Gary Payinda: Doctors at the pointy end of Covid conundrum


A doctor arrives for work on the cancer ward. She’s had a bad cough for three days and has a high fever. She probably has pneumonia but she chose to go to work anyway. Would we condemn her actions as irresponsible, a potentially life-threatening risk to a ward full of patients with compromised immune systems? Of course we would. As a health professional, bringing infection to susceptible patients is just plain careless. Reprehensible, really.

Another doctor on the same ward has made a decision to skip the Covid vaccine because he’s young and healthy and low-risk for Covid complications or death. He would have got the vaccination if it was required for work, but it isn’t. It’s “voluntary”. He feels perfectly healthy. Strong as an ox. He doesn’t know it but he’s got Covid and has been spreading it from room to room, patient to patient for the last three days. Some of the patients he’s exposed will get sick and some will die. For these vulnerable people, it wasn’t a “voluntary” exposure.

Similar logic applies to both scenarios: if we doctors can avoid bringing a potentially fatal infection to our vulnerable patients, we must. Not “elect” to do it, not “try” to do it, not “aim” to do it; but absolutely get it done.

Currently the doctors’ unions, nurses’ unions, and district health boards are debating how to achieve high levels of vaccinations for health professionals. “Mandatory” is a dirty word. “Voluntary” sounds so much nicer.

But facts are facts. Covid killed more than two million people worldwide but has now been reduced to a vaccine-preventable disease. Most reasonable people would agree that healthcare workers shouldn’t be allowed to willingly expose their vulnerable patients to infection when effective prevention exists. We wouldn’t let surgeons operate on patients without sterile gloves. We shouldn’t let doctors see and treat patients without being vaccinated.

But isn’t there a less pushy method than mandating healthcare worker vaccination? Can’t nurses just isolate at home if they’re high-risk for Covid and can’t doctors quarantine at home if they’re feeling sick? If only it was that easy.

Around 20 per cent of people with Covid are completely asymptomatic, meaning they will never feel sick even as they’re infecting those around them. If they’re a healthcare worker, this is especially dangerous, because they’re silently spreading disease to the vulnerable. It’s a nightmare scenario but it is preventable.

Worldwide, we’re already seeing vaccination result in fewer cases of Covid, along with lower viral loads in infected patients and milder symptoms in those who do become ill. Patients are less infectious and less likely to develop severe disease or die. It’s a win-win situation.

To the doctors, dentists, nurses, and healthcare assistants who still don’t want to be vaccinated in the face of all this, I say fine. If you don’t want the jab, don’t get it. Just stay away from patients – and colleagues who treat patients.

In the debate over mandatory vaccination, it’s evident that some in our society are keen to emphasise private health gains over public health benefits. This is myopic. Infectious disease is a shared burden. For a treatment to be truly effective, it must leave no gaps or the virus will come back even stronger. Infectious disease control must not be about me, but about us.

What would a public health vaccine success look like? It would be 90 per cent of our society getting vaccinated so that the 10 per cent who cannot get vaccinated due to medical reasons can remain alive and healthy. Public health success – societal success – looks like all of us understanding that sooner or later we will all be “vulnerable”.

One-third of New Zealanders have chronic heart disease, lung disease or diabetes. Two-thirds of Kiwis are overweight or obese. Add in pregnancy, infancy, cancer treatment, immuno-compromise or recent surgery and you’re talking about millions of New Zealanders who are at-risk. Throw in poverty and ethnic disparities and you’ll soon see that helping the “vulnerable” means helping the majority of our society.

So doctors, unions, lawyers, DHBs: do the right thing. Honestly admit the facts. Avoiding or postponing healthcare worker vaccinations will ultimately increase the Covid death toll in our hospitals, clinics and communities. There’s no theoretical excuse that trumps actual patient deaths.

Vaccination will save patients’ lives. Let’s get on with it. Let’s achieve a safety blanket of near-total coverage, with exceptions only for (real) medical contraindications.

Healthcare workers: Get vaccinated. Or if you won’t, have enough respect for your patients’ health to step away from the bedside and hang up your stethoscope. Find work that won’t risk patient health. Working in healthcare – being allowed into patients’ most private and vulnerable moments – is a privilege, and vulnerable patients deserve better than to have a health professional who is a threat to their health.

• Dr Gary Payinda works as an emergency medicine and rescue helicopter doctor in Auckland and Whāngārei. He will be vaccinated against Covid as soon as it becomes available to healthcare workers.

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