LTCcovid Country Profiles

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

Australia

Vaccination rollout:

COVID-19 vaccination in Australia began in late February 2021 with people living in care homes and staff working in health and aged care included in phase 1a of the national rollout strategy. From 17th September 2021, residential and community-based aged care workers were required to be vaccinated against COVID-19 as a condition of employment (source: DoH). By this date, 95.8% of residential aged care workers had received their first dose, and 76.9% had received both doses (source: health.gov). As of 6th January 2022 99.4% of staff were double vaccinated. Approximately 85.9% of care home residents had received two doses, and 89.3% had received one dose.

At 9th January 2022 92.0% of the population aged over 16 and 74.04% of 12-15 year olds were double vaccinated. 3,565,888 people aged 16 and over had had more than two doses. The rates of vaccination for aboriginal and Torres Strait Islander peoples are lower, with 71.8% of people aged 16 and over having had two doses and 59.9% of people aged 12-15 having had at least one dose.

Booster/third doses:

The booster program for residential care began on 8^th November 2021, with in-reach teams visiting care homes which have been prioritised in each rollout. Booster data are not being routinely reported (source: health.gov). As of 7^th January 2022, a total of 425,273 vaccine doses had been administered to care home residents.

Impact of the COVID-19 vaccination on care home infections and deaths:

There have been no formal studies of the impact of vaccination on care home deaths. From official government data, up until 17^th December 2021, 206 residents had passed away from 1,601 infections. This contrasts sharply with data from 2020, when – as of 20^th November – there had been 678 deaths and 2027 COVID infections in residential care homes (source: DoH). This could be attributed to better healthcare and vaccinations. However, it seems that there is a similar rate of death per infection in residential aged care, despite lower numbers of deaths: as of 21^st November 2021, the total Australian death rate was 0.46% against the total number of residential aged care bed across the country. By comparison, this figure was around 0.37% in November 2020.

Mandatory vaccinations for care home staff:

All states and territories have mandated COVID-19 vaccinations for staff in residential aged care through public health orders.

Visiting in care homes and vaccination requirements:

In relation to mandatory vaccination for long-term care facility visitors, advice from the Quality and Safety Commission is given. This does not mandate vaccination, but heavily encourages it. In the advice, Industry Code is mentioned, whereby level of risk is used to provide or deny access to visitors.

Last updated: January 19th, 2022   Contributors: Lee-Fay Low  |  Sara Charlesworth  |  

Austria

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 (https://info.gesundheitsministerium.at/en/).

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: https://www.sozialministerium.at/Themen/Gesundheit/Impfen/Impfempfehlungen-Allgemein/Empfehlung-f%C3%BCr-Gesundheitspersonal.html

Last updated: September 7th, 2021

Belgium

After an initial pilot in care homes, the official COVID-19 vaccination campaign started on 5^th January 2020. By 31^stMarch 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 (https://covid-19.sciensano.be/sites/default/files/Covid19/COVID-19_Weekly_report_FR.pdf). On the 23^rd March 2021 it was reported that 95% of care home residents in Flanders had been vaccinated, as well as 87% of staff (https://www.rtbf.be/info/dossier/epidemie-de-coronavirus/detail_coronavirus-95-des-residents-des-maisons-de-repos-de-flandre-vaccines?id=10725504). On the 5^th March that 94% of all care home residents in Brussels and 92% in Vallonia had been vaccinated (https://www.rtbf.be/info/dossier/epidemie-de-coronavirus/detail_derriere-les-chiffres-9-residents-sur-10-vaccines-en-maisons-de-repos-les-deces-en-chute-libre?id=10712029).

In long-term care, management may not simply ask if someone has been vaccinated. For many people, vaccination does appear in a medical record (https://www.vilans.nl/vilans/media/documents/publicaties/covid-19-in-long-term-care-until-june-2021.pdf).

Last updated: September 7th, 2021

Brazil

From 3 January 2020 to 20 December 2021, there have been 22.204.941 confirmed cases of COVID-19 with 617.395 deaths, as reported to WHO. The first vaccination date was 17 January 2021. Once supplies become available, despite the political crisis, vaccination coverage skyrocketed in the second semester of 2021. So far, Brazil has administered at least 325.593.485 doses of COVID-19 vaccines (approximately 151.80 doses/100 people). Assuming every person needs 2 doses (the number of people who received single-dose vaccines was low in the country), that’s enough to have vaccinated about 77.1% of the country’s population, at least 66% of them fully vaccinated. About 23.33 million booster doses were administered (10.90/100 people).

However, the inequity of these doses distribution in a continental country means that while some states have more than 76.7% of their population fully immunized (12.8% of these having already received the booster dose), others have only 38.8% fully vaccinated.

As the decision to prioritize population groups is currently under the responsibility of municipal and state administrations, there are not enough national data to estimate the coverage of the booster dose in the resident population and workers of LTCFs.

Higher vaccination coverage among Brazilian older adults was associated with substantial declines in relative mortality (when compared to younger individuals, with the two vaccines primarily distributed in the country until then, namely, CoronaVac and AstraZeneca, in a setting where the gamma variant predominates) (Victora CG et al., 2021).

Unfortunately, again, there are no national data to assess the effectiveness of immunization only in the population that depends on long-term care.

The country has not adopted mandatory vaccination policies for LTC staff, nor did it require visitors to present proof of their vaccination status when visits to the facilities were allowed. The current vaccination rates of staff (and the booster rollout in older residents) remain largely unknown.

Recently, researchers from the ‘Frente Nacional de Fortalecimento à ILPI’ published a study estimating the number of LTCF in the country in 7029 facilities, noting that 64% of the 5 570 Brazilian municipalities do not have LTCF for older adults. (Lacerda TTB et al., 2021)

Last updated: December 21st, 2021   Contributors: Patrick Alexander Wachholz  |  

Canada

COVID-19 vaccination policies are created by each of the thirteen provinces or territories. As a result, significant variation exists across the country. People who live in Long-Term Care Facilities (LTCFs), staff working there and, in some provinces, essential family caregivers (EFCs) were prioritised for vaccination. This resulted in a rapid reduction in COVID-19 infections and deaths in LTCFs during 2021. Vaccination take up among LTCF residents has been very high, but there has been some hesitancy among staff, which has led to several provinces introducing vaccination mandates for their LTC staff. Also, British Columbia and Nova Scotia also require that all visitors, including EFCs are fully vaccinated before visiting.

Booster shots for residents in LTCFs were recommended on 28th September 2021 by the National Advisory Community on Immunization (NACI). This recommendation is supported by increasing evidence from studies in nursing homes and assisted living facilities (see, for example, Zhang et al. 2021).

References:

Zhang, A. et al. (2021). ‘Antibody Responses to 3^rd Dose mRNA Vaccines in Nursing Home and Assisted Living Residents’. doi.org/10.1101/2021.12.17.21267996. Retrieved from:  Ontario study (pre-print). 

Last updated: February 11th, 2022

British Columbia (Canada)

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 (https://www2.gov.bc.ca/gov/content/safety/emergency-preparedness-response-recovery/covid-19-provincial-support/vaccines). Distribution depends on the province/territory jurisdiction – distribution difficult in northern areas, Moderna vaccine may easier to deliver than Pfizer (https://ltccovid.org/2021/01/25/the-rollout-of-the-covid-19-vaccines-in-care-homes-in-canada/). Pfizer’s discontinuation of shipment for week of Jan 25 sets back vaccination schedule (https://ltccovid.org/2021/01/25/the-rollout-of-the-covid-19-vaccines-in-care-homes-in-canada/). 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 (https://bc.ctvnews.ca/all-residents-and-staff-of-b-c-s-long-term-care-homes-have-been-offered-vaccines-top-doctor-1.5288511).

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 (https://www.cbc.ca/news/canada/british-columbia/bc-health-care-worker-vaccination-1.6008486).

The Ministry of Health is taking an educational approach, informing staff working in Long-Term Care instead of making vaccines compulsory (https://vancouversun.com/news/covid-19-high-rate-of-vaccinations-among-care-home-staff-dispels-anti-vax-fears).

Last updated: November 6th, 2021

Chile

Long-Term Care residents were prioritized and mass vaccination started in January 2021 using an extramural vaccination strategy. This primary scheme used Coronavac – Sinovac (96%) and Pfizer/BioNTech (4%). Later in, August 2021, a booster mass vaccination strategy was carried out reaching 83% of the residents who had been vaccinated with the primary scheme. The booster scheme used the Oxford – AstraZeneca vaccine except for those with known thromboembolic disease (eg. Myocardial Infarction, deep vein thrombosis).

Long-Term Care staff have been also identified as a prioritized group and where vaccinated using extramural strategies in their place of work. Furthermore, booster doses were given simultaneously to residents. Vaccination remains optional, no governmental compulsory policies have been implemented.

Data available: SAS Report

Last updated: December 22nd, 2021   Contributors: Jorge Browne  |  

China

The Chinese Government announced that over 215.2 million people aged 60 and over have been vaccinated in mainland China by the 29th November, with the remaining 50 million (20%) older people not vaccinated. The National Health Commission of the PRC requires local authorities to promote the vaccination rate among older people based on their health conditions and provide follow-up observation service in the community-level after being vaccinated. Currently, some areas also have set up a vaccination “Green Channel” for older people or provide mobile vaccinating services (e.g., mobile medical vans) to reduce their waiting time.

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: December 6th, 2021   Contributors: Cheng Shi  |  

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 –the findings have been published online (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.

(Source: https://ltccovid.org/2021/05/25/national-discussions-on-mandatory-vaccination-among-long-term-care-staff-in-23-countries-ltccovid-international-overviews-of-long-term-care-policies-and-practices-in-relation-to-covid-19-no-1-may/).

Last updated: November 30th, 2021

Denmark

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.

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. Among those receiving home care, the rate is 97.9% and 98.4% among staff working in LTC.

The fast rollout of the booster soon proved effective as the incidence rates in nursing homes started falling. By week 37 only 11 nursing homes experienced new incidences of the disease and only 22 double vaccinated residents were infected.  By September 21st (week 38), 46.5% of residents had received the booster vaccination. From this week to the following, the incidence rate increased in the general population from 43 to 52 new cases per 100.000 inhabitants, while the number fell from 18 to 4 in nursing homes, a fall of 78% just within a week.

In early November, the number of incidences among residents started increasing again and had within two weeks tripled from 36 to 87 persons infected. In the same period, the number of incidences among nursing home staff increased from 272 to 738 persons. Only 49.2% of staff had received the booster vaccination at that time. In comparison, 60.4% of hospital staff had received the booster. The Danish Patient Safety Authority reported that they were aware of nursing homes where staff needed to go to work even though they were infected, as there was a shortage of staff.

There  has been no policy for prioritizing offering the booster to staff in hospitals and nursing homes. With the Omicron variant (first reported in Denmark Nov 28th), the general roll-out of the booster vaccination was speeded up and regardless of timing of the second vaccination, every person over 40 years is currently (Dec 21^st) offered the booster. The age group 18-39 year old is offered the booster 5.5. months after the second vaccination. In the whole population, 80.9% have received their first vaccination and 76.9% their second, while 34.7% have received the booster.

As of Oct 1st 2022, a fourth vaccine will be offered to all persons 50 years or older. By Sept 2022 0.9% have already received the fourth vaccine

Data sources:

https://files.ssi.dk/covid19/brancher/vaccinationstilslutning/vaccinationstilslutning-brancher-covid19-uge50-2021-fg45  https://covid19.ssi.dk/overvagningsdata/vaccinationstilslutning

Last updated: May 25th, 2023   Contributors: Tine Rostgaard  |  

Finland

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 (https://stm.fi/en/coronavirus-vaccines). Rates of vaccination by age can be found at (https://www.thl.fi/episeuranta/rokotukset/koronarokotusten_edistyminen.html).

Last updated: November 23rd, 2021

France

In late 2020 priority for vaccination was given to older people residing in collective housing and vulnerable people working there – following recommendations from the High Health authority. Vaccination is free. The 2nd phase addressed those over 75, then 65-74, then health professionals in health and social care over 50, and/or with comorbidities.

To accelerate coverage, a “health pass” was introduced for all people over 17 from July 2021, and for all people over 12 from September 2021. The health pass is required for access to cultural spaces, bars and restaurants, cinemas, and transport, as well as for access to health and social care facilities. The pass is valid if a person has a full vaccination cycle according to the French government (n.b. in France, this includes people with antibodies and a single dose) or a negative test of less than 24 hours. As of 15 December 2021, the “health pass” for those over 65 will not be valid without a booster dose. This will apply for those aged 18-65 from 15 January 2022. In January 2022 Ministers will vote on a law to make the “health pass” into a “vaccine pass”, where negative tests would no longer be accepted as sufficient. The possibility of making the “vaccine pass” a requirement in work and businesses is currently being debated, although unions are strongly opposed to this.

Covid-19 vaccination is mandatory for health and social care staff since 15^th September 2021. This follows a precedent from 2005/6, where 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.

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. Where staff are not vaccinated, they must be ‘very frequently’ tested. 92.9% of staff in care homes have also had at least one dose of vaccine, and approximately 92.2% have had a ‘full’ vaccination cycle. 36.4% have had their booster dose. In September 2021, estimates suggested around 5% of domiciliary care staff had not been vaccinated, but data are limited.

As of 20 December 2021, 92.9% of residents in care homes and long-term care facilities have received a full dose cycle of vaccination, and 64.8% have received their booster dose. The booster campaign in long-term care facilities has been underway since August 2021 and was seen to be more straightforward than the previous campaigns with a high uptake from residents, however fewer staff have been available to facilitate roll-out. Numbers presented by the Minister for Care are higher, claiming that more than 80% of care home residents have received  their booster dose.

A study by the French Directorate of Research and Statistics (DREES) published in November 2021 has looked at the impact of vaccination on infection rates in care homes. They found that a 10 percentage point increase in vaccine coverage among care home residents has led to a reduction of around 20% in the number of confirmed COVID-19 cases. A similar impact has been observed for single-dose vaccinated residents, however the reduction in number of cases is around 10 times smaller. In France, the uptake of the vaccine among residents was much higher in early 2021 than among staff and the authors posit this has made a difference: the number of infection episodes where only staff have been infected has increased from 15% in June 2020 to 60% in June 2021. It is worth noting other factors may have impacted on these results, including restrictions on visiting in early 2021, turnover in residents, and local infection rates.

Last updated: December 21st, 2021   Contributors: Camille Oung  |  

Germany

COVID-19 vaccination rollout:

Germany’s vaccination strategy has been described here (Lorenz-Dant, 2020). As of 21 December 2021, it is estimated that 70.5% of the general population had received their basic immunisation against COVID-19 and 33.8% had also received a booster (Impfdashboard.de, 2022).

Progress has been relatively slow, but most people living in residential care setting had received the first dose by mid-February 2021 (Lorenz-Dant & Ettelt, 2021). Ongoing progress is reported through the vaccination dashboard (Impfdashboard.de, 2022). However, the dashboard only reports estimates, as a reliable monitoring system is not in place in Germany.

Systematic monitoring of vaccination in residential care facilities was only introduced in October 2021, based on a nationwide sample of care homes and Bavarian monitoring data (n = 1003 facilities). A first report indicates that in October 2021 on average 89.3 % of all residents in care homes and nursing homes had received their basic immunisation and 48.7% had received a booster. However, large variations between different residential care facilities were also reported with individual rates ranging between 28% -100% for the basic immunisation and 0% to 100% for booster vaccinations (Robert Koch Institut, 2021).

According to the same report, on average 81.1% (range: 20% – 100%) of staff in residential care facilities had received their basic immunisation in October and 23.4% (range: 0% – 100%) had received a booster (Robert Koch Institut, 2021).

Unlike in the earlier phases of the vaccination rollout, older persons or residents of residential care facilities are not prioritised to receive booster immunisations. While vaccinations to residential care facilities are still usually organised by the respective state or municipal authorities, persons cared for in their own homes have to rely on their primary care physicians to prioritise them or compete for appointments at vaccination centres in those Länder where they still exist.

Even during the initial rollout, persons cared for in their own homes had to visit a vaccination centre or their personal primary care physician for their immunisation in many Länder, as mobile teams were only deployed to these individuals in some Länder (such as Berlin). This is the case even if a home care service is employed, as Registered Nurses in Germany are not allowed to administer vaccinations independent from a physician. Restricted mobility as well as impaired social, cognitive and financial resources can impede access to the vaccination centres or arrangement of appointments with the individual’s physician. 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 meant that many people with disabilities living independently had long waiting times for access to vaccines as they fell 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 power as older people (Deutschlandfunk.de, 2021).

Mandatory vaccination for Long-Term Care staff

Early in 2021, there was some debate about introducing mandatory vaccination for health and LTC workers, but the Government had then decided against it. With the fourth wave of the COVID-19 pandemic in Autumn 2021 that also led to a resurgence of cases and fatalities in residential care facilities and a growing debate around low vaccination rates among employees in residential care facilities, the debate resurfaced. The newly elected Federal Parliament on 10 December  2021 introduced mandatory COVID-19 vaccinations for all employees at hospitals, residential care facilities and providers of community care services coming into effect on 15 March 2022.

On 10 December 2021 the Federal Parliament also limited access to public transport to persons who are vaccinated or who have recovered from COVID-19 or who can provide a current negative lateral flow test. The same applies to all work places where employers have to provide lateral flow tests to employees. Some states have also limited access to restaurants, retail, gyms and other venues to persons who can provide proof of vaccination or recovery from COVID-19.

References

Deutschlandfunk.de (2021) Coronavirus – Menschen mit Behinderung fühlen sich im Stich gelassen. Available at: https://www.deutschlandfunk.de/coronavirus-menschen-mit-behinderung-fuehlen-sich-im-stich-100.html (Accesse 11 February 2022).

Impfdashboard.de (2022) Wie ist der Fortschritt der COVID-19-Impfung? Aktueller Impfstatus. Available at: https://impfdashboard.de/ (Accessed 11 February 2022).

Lorenz-Dant (2020) A brief overview of the current German Covid-19 vaccination strategy. Available at: https://ltccovid.org/2020/12/18/a-brief-overview-of-the-current-german-covid-19-vaccination-strategy/ (Accessed 11 February 2022).

Lorenz-Dant & Ettelt (2021) Roll-out of Sars-CoV-2 vaccination in Germany: how it started, how it is going. Available at: https://ltccovid.org/2021/02/09/roll-out-of-sars-cov-2-vaccination-in-germany-how-it-started-how-it-is-going/(Accessed: 11 February 2022).

Robert Koch Institut (2021) Monitoring von COVID-19 und der Impfsituation in Langzeitpflegeeinrichtungen STAND DER ERHEBUNG SEPTEMBER BIS OKTOBER 2021 Durchgeführt vom Robert Koch-Institut (RKI) Bericht vom 15.12.2021. Available at: https://www.rki.de/DE/Content/Infekt/Impfen/ImpfungenAZ/COVID-19/Bericht1_Monitoring_COVID-19_Langzeitpflegeeinrichtungen.pdf?__blob=publicationFile (Accessed 11 February 2022)

Last updated: February 12th, 2022   Contributors: Thomas Fischer  |  

Hong Kong (China)

COVID-19 vaccine and booster doses roll-out

On the 8th April 2022, the Hong Kong Government announced that persons aged 60 or above who have received three doses vaccine may receive the fourth vaccine dose at least three months after their last dose. This additional dose is recommended for older people living in the community as well as those living residential care settings.

Measures to increase COVID-19 vaccination uptake among people using and providing Long-Term Care 

Providing at home vaccination for people who are house-bound

Since the 31st March 2022, the Hong Kong Government have started home vaccination trial to provide a door-to-door COVID-19 vaccination service for citizens aged 70 or above who have not yet been vaccinated and people who are unable to leave home for vaccination due to illness or physical disability.

Considerations of making COVID-19 vaccinations mandatory among LTC staff and residents

On the 1^st May 2021, following discussions with the governments of Philippines 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 https://www.chp.gov.hk/en/features/21702.html. 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 https://www.covidvaccine.gov.hk/pdf/RVP_DoctorsGuide.pdf.

Mandatory vaccination for people moving into care homes

The Hong Kong Government announced on the 4th February 2022, that from the 14th March onwards, all persons newly admitted to the care homes must have received at least the first dose of a COVID-19 vaccine, unless COVID-19 Vaccination Medical Exemption Certificates is issued by doctors.

Last updated: April 11th, 2022   Contributors: Cheng Shi  |  

Iceland

As of 23 November 2021, 621,821 doses of vaccine have been given in Iceland. This represents double vaccination of 79% of the entire population, or 89% of Icelanders aged 12 years and older. In addition, 31% have received a third dose.

Source:

Low LF, Feil C, Iciaszczyk N, Sinha S, Verbeek H, Backhaus R, Fadnes Jacobsen F, Hulda Tómasdóttir Þ, Ayalon L, Dixon J and Comas-Herrera. (2021) Care home visitor policies: a rapid global scan of current strategies in countries with high vaccination rates. International Public Policy Observatory and LTCcovid.org.

Last updated: November 29th, 2021

India

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

(Sources: https://www.bloomberg.com/news/articles/2021-02-24/india-to-start-giving-covid-19-shots-to-the-elderly-at-a-cost; https://www.straitstimes.com/asia/south-asia/indias-covid-19-vaccination-for-senior-citizens-launches-to-relief-and-confusion).

Last updated: September 7th, 2021

Ireland

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 (https://www.carealliance.ie/userfiles/files/CAI-C19Vaccine_Position_Paper.pdf).

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 (https://www.hiqa.ie/sites/default/files/2021-04/International_review-HCPs_who_do_not_avail_of_vaccination.pdf).

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 (https://www.hiqa.ie/sites/default/files/2021-04/Advice-to-NPHET_HCPs-who-do-not-avail-of-vaccination.pdf). 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.

Source: https://ltccovid.org/2021/05/25/national-discussions-on-mandatory-vaccination-among-long-term-care-staff-in-23-countries-ltccovid-international-overviews-of-long-term-care-policies-and-practices-in-relation-to-covid-19-no-1-may/

Last updated: September 7th, 2021

Israel

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.

Some studies of how successfully the vaccination program is within residents of LTCF and geriatric hospitals as well as the LTC workforce have been published and some are underway. A recent study showed evidence of the high effectiveness of the BNT162b2 COVID-19 vaccine (Biontech/Pfizer) in preventing the acquisition of SARS-CoV-2 infection within the LTCF workfoce. The researchers conclude that the rapid deployment of Covid-19 vaccines among the LTCF workforce and residents of LTCFs should be a high priority globally to reduce fatalities and transmissions of the virus. Another 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.

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 has not been 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. As already noted, currently, 4,056,586 people have received  the third jab.

Last updated: December 5th, 2021   Contributors: Shoshana Lauter  |  LIAT AYALON  |  

Italy

On December 12th, 2020 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. There was also 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 made a major push to accelerate vaccination rates up to 600,000 per day in March 2021.

In March 2021, Covid-19 vaccination became mandatory for health professionals working in health and in LTC settings, including GPs, nurses and pharmacists who are deployed in social care settings. Mandatory vaccination concerned only clinical staff. Those who refuse cannot have their employment terminated. 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 are no administrative data over the vaccination rate among LTC staff and users, but a recent study from the Ministry of Health on a sample of LTC facilities shows a sharp decrease in the number of new cases and of deaths after the launch of the vaccination campaign.

At present, 85% of people aged 12 and more have received two doses from the vaccine, and the Government is pushing the booster rollout.

Mandatory vaccination policies for staff and visitors 

In October 2021 mandatory vaccination also extended to care and administrative staff working in LTC settings, although there is lack of clarity over who is responsible for to monitoring compliance.

From December 30th 2021 nursing home visitors need to have either a “super green pass” (two doses or a booster, or two doses and a negative test).

Last updated: February 1st, 2022   Contributors: Elisabetta Notarnicola  |  Eleonora Perobelli  |  

Japan

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 (https://www.theguardian.com/world/2021/jan/28/japan-faces-olympian-task-slow-start-covid-vaccinations). Japan also faces logistical difficulties in roll out of the Pfizer vaccine in that it lacks sufficient syringes to deliver it (https://www.theguardian.com/world/2021/feb/10/japan-pfizer-vaccine-doses-wrong-syringes). There do not appear to be plans to prioritise people who live in care homes.

Last updated: September 7th, 2021

Kenya

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) https://amref.org/coronavirus/vaccine/) 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.

(Source: https://ltccovid.org/2021/05/25/national-discussions-on-mandatory-vaccination-among-long-term-care-staff-in-23-countries-ltccovid-international-overviews-of-long-term-care-policies-and-practices-in-relation-to-covid-19-no-1-may/)

Last updated: September 7th, 2021

Malaysia

Vaccination overview

Vaccines were rolled out during the Ministry of Health’s National COVID-19 Immunization Plan; a framework describing three phases with an aim to vaccinate 80% of the population and achieve herd immunity by February 2022. In the first phase of vaccination, priority was given to frontline staff, followed by vulnerable and high-risk groups – including elderly people (Hashim et al., 2021).

Vaccination rollout in care homes and the LTC community

Information on the vaccination rollout in Malaysia has not been made publicly available. Due to the delay in vaccination at care homes, most care home residents had received their vaccines through a separate individual vaccination route through vaccination centres, facilitated either by family members or care home staff. It is impossible to tell, therefore, how many care home residents eventually had been vaccinated as these would not be recorded as care home residents. The vaccination rate is high in Malaysia with 97.6% of all its adult population reported to be fully vaccinated by 28 December 2021.

Booster/third doses:

As care homes were not prioritized for initial vaccines, the policy of only boosting at 6 months meant that care homes residents who received vaccines at their homes would not yet be due their booster shots (as of December 2021). However, the many who took matters into their own hands and received their vaccines through individual efforts during Phase 2 of the national vaccination programme in May and June 2021 would now have been offered their booster shots. Empirical reports have suggested poorer uptake for booster shots.

Impact of the COVID-19 vaccination on care home infections and deaths:

There is no available data on the impact of the vaccination on care home infections and deaths. Although the number of deaths from care homes have almost certainly seen a significant reduction since August 2021 (when the number of cases nationally also started coming down), this has been largely attributed to high vaccination uptake. The initial delay in vaccine roll out was attributed to a lack of vaccine availability.

Policy in relation to mandatory vaccination for LTC Staff and visitors to care homes

There is no mandatory vaccination policy for users or providers of LTC. However, there is a mandatory vaccination policy for civil servants, with those who do not comply being asked to resign from their posts. With this severe policy, it is likely that care home owners and managers are likely to have a similar approach to their staff.

With thanks to Professor Tan Maw Pin

References:

Hashim, J. H., Adman, M. A., Hashim, Z., Mohd Radi, M. F., & Kwan, S. C. (2021). COVID-19 Epidemic in Malaysia: Epidemic Progression, Challenges, and Response. Frontiers in Public Health, 9, 247. https://doi.org/10.3389/FPUBH.2021.560592/BIBTEX

Last updated: February 17th, 2022

Netherlands

National COVID-19 vaccination coverage and booster rollout

As of 2nd January 2022, 86.0% of people over the age of 18 have completed the basic vaccination for COVID-19 in the Netherlands, while 89.1% have had at least one dose. With regard to people over the age of 12, 87.4% have had at least one dose, while 84.4% are fully vaccinated. With regards boosters/third doses, according to the RIVM (national institute for public health and environment), Dutch inhabitants are invited by the Municipal Health Service (in dutch ‘GGD’) for their booster vaccine in order of birth year (oldest first). By the 2nd January 2022, 32.0% of all over 18 y/o have received a booster dose.

The website of national organisation for 25 national Municipal health services (GGD’s) and Medical Aid Organizations (GHOR’s) in the regions announces that by the 4th of January 2022, all 18y/o or older, who have been vaccinated or got COVID-19 at least 3 months ago, can now plan an appointment to receive a booster vaccine within the coming weeks.

Vaccination among people living in care homes and staff

In the Netherlands, as in many other countries, care home residents and staff were among the first to be vaccinated against COVID-19. The first residents were vaccinated on 18 January 2021. After residents had been fully vaccinated, COVID-outbreaks and deaths in care homes declined.

According to the website of professional association for carers and nurses ‘V&VN’, the booster vaccination for healthcare workers was to start on the 19th November 2021. This had been planned for December but, due to high rates of COVID-19 related absences for nurses and carers, the Ministry of Health, Welfare and Sports decided to start earlier.

Hospitals vaccinate their own employes, ambulance staff, employees of rehabilitation institutions and categorical institutions (such as asthma clincs, orthopedic clinics), general practitioners and their employees.

Employees in the other care sectors, after invitation from RIVM, can visit the GGD (municipal health service) locations to receive their booster vaccine. Healthcare institutions can also choose to provide the booster to their employees themselves.

Measures to increase vaccination uptake among staff working in the long-term care sector

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 has decreased over time. However, there are no hard figures for vaccination coverage in healthcare, because the standards for privacy protection applicable in the Netherlands also apply to nurses and carers.

This factsheet (in Dutch) provides an overview of the strategies that long-term care organisations have used to improve the willingness of staff to take up COVID-19 vaccinations.

Last updated: January 6th, 2022   Contributors: Lisa van Tol  |  

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: https://ltccovid.org/2021/05/25/national-discussions-on-mandatory-vaccination-among-long-term-care-staff-in-23-countries-ltccovid-international-overviews-of-long-term-care-policies-and-practices-in-relation-to-covid-19-no-1-may/)

Last updated: September 7th, 2021

Norway

As of 23 November, Norway’s single vaccination rate for people aged 18 and over is 91.7%, while the double vaccination rate is 87.6% (Norwegian Institute of Public Health, 2021).

Care home residents were the first to be vaccinated in Norway, followed by healthcare staff in direct contact with patients. Presently, persons 65+ and people in a vulnerable health condition are receiving their third dose, aimed to be completed by the end of 2021.

Source:

Low LF, Feil C, Iciaszczyk N, Sinha S, Verbeek H, Backhaus R, Fadnes Jacobsen F, Hulda Tómasdóttir Þ, Ayalon L, Dixon J and Comas-Herrera. (2021) Care home visitor policies: a rapid global scan of current strategies in countries with high vaccination rates. International Public Policy Observatory and LTCcovid.org.

Last updated: November 29th, 2021   Contributors: Elisa Aguzzoli  |  

Pakistan

Although older people are a priority group for vaccination, progress to date has been relatively slow. By May 2021, only 1.7 per cent of the population had received at least one dose. To date (January 2022), 52% of the eligible population has been vaccinated (Ministry of National Health Services and covid.gov.pk).

Last updated: January 27th, 2022   Contributors: Daisy Pharoah  |  

Poland

Vaccination priority was given to older people, residents of long-term care facilities, medical and care personnel, and groups facing the risk of severe development of the disease due to the existence of other health risks (e.g. cancer). By mid-June 2021, over 60% of the people age 60 + received at least one dose of the vaccine, a higher share of people aged 70-79 were vaccinated (about 78%) than those aged 80+ (just under 60%) (source: Ageing policies – access to services in different EU Member States; Szczepienie przeciwko COVID-19 Gov.pl).

Last updated: November 24th, 2021   Contributors: Joanna Marczak  |  Agnieszka Sowa-Kofta  |  

Republic of Korea

COVID-19 vaccine rollout in care homes

By the 13th September 2021 approximately 99.9% of those eligible for the vaccine in Long-Term Care Hospitals (LTCHs) had received the first dose and 90.0% the second dose. In Long-Term Care Facilities (LTCFs), 99.9% had received the first dose and 91.8% the second dose (Central Disease Control Headquarters data).

Booster rollout in care homes

The Central Disease Control Headquarters announced that the rapid rollout of booster shots for LTCF staff and residents would be a priority. Currently 466,648 people are eligible for the booster shot in LTCF and LTCHs and as of the 26th November 2021, 285,909 have received a third dose of COVID-19 vaccination.

This vaccination effort has been supported by personnel from the Ministry of Defence (60 military nurses) to carry out the booster shot vaccinations in LTCHs and LTCFs.

There are no published statistics allow to separate numbers of staff and residents who have been vaccinated.

Impact of COVID-19 vaccination on mortality in care homes

The Central Disease Control Headquarters analysed vaccination, infection, and severity data from seven mass infections in high-risk facilities (LTCH, LTCF, adult day care) to identify associated factors. They found that the severity of infection was higher among non-vaccinated people compared to those who were vaccinated. Analytic results suggest a 75% protective effect of vaccination on severity.

Last updated: January 26th, 2022   Contributors: Hongsoo Kim  |  Jae Yoon Yi  |  

Singapore

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) (https://www.moh.gov.sg/news-highlights/details/progress-of-covid-19-vaccination-programme/).

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.

The Agency for Integrated Care supports people who are housebound and need to be vaccinated at home or who need escorting or transported to vaccination centres.

Last updated: December 17th, 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.

Source: https://ltccovid.org/2021/05/25/national-discussions-on-mandatory-vaccination-among-long-term-care-staff-in-23-countries-ltccovid-international-overviews-of-long-term-care-policies-and-practices-in-relation-to-covid-19-no-1-may/

Last updated: September 7th, 2021

Spain

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 (https://www.mscbs.gob.es/profesionales/saludPublica/prevPromocion/vacunaciones/covid19/docs/COVID-19_Actualizacion6_EstrategiaVacunacion.pdf).

Last updated: September 7th, 2021

Sweden

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 (https://www.krisinformation.se/en/hazards-and-risks/disasters-and-incidents/2020/official-information-on-the-new-coronavirus/vaccine-medicine-and-treatment).

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 (https://www.vilans.nl/vilans/media/documents/publicaties/covid-19-in-long-term-care-until-june-2021.pdf).

Last updated: September 7th, 2021

England (UK)

Latest data on COVID vaccinations among people using and providing social care in England

Detailed data on COVID vaccinations is published weekly by NHS England. By December 16 2021, it was reported that 95% of all eligible residents and 94.2% of staff in all care homes had been given a second COVID-19 vaccine dose. 77.9% of residents and 33.6% of care home staff had had a booster.

Among social care staff working for registered providers in other settings, including domiciliary care, 81.2% had two vaccine doses and 23.1% had had a booster.

For the 8.5 million people aged 16 to 64 who are identified as “at risk” or as carers, 83.6% had had two doses and 50.1% had had a booster. This group includes people with intellectual disabilities.

Vaccination rollout and social care

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 announced 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. 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 intellectual 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 (PCNs) 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.

On January 26, the National Care Forum (NCF) published the results of 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.

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.

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

From September 16, 2021, the government began rolling out booster vaccinations to those in JCVI cohorts 1 to 9 who received their second dose more than 6 months ago, and boosters are now being delivered and administered to older adult care home residents and staff within their homes.

Policy on mandatory vaccinations:

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 August 4, it was announced that full COVID-19 vaccination would be mandatory for staff working in care homes by November 11, despite it being reported by the Guardian that there were concerns from providers that this may worsen existing staff shortages. Analysis of data reported by the Department of Health and Social care indicated that as of 26th October 2021, 39% of agency staff and 10% of directly employed staff deployed in care home settings had not yet received two doses of a covid-19 vaccine (Skills for Care, 2021).

Published on November 3, 2021, the Adult social care: COVID-19 winter plan 2021 to 2022 sets out the key elements of national support available for the social care sector for winter 2021 to 2022. This will provide £388.3 million in further funding to support IPC, testing, and vaccination uptake in adult social care settings. Following consultation, the government announced on November 9, 2021, that all frontline NHS and care staff, including volunteers, will also be required to be fully vaccinated against COVID-19 from April 1, 2022. From November 11, 2021, being fully vaccinated against COVID-19 will be a condition of deployment for people working or volunteering in care homes, unless they are exempt. These requirements will apply to all CQC-registered care homes in England that provide accommodation for persons who require nursing or personal care.

On the 31st January 2022, the Health and Social Care Secretary announced that the legal requirement for health and social care staff to be double vaccinated to work would be removed, subject to consultation and approval by Parliament. The announcement justifies this changed based on high levels of vaccination and boosters in the population and lower levels of hospitalisations and mortality. Health and social care professionals are still urged to get vaccinated and boosted but it is no longer mandatory. The care home sector has estimated that mandatory vaccinations contributed to over 30,000 care workers leaving the sector, at a time of acute workforce shortages (see section on workforce shortages during the pandemic).

References:

Skills for Care, (2020). The state of the adult social care sector and workforce in England. Retrieved from: skillsforcare.org.uk. Accessed on 24/03/2022

Last updated: March 24th, 2022   Contributors: William Byrd  |  Nina Hemmings  |  Chris Hatton  |  Adelina Comas-Herrera  |  

Scotland (UK)

COVID-19 vaccination rollout in the long-term care sector

Care home residents were prioritised for boosters, with teams going in to care homes to vaccinate residents and available staff. Thereafter staff were invited to attend other locations in the community to receive their booster vaccination.

By the 29th December 2021, Public Health Scotland estimated that 89.4% of all care home residents in Scotland had received a booster or 3rd dose and 95.1% had had at least two doses. 63.6% of staff had had the booster (or 3rd dose) and 88.6% had had two doses.

Calculating the share of care home residents who have received vaccinations is difficult as there is no complete method to identify all people who live in care homes in Scotland using routine data sources, or staff working in care homes.

Policy on mandatory vaccination for long-term care staff

The UK Government has mandated that all care home staff in England are required to be fully vaccinated. Scottish Care released a statement in June 2021 to say that this mandate had little relevance in Scotland since Public Health Scotland figures released up until 15^th June 2021 showed that a very high percentage of care home staff had already been fully vaccinated. It is not Scottish Government policy to make vaccination mandatory for care home staff.

Last updated: March 24th, 2022   Contributors: Jenni Burton  |  David Henderson  |  David Bell  |  Elizabeth Lemmon  |  

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.

Due to the raising infections and deaths in nursing home facilities in Omicron wave in the US, there has been a renewed push to get more residents and staff members vaccinated and boosted. In December 2021, a federal appeals court revived in 26 U.S. states a COVID-19 mandate issued by President Biden’s administration requiring healthcare workers to get vaccinated if they work in facilities that receive federal funding.

Last updated: January 18th, 2022

Vietnam

In early 2021, the Vietnamese Ministry of Health set out a target of 150 million doses to vaccinate 75% of the population and achieve herd immunity by early 2022. A rollout plan was issued which included 16 priority groups. These groups included medical workers and those who participate in COVID-19 prevention and control work, people with chronic conditions, people aged 65 and older, poor people, and social policy beneficiaries. No mention is made of people who provide long term care (although notably these are mainly informal carers / family members of older people) (source: CCI France Vietnam).

For those who were unable to go to health facilities to receive the vaccine (for example, due to old age or disability) in some areas, vaccination medical teams did home visits (source: WHO).

To date (end of December 2021), almost 80% of the total population have received at least one dose of the vaccine and around 58% are fully vaccinated (source: Our World in Data). On December 24^th 2021, the Ministry of Health declared that they aim to complete the administration of booster shots by the end of the first quarter of 2022 (source: Reuters).

There is no information available (in English) on the number of vaccines different segments of the population (for example, elderly people) have received.

Last updated: January 3rd, 2022   Contributors: Daisy Pharoah  |