific vaccinations done. In general, across Austria care personnel that are still undergoing training might not be accepted if no tighter tests are provided. Care homes deviate in their views on how to handle the situation (whether or not to make vaccinations obligatory).

Information in German on COVID-19 vaccinations for care personnel:

Last updated: September 7th, 2021


After an initial pilot in care homes, the official COVID-19 vaccination campaign started on 5th January 2020. By 31stMarch 2021, 1,868,577 doses had been administered, by that date, 73% of people aged 85 or more had had at least one dose and 26% had both doses. Care home residents and staff were prioritized for vaccination ( On the 23rd March 2021 it was reported that 95% of care home residents in Flanders had been vaccinated, as well as 87% of staff ( On the 5th March that 94% of all care home residents in Brussels and 92% in Vallonia had been vaccinated (

In long-term care, management may not simply ask if someone has been vaccinated. For many people, vaccination does appear in a medical record (

Last updated: September 7th, 2021


As of March 14th, 2021, 11.5 million doses have been administered in Brazil (8.63 million recipients of Dose 1, and 2.88 recipients of both). Approximately 3.5 million of these doses were given to those 80 and older, who, alongside healthcare workers have been Brazil’s top priority vaccination group since January 2021. We are not aware of data on vaccination in care homes (

Although recommended at the federal level, the definition of priority groups in Brazil currently follows state and local protocols. The Brazilian vaccination strategy has been primarily focused on age, rather than risk or levels of exposure (except for healthcare professionals who were the first group to be vaccinated). More recently those with comorbidities aged 44 to 60 years have been included as a priority group. While in some regions of Brazil long-term care (formal\paid) workforce were included in the first priority groups to receive vaccines against COVID-19, along with residents, in other regions they remain unvaccinated or partially vaccinated. Scientific Societies like the Brazilian Geriatric and Gerontology Society reinforced the importance of vaccination for the long-term care workforce (paid and unpaid). Managers and workers engaged with the ‘Frente Nacional de Fortalecimento à ILPI’ claim that most workers at LTC facilities have now had access to vaccines, but there is a lack of formal evidence on this specific group. There are also no figures on family/informal carers, or domiciliary formal carers, vaccination rates.


Last updated: September 7th, 2021

Canada (British Columbia)

Phase 1 prioritized LTC: residents and staff of LTC facilities, individuals assessed and waiting for LTC, residents and staff of assisted living residences, essential visitors to LTC and AL facilities ( Distribution depends on the province/territory jurisdiction – distribution difficult in northern areas, Moderna vaccine may easier to deliver than Pfizer ( Pfizer’s discontinuation of shipment for week of Jan 25 sets back vaccination schedule ( All LTC facility residents and the people who care for them have been offered vaccine in all health authorities around the province, as of February 9. Uptake is quite high, 87% of long-term care residents have received their 1st dose (

Covid-19 vaccinations are not mandatory for long-term staff or any sector. As of April 30, 2021, 142,000 healthcare, assisted-living and long-term care staff in British Columbia (B.C.) had received vaccinations but the percentage of vaccinated staff in the province is unknown because not all provincial health authorities report total number of registered staff. 82.9 per cent of Vancouver Coastal Health’s eligible staff had received a first dose of COVID-19 vaccine, leaving more than 4,200 workers unvaccinated (

The Ministry of Health is taking an educational approach, informing staff working in Long-Term Care instead of making vaccines compulsory (

Last updated: September 7th, 2021


COVID-19 vaccination policies are created by each of the thirteen provinces or territories. As a result, significant variation exists across the country. As of June 23, 2021, no jurisdiction in Canada has completely mandated COVID-19 vaccinations for long-term care (LTC) workers. Instead, five provinces (Ontario, Quebec, New Brunswick, Prince Edward island, and Manitoba) have incentivized vaccination through the introduction of policies for unvaccinated or partially vaccinated LTC workers including educational requirements, testing requirements, and employment restrictions.

The rest of the Canadian provinces and territories, including British Columbia, Alberta, Saskatchewan, Nova Scotia, Newfoundland and Labrador, Yukon, Northwest Territories, and Nunavut, have no policies mandating or incentivizing COVID-19 vaccination for their LTC home workers, although some are considering it. As of June 23, 2021, each provincial or territorial government has encouraged and recommended that their citizens get a COVID-19 vaccine but have not made it compulsory.

The Ministry Health is taking an educational approach, informing staff working in Long-Term Care instead of making vaccines compulsory (

As of April 30, 2021, 142,000 healthcare, assisted-living and long-term care staff in British Columbia (B.C.) had received vaccinations but the percentage of vaccinated staff in the province is unknown because not all provincial health authorities report total number of registered staff. 82.9 per cent of Vancouver Coastal Health’s eligible staff had received a first dose of COVID-19 vaccine, leaving more than 4,200 workers unvaccinated (

Until December 2019, flu shots were mandatory for nurses working in BC. Nurses had to “vaccinate or mask”, with the latter requiring nurses to wear masks for the duration of their shift (

Educational Requirements:

As of July 1, 2021, the Ontario government requires that LTC workers either show proof of vaccination, provide proof of a medical exemption from vaccination, or participate in a mandatory COVID vaccine education program to understand the benefits and risks of vaccination (

Testing Requirements:

As of April 10, 2021, healthcare workers, including workers in LTC homes in Quebec, are required to show their employer proof of at least one dose of COVID-19 vaccination. If they are unable to provide this, they are required to undergo COVID-19 screening tests at a minimum of three times per week. If the worker refuses the screening tests, they can be redeployed to other work where possible (

Similarly, in New Brunswick, unvaccinated LTC workers in homes where the vaccination rate is less than 50% are required to take a COVID-19 test every other day (

Single-Site Requirements:

In Prince Edward Island and Manitoba, vaccines are not mandatory. However, they are highly encouraged as unvaccinated LTC workers cannot work in multiple care homes, which is a common practice in the Canadian long-term care sector. (;


Last updated: September 7th, 2021


Currently all Covid-19 vaccines available have “Emergency approval in Chile” so there is no legal ground to make it compulsory. This might change in the future.

In July 2021, 87% of all residents and staff in Long-Term Care facilities had been fully vaccinated, of these, 96% had received the Sinovac vaccine and 4% Pfizer/BioNTech.

Sources: and

Last updated: September 7th, 2021


In Mainland China, long-term care staff have been identified as the priority group to receive COVID-19 vaccination in national level. For now, there is no sign that Covid-19 vaccination will be mandated in law for long term care staff, however, in practice, local government and care providers have made vaccination compulsory already without passing any regulation. Care staff and care institutions have very high willingness be vaccinated.

Other vaccinations such as flu are not compulsory.


Last updated: September 7th, 2021

Czech Republic

Covid-19 vaccination is not compulsory for anyone. However, care home workers were among the first groups, together with health care workers, who were offered vaccination. The Czech Association of Social Services Providers published several surveys on progress in vaccination in social services – we published the findings in this article (in Czech only):

There has been no specific vaccination campaign at national level targeting long-term care staff, nevertheless they are prioritized group, and were among the first groups who got vaccinated. There has been a more general campaign to promote vaccination among vulnerable groups and prioritized group of workers.


Last updated: September 7th, 2021


Denmark was one of the first countries to reach near full-vaccination of people living in care homes, concluding the first round of vaccinations by mid-February 2021, and by mid-March for older people who receive long-term care (

The Danish Health Authority has determined that the target groups for the vaccination programme should be given priority in the following order:

  1. Residents in nursing homes, etc.
  2. People aged ? 65 years who receive both personal care and practical assistance.
  3. People aged ? 85 years.
  4. Personnel in healthcare, elderly care and selected parts of the social sector who are at particular risk of infection or who has been identified as performing a critical function in society.
  5. Selected persons with conditions and diseases that result in a significantly increased risk of severe illness from COVID-19.
  6. Selected relatives of persons at significantly increased risk of severe illness from COVID-19 or relatives who are indispensable as carers.
  7. People aged 80-84.
  8. People aged 75-79.
  9. People aged 65-74.
  10. People under 65 years of age who have conditions and diseases that put them at risk of severe illness from COVID-19.
  11. Staff in other sectors critical to the functioning of society.
  12. The remaining population, for example prioritised according to age.

This prioritised order is based on a professional assessment on how best to protect vulnerable citizens and frontline staff (

In November 2020 new legislation was proposed which would give the Danish Health Authority the power to “define groups of people who must be vaccinated in order to contain and eliminate a dangerous disease” ( The proposal applied to diseases posing threats to public health; diseases which the global community are seeking to eradicate; diseases with a high mortality rate; or in instances where a person is deemed to be a danger to themselves or others ( In January 2021 the proposed legislation was not passed due to concerns about the use of coercion and physical detainment to control the disease. Any proposed future interventions will instead be on a case by case basis, requiring a parliamentary vote. The Health Minister noted: “we believe that information and openness are better for the vaccination case than threats and force” (

In early September 2021 the vaccination rate among care home residents was 96% and it was announced that all care home residents will be offered a third those, following an increase in infections in care home during August 2021.


Last updated: September 7th, 2021

England (UK)

On November 27, 2020, Public Health England (PHE) published their COVID-19 vaccine guidance for health and social care workers ( On December 7, NHS England (NHSE) published a standard operating procedure on vaccine deployment for care home staff. This gave care home providers the responsibility to inform their staff, organise logistics, and encourage vaccine uptake (

On December 20, NHSE published information stating that a roving model to deliver the vaccine in care home settings was to be deployed as soon as possible. ( On December 30, NHSE published information which stipulated that vaccines should still be offered to older adults in care homes which have cases, although for those who are acutely unwell or within four weeks of the onset of COVID-19 symptoms, this should be temporarily deferred (

On December 30, the Department of Health and Social Care (DHSC) published information on vaccination priority groups. Previous publications by the Joint Committee on Vaccination and Immunisation (JCVI) had stated that the first priority group for receiving COVID-19 vaccinations were residents in care homes for older adults and their carers. Frontline social care workers, including those who work in hospice care, are to be included in the second priority group. Carers of those with an underlying health condition should be offered vaccines alongside these groups, which is group six unless the person they are caring for is in a higher group (

On January 7, 2021, NHSE published additional operational guidance, further to the guidance from December 30, 2020. This stated that by mid-January, NHS Trusts would be established as hospital hubs, which were the default provider of COVID-19 vaccinations for all healthcare and social care workers. Significant progress is expected to be made by the first week of February, with vaccinations being provided 7 days a week ( On January 11, DHSC published an update to their vaccine delivery plan. This aimed to have offered a first vaccine to everyone in the top 4 priority groups by 15 February. This stated that local vaccination services had a responsibility to coordinate and deliver vaccination to people who were unable to attend a vaccination site, such as the homes of housebound individuals, and residential settings for people with learning disabilities or autism (

On January 13, NHSE published information regarding the next stage of the vaccine rollout in older adult care homes. The addition of the Oxford/AstraZeneca vaccine to the schedule from the w/c January 4 meant that smaller care homes could be vaccinated. First doses were expected to be administered to care home residents and staff by January 17, and by January 24 at the latest. This was to occur 8am to 8pm, 7 days a week. It was suggested that primary care networks had a responsibility to provide mutual aid to other PCNs to ensure that all care homes had been vaccinated by the end of the w/c January 18 ( On January 14, NHSE published an update outlining the next steps for eligible social care worker vaccination. This reported that a national booking system was to be made available for eligible social care workers to self-refer. Until February 28, eligible staff will be able to self-book a vaccination (

On January 26, the National Care Forum (NCF) carried out a snapshot survey across 750 care homes for older people in England between January 25 and 26. Of these 750, 715 had achieved whole home vaccination, representing 95% vaccine take up. Whilst most organisations who responded noted that 50% or more of staff had been vaccinated, only 27% reported vaccination over 70% for their staff. The NHSE target to vaccinate all residents and staff by January 24 has been missed, and the next goal is the government objective of getting all those in JCVI groups 1-4 vaccinated by February 15 ( On February 15, the BBC reported the announcement from the Health Secretary that a third of social care staff in England had not had the COVID-19 vaccine. Everyone in the top four groups had been offered the COVID-19 vaccine (

On February 24, PHE reported that the JCVI had advised that all people on the GP Learning Disability Register were to be invited for vaccination as part of the JVCI group 6 (people with Down’s syndrome are included in group 4) ( On March 8, NHSE published an operating procedure relating to COVID-19 vaccine deployment for unpaid carers who will now be part of the JCVI cohort 6. Where the person they care for is part of the JCVI vaccine cohort 6, then they are able to receive their vaccination at the same time (,0,0,0,0).

On March 10, Nuffield Trust released some analysis. This showed that by the end of February, fewer than 3 in 4 staff working in care homes for older adults had received their first dose. This showed regional variation, with rates highest in the North East and Yorkshire and lowest in London. Rates for other social care staff are even lower with fewer than 3 in 5 having had their first dose (

On March 22, The Telegraph reported that leaked details of a paper, ‘‘Vaccination as a condition of deployment in adult social care and health settings’, submitted to the Covid-19 Operations Cabinet sub-committee showed that the Prime Minister and the Health Secretary had requested that vaccinations become a legal requirement for care home workers. The legal change would be likely to affect England only, with health policy the remit of the devolved administrations in Wales, Northern Ireland, and Scotland. Only around a quarter of care homes in London, and half in other parts of England, have reached the level of vaccination among staff and residents deemed safe by government scientists, which SAGE set at 80% vaccination among staff and 90% among residents of a care home (

On 4th August 2021 it was announced that full Covid-19 vaccination would be mandatory for staff working in care homes by 11th November 2021, despite concerns from providers that this may worsen existing staff shortages.

By 29th August 2021, 95% of all eligible residents and 82% of staff in older adult (65+) care homes had had a second Covid-19 vaccine dose. 78.7% of all care homes in England had had at least 80% staff and 90% residents vaccinated with at least one dose. Among younger adults living in care homes, 88.9% had had a second dose (

Last updated: September 7th, 2021


The vaccination rollout in Finland, determined by the THL and their vaccine expert taskforce (KRAR), prioritized older people (70+) and healthcare personnel. Finland receives its vaccines through the EU joint procurement plan ( Rates of vaccination by age can be found at (


Last updated: September 7th, 2021


Priority has been afforded to older people residing in collective housing and vulnerable people working there – following recommendations from the High Health authority. Vaccination is free. 2nd phase to be those over 75, then 65-74, then health professionals in health and social care over 50, and/or with comorbidities ( All vaccinations were planned to be completed in care homes by week ending 5/2/21 (BFMTV 04/02).

Coverage of other vaccinations (e.g. flu, MMR) has been decreasing in care homes in recent years, especially among those with Long-term conditions, and much below WHO targets. In 2006 vaccination against flu was made mandatory for care professionals but was revoked 10 months later. The Senate recommends having an open debate around mandatory vaccination of care home staff (

Covid-19 vaccination is not mandatory, but in 2005/6, legislation was passed mandating a number of other vaccines for health and social care staff. An amendment to the Public Health code of 2016 introduced a condition that health and social care professionals should be vaccinated if it presents a risk to those they care for. With equally low numbers of covid-19 vaccination across health and social care staff groups, the National Academy of Medicine has called for mandatory vaccination, stating it to be “ethically unacceptable” for health and social care staff (including personal assistants for older people) to not do so ( This would however require new legislation, rather than an amendment to existing legislation ( The issue was discussed in Autumn 2020 in the context of Covid-19 Winter planning (’Acad%C3%A9mie%20nationale,auxiliaires%20de%20vie%20pour%20personnes).

Most recent visiting guidance places the ethical responsibility for vaccination on care staff and highlights that full ‘return to normal’ is not possible without high vaccination rates among staff. In absence of vaccination for staff, these must be ‘very frequently’ tested (

Most residents and 70% of employees have been vaccinated (1 or 2 vaccinations), as of April 16, 2021 (

Last updated: September 7th, 2021


Germany’s vaccination strategy has been described here (

Progress has been relatively slow, but most people living in residential care setting had received the first dose by mid-February 2021 ( Ongoing progress can be seen through the vaccination dashboard (

Persons cared for in their own homes had to visit a vaccination centre for their immunisation as no mobile teams are deployed to these individuals. This is the case even if a home care service is employed as Registered Nurses in Germany are not allowed to administer vaccinations. Restricted mobility as well as impaired social, cognitive and financial resources can impede access to the vaccination centres. Home care services can be reimbursed for some limited assistance in these cases in some Länder. Support for this user group varies between the Länder.

Many people with disabilities have been isolating since March 2020. The focus of the vaccination on older people, people living in residential care setting and health care workers means that many people with disabilities living independently continue to wait for access to vaccines as they fall into Group 2 or lower. There has been criticism that people with disabilities, many of which are at high risk, do not have the same lobby as older people (

There is no mandatory Covid-19 vaccination in Germany for any group so far. There has been some debate about introducing mandatory vaccination for health and LTC workers earlier this year, but the Government has decided against it ( However, it is possible that vaccination will be a condition for participation in certain services such as air travel and tourism. There is substantial debate about vaccinated people having more “freedoms” than the non-vaccinated, especially once the vaccination passport is introduced in the EU. Some researchers strongly recommend making vaccination mandatory, given that vaccination rates among care home staff are reported to be low in some areas, e.g. Nuremberg (,SW3wZxz).

As of 7th September 2021,  61.9% of the general population) were fully vaccinated (

Last updated: September 7th, 2021

Hong Kong

On 1st May, following discussions with the governments of Phillipines and Indonesia, and in light of concerns raised by  labour groups, the government abandoned their proposal to make Covid-19 vaccination mandatory for foreign-born domestic care workers (many of whom provide domestic services to older people in their own homes)  ( The proposal required foreign-born domestic workers to demonstrate they had received two doses as condition of approval or renewal of work visas. Covid-19 vaccination therefore remains voluntary in Hong Kong.

The Hospital Authority usually check all their new nurses for vaccination records and will “highly recommend” them to get vaccinated before starting employment. We are unsure about the current practice in Nursing Homes. The Hong Kong government has not published any data about the adoption of vaccination among healthcare workers.

Under the Residential Care Home Vaccination Programme administered by the Department of Health, it provides free Seasonal Influenza Vaccination and Covid-19 Vaccination for all residents and staff at residential care homes. Residents and staff who wish to receive vaccination would need to provide consent. Enrolled doctors, i.e. Visiting Medical Officers (VMOs), would administer vaccinations at residential care homes Besides, residents and staff can also arrange their own appointments to receive Covid-19 Vaccination in Community Vaccination Centres, private hospitals or clinics. Staff who have completed two doses of vaccination are exempted from the regular compulsory testing of Covid-19

Last updated: September 7th, 2021


India’s vaccination programme for those 60 and older, and those deemed 45+ and high risk, began on March 1st, 2021. This coincided with the opening of a partially private market (e.g. vaccination out of pocket): approximately 10,000 government centres nationwide are offering free vaccinations, and 20,000 private hospitals charge the state-fixed rate of 250 rupees ($4.57). Over 12 million health, long term, and frontline workers have already been vaccinated through the state-funded program


Last updated: September 7th, 2021


Family carers are not currently included on the Vaccine Prioritisation Programme in Ireland, this led Care Alliance Ireland to publish a position paper calling for vaccine prioritisation for Ireland’s family carers (

In Ireland, an international review of policies relating to mandatory vaccination for health care professionals was undertaken by the Health Information and Quality Authority (HIQA) in April 2021 (

A report outlining advice to the National Public Health Emergency Team (NPHET)  by HIQA relating to this issue was also produced in April 2021. In this report, the evidence from the literature and input from the COVID-19 Expert Advisory Group was considered ( The report states that, among the Covid-19 Expert Advisory Group, ‘there was a general consensus that mandating Covid-19 vaccination may not be appropriate at this time as this may act as a deterrent. Additionally, such a measure may be perceived as being overly harsh on a workforce that have had a particularly traumatic year. If all lesser restrictive measures have been exhausted and there is still low uptake, consideration may be given to mandatory vaccination in the future. However, caution was expressed with regards to how far one should go to ensure high levels of vaccination, and the potential creation of a negative work environment’. The advice given to NPHET by HIQA is to maintain a ‘support and encourage’ model, whereby staff are facilitated to make the decision to become vaccinated in a supportive environment’. According to the report, anecdotally, uptake and demand for COVID-19 vaccine among healthcare workers are currently high.


Last updated: September 7th, 2021


Israel has been globally recognized for its vaccination rollout ( By early February 2021, over 90% of individuals aged 60 years and older had received their first vaccine; by end of March some reports said that almost all nursing home patients have received both doses ( According to Ran Balicer, Chief Innovation Officer of Clalit Health Service and Chair of the Ministry of Health’s COVID-19 National Experts Team, much of the success of the scheme was due to its simplicity of prioritization categories ( Studies of how successfully the vaccination program was able to target residents of LTCF and geriatric hospitals are underway. One recent study highlighted the key role that Israel’s emergency ambulatory services, Magen David Adom, had in coordinating paramedic-led teams that were focused almost exclusively on vaccinating geriatric hospitals (

By February 2nd, 2021, Magen David Adom, the national emergency services system in charge of the vaccination rollout in LTCFs, announced it had completed its vaccination of all residents and employees of LTCFs (sheltered housing and nursing homes in Israel)– the first country in the world to do so. (source:

The Green Passport gives vaccinated people access to most places in society and is seen as an incentive towards vaccination. There was some discussion of mandatory vaccination but this was not taken forward (

At the end of July 2021 it was announced that Israel would start offering a third dose of the vaccine to the whole population aged 60 or over.


Last updated: September 7th, 2021


On December 12th, the Ministry of Health published the Italian strategic plan for the vaccination against Covid-19. The plan identified three priority groups for the vaccination: 1) Front-line health and LTC personnel, 2) Nursing homes’ residents, 3) People aged 80 or above. These three categories accounted for 6,416,372 people, almost 11% of the Italian population. The vaccination rollout has been considered relatively slow, with only 1.4 million people having received both doses so far due to supply chain issues in February. There has also been criticism that older citizens have not been prioritized in practice as they were in the original plans (only 30% of vaccination doses have been given to those over 70). The government is making a major push to accelerate vaccination rates up to 600,000 per day in March (;;

As of March 2021, Covid-19 vaccination is mandatory for health professionals working in health and social welfare settings, which may include, for example, GPs, nurses and pharmacists who are deployed in social care settings ( Those who refuse cannot have their employment terminated (

Instead the employer is responsible for either transferring the employee to another job where the risk of spreading infections is lower (without affecting salary) (, or enforcing unpaid leave, with suspension of pay until December 31, 2021 (; There is a lack of clarity over which health and/or social care professionals must be vaccinated by law ( There are questions about whether this applies to new employees given the need to respect private information when hiring new staff. There has been much discussion on making vaccination compulsory for long-term care staff, however the vast majority of political parties are against such an approach (

Last updated: September 7th, 2021


Japan has been relatively slow to roll out vaccines. Vaccination started in April 2021 for all people aged 65 and over, followed by care home staff from June but it faces issues with high levels of vaccine hesitancy ( Japan also faces logistical difficulties in roll out of the Pfizer vaccine in that it lacks sufficient syringes to deliver it ( There do not appear to be plans to prioritise people who live in care homes.

Last updated: September 7th, 2021


The Ministry of Health in Kenya prioritized the use of COVID-19 vaccine based on the World Health Organization (WHO) Strategic Advisory Group of Experts (SAGE) Roadmap and targeted high priority groups (at higher risk of exposure) (Africa Medical and Research Foundation (AMREF) such as health care workers, other front-line workers, individuals above 50 years as well as adults with underlying conditions. Although the Ministry of Health urged eligible populations to receive the vaccines due to the high transmission rates (10-11%), it is not yet mandatory and an individual may decide not to be vaccinated. Whilst receiving the vaccine is very important for all Kenyans, the government is only able to use a phased approach to provide vaccines to different populations in order to reduce the risk of social injustice in case there is inadequate supply of vaccines.


Last updated: September 7th, 2021


Covid-19 vaccination is voluntary. The government required care homes to submit name lists by end of February but, in May 2021, they had not yet delivered vaccines to care homes. So far 400 out of an estimated 1500 homes in Malaysia have submitted name lists, constituting 300 of the estimated 350 legally-registered home and only 100 out of the 1000 or so unregistered homes. So far, the Ministry of Health and Department of Welfare have not guaranteed protection against prosecution for homes that are unregistered and this may be reducing the willingness of unregistered homes to submit name lists for vaccination. Most healthcare workers have been vaccinated and the country is now well into the second vaccination phase, which targets vulnerable groups.


Last updated: September 7th, 2021


Nursing home residents and residents of homes for people with intellectual disabilities were put in the top priority group alongside healthcare personnel; as of early March, 149,711 people living in nursing homes and long-term care facilities have received both doses. As of March 7th, 2021, 64% of people over 90 living at home had received their first vaccination and 12% their second. 73% of people aged 85-89 living at home, and 63% of people aged 80-84 living at home have received their first (

Vaccinations are voluntary, according to guidelines of the ministry of Health Welfare and Sports. This statement is supported by all professional associations in the long-term care sector. In accordance with the General Data Protection Regulation (GDPR) by the European Union (EU), it is not mandatory for employees to inform their employer of their vaccination status. Among politicians and within the media, debate about making vaccinations for long-term care staff compulsory has been limited. There has been some discussion about the legal grounds on which an employer could change the terms of employment for employees who work with vulnerable people and refuse to be vaccinated (

In December 2020, before the vaccination program was rolled out, some polls found that vaccine hesitancy among healthcare personnel (in long-term care and other healthcare sub-sectors) was about 30% ( Currently this hesitancy is lower ( However, overall and exact numbers are missing.

The National Institute for Public Health and the Environment [RIVM] shows that among the total Dutch population approximately 90% are willing to get a vaccine, 5% are still in doubt, and 5% refuse (

Last updated: September 7th, 2021

New Zealand

In NZ vaccinations are offered to LTC staff but not mandatory. Uptake has been high for staff. Currently vaccinations are being rolled out to Aged Residential Care facilities, and the process has been variable regionally. (Source:

Last updated: September 7th, 2021


As of June 29, 2021, 84% of nursing home residents had been vaccinated with two doses, and 7% had been vaccinated with one dose (Pfizer). Some of the nursing home residents cannot be vaccinated due to poor health (

It is voluntary to take the vaccine. Healthcare workers cannot be fired if they do not want the vaccine. Employees in the health and care services do not lose their jobs if they don’t want to be vaccinated. The Norwegian Nurses Association and The Norwegian Medical Association have recommended to their members that they should take the vaccine. There are few people in Norway who will not take the COVID-19 vaccine (

Last updated: September 7th, 2021

Republic of Korea

South Korea has been relatively slower than other countries to vaccinate their population, however their inoculation strategy intends to prioritise frontline healthcare workers and older people. They aim to inoculate 10 million high risk people by July 2021. Their national pharmaceutical panel has urged caution over the use of AstraZeneca’s COVID-19 vaccine for people older than 65 (

On 17th August 2021, there were reports of concerns linked to outbreaks of post-vaccination infections in nursing homes (9 outbreaks  involving 159 people and 3 deaths since the last week of July. The possibility of a third “booster” dose for older adults and other people more susceptible was being discussed, but there was concern about lack of availability of vaccine supplies.

Last updated: September 7th, 2021


Covid-19 Vaccinations have been voluntary for the whole healthcare sector (and country), but Care Providers proactively educate their staff and regularly report vaccination rates.  As of Mid-February, already 73% of healthcare workers had been vaccinated with at least 1 dose (the vaccination campaign started around Mid-Jan, so the coverage is likely much higher now) (

On the 3rd September 2021, the Expert Committee on Covid-19 Vaccination recommended that people aged 60 and over, as well as those who live in aged care facilities, should receive a booster dose of an mRNA vaccine six to nine months after the completion of vaccination with two doses.

Last updated: September 7th, 2021

South Africa

Covid-19 vaccinations are completely voluntary in South Africa.  The Constitution protects individuals’ rights to decide for themselves, without due influence.  Care homes strongly encourage vaccination of staff (flu and Covid-19) but cannot make it compulsory or preclude staff from coming to work (this would become a labour law issue).  The phase 2 of vaccination (general population – beyond health care workers) started during May 2020 and, at least the in Western Cape (if not the whole country) people in Long-Term Care Facilities and people aged 60 or over were being prioritized.


Last updated: September 7th, 2021


Spain’s vaccination programme began in early January 2021, with nursing home and long-term care facility residents in the highest prioritization group alongside frontline healthcare workers. Vaccination campaign responsibilities fall to the individual regions.

In Spain, like with any other vaccine, vaccination for COVID-19 is voluntary for all the citizens, including workers from the health sector and the long-term care sector. Workers from the health and the long-term care sector have been prioritized groups in the COVID-19 vaccination strategy, but vaccination is not compulsory (

Last updated: September 7th, 2021


Vaccination started on 27th December 2020, after the approval of Pfizer/BioNTech vaccine by the European Union commission (Sweden is part of an EU cooperation on a joint agreement for the purchase of Covid-19 vaccines). Vaccination against Covid-19 is free of charge for everyone. The national plan for Covid-19 vaccination has been drawn up by the Public Health Agency of Sweden, the National Board of Health and Welfare, the Swedish Civil Contingencies Agency (MSB), the Swedish Association of Local Authorities and Regions (SKR), the national coordinator for Covid-19 vaccine, and infectious disease doctors and representatives from the regions. Vaccine availability will determine how quickly the vaccine can be offered to more people. The order of priority for vaccines is divided by 4 phases: Phase 1: Individuals who live in residential care homes for older people or who use home care services under the Social Services Act. Healthcare personnel working with this risk group. Adults who live with someone in this risk group. Phase 2 Other individuals aged 70 years or older. The oldest will be vaccinated first. Individuals aged 18 years and older who receive help under the Act concerning Support and Service for Persons with Certain Functional Impairments (LSS). This also applies to individuals aged 18 years and older who have been granted assistance allowance under the Swedish Social Insurance Code. Medical and care service professionals, including LSS, who work closely with patients and recipients of care (

No vaccination is compulsory in Sweden and, comparatively, there is very high acceptance of all kinds of vaccines.  A survey from March 2021 showed that 91% of the population intended to take the COVID-19 vaccine when offered. There was some discussion (at the local level) that staff who refused vaccination would not be allowed to work directly with residents in care homes, but more recently that does not seem to be on the agenda (probably due to the clear evidence of the rapidly declining number of cases among residents once they have been vaccinated). From the beginning, care home staff were in the first priority group together with care home residents, but when there were problems with the amount of doses arriving, the vaccination of care home staff stopped and instead the recommendation is to prioritise only according to age (once care home residents and home care users have got their first dose).

As of June 2021, the vaccination rate of people living in LTC or receiving home care (priority group number 1 in Sweden) is 94% at least one dose, 89% fully vaccinated (

Last updated: September 7th, 2021

United States

The United States’ federal effort to get nursing and long-term care home residents vaccinated, known as the Pharmacy Partnership for Long-Term Care Program, partnered with pharmacies such as Walgreens and CVS to set up vaccination clinics in and around LTCFs. The federal program used a statistical formula that has significantly overestimated how many doses would be needed for long-term care facilities, leading some states such as Oklahoma and Maine to redistribute the federally-provided vaccinations to those 65 and older living at home. A map containing the number of doses distributed from this Long-Term Care Program specifically was shared on the CDC website.

On March 11th 2021, President Biden’s administration announced an updated timeline for vaccination across the country, making all adults eligible for vaccination by May 1st due to the success of vaccination rates of the highest priority groups.

On 18th August 2021, President Biden announced that the week of 20th September booster shots would start being administered to individuals who had had the second dose eight months before, the first citizens that will be eligible will be healthcare providers, residents in nursing homes and other older people. The President also announced that COVID-19 vaccinations would be mandatory for all Long-Term Care workers for Medicare and Medicaid services.

Last updated: September 7th, 2021