Prerequisites for mandatory COVID‐19 vaccination
Is the mandate legal?	State and territory public health orders can require certain employees to be vaccinated. Where a public health order is not in place, the Fair Work Ombudsman (https://coronavirus.fairwork.gov.au/coronavirus‐and‐australian‐workplace‐laws/covid‐19‐vaccinations‐and‐the‐workplace/covid‐19‐vaccinations‐workplace‐rights‐and‐obligations) states that individual employers’ mandates are more likely to be considered reasonable where affected staff are Tier 1 or Tier 2 workers (eg, health care workers), due to the increased risk of contracting and transmitting coronavirus to at‐risk populations.
Is the burden of disease high enough?	Areas with outbreaks of COVID‐19 present a high burden of disease, which pose a threat to both the worker and those that they interact with or care for, particularly when many patients are likely to be unvaccinated.
Is the vaccine safe?	Workers should be able to access the safest vaccine. Currently, the AstraZeneca (Vaxzevria), Pfizer (Comirnaty) and Moderna (Spikevax) vaccines currently approved in Australia are generally very safe. However, in view of the low risk of thrombosis with thrombocytopenia syndrome associated with Vaxzevria, it is preferable that workers under a mandate can access their vaccine of choice. On 28 August 2021, the federal Minister for Health announced that government had finalised details for a COVID‐19 Vaccine Claims Scheme to compensate those who suffer injury and loss of income due to their COVID‐19 vaccine (https://www.health.gov.au/ministers/the‐hon‐greg‐hunt‐mp/media/no‐fault‐covid‐19‐indemnity‐scheme).
Do the vaccines reduce transmission?	A vaccinated health care worker is less likely to acquire a SARS‐CoV‐2 infection and, if infected, is less likely to pass on the virus, according to current evidence. 5
Is vaccine supply sufficient and accessible?	All affected staff should have had prior opportunity to access vaccination without facing any barriers. The Fair Work Ombudsman advises that employers should cover employee travel costs for vaccination and time off to receive the vaccine during work hours.
Have other less restrictive measures been tried first?	In certain health care settings, it may be sufficient to require documentation of protection.
Procedural recommendations
Does the mandate penalise the poor unfairly?	Where access remains difficult, some workers will need more help to be vaccinated. Employers have a duty of care to ensure all possible barriers are removed for all staff, irrespective of employment status or role, before imposing requirements. On‐site vaccination should be considered for optimal convenience, or workplaces should provide paid time off for employees to receive a vaccine, particularly those on lower incomes. Certain health care workers may need additional time and resources to address vaccine questions and concerns. This group may include those with lower levels of health literacy and those who come from cultural backgrounds where English is not the first language.
Is there a plan to support those mandating vaccination?	Employers should train and resource staff implementing the mandate. This could include training to support conversations with hesitant staff and advice for those who plan to decline vaccination. Medical exemptions, including consideration of special medical exemptions if applicable, must be available with clear pathways and support. Such staff may need temporary relocation. Workers who lose their jobs as a result of non‐compliance are owed a duty of care from employers to support transition and provide assistance.
Are affected populations considered in planning?	Employers should consider the items above and develop policies in consultation with affected groups, including peak bodies and unions, across all the health care worker groups affected.
Conclusion	A vaccine mandate may be justified for health care workers in situations where they are at high risk of infection and of infecting others who are at greater risk of the severe effects of COVID‐19. This should only occur once sufficient vaccine supply is available and employees have had ample opportunity to access the vaccine. Worker representatives should be consulted on the policy details and implementation.