The government earlier this year had commissioned a group of doctors, virologists and epidemiologists to submit an opinion on introducing a vaccine mandate. The group had initially suggested making vaccination mandatory for over-50s and healthcare staff but on Tuesday revised this initial opinion in light of new evidence and the changing face of the pandemic.

“Over-50s have the biggest risk of falling severely ill if they become infected,” said Gérard Schockmel, a specialist at the Robert Schuman hospital. Around 30,000 people in that age group have not been vaccinated at all, while another 20,000 are only partially vaccinated.

The expert group warned of the next wave in the autumn, even if we cannot now know what this will look like. “We don’t know what we’re facing,” said Claude Muller of the Luxembourg Institute of Health.

The group produced models based on different variants and their transmissibility, virulence and vaccine effectiveness. For a delta-variant style wave, the group said with a vaccine mandate, including a fourth dose, the number of patients treated in intensive care could decrease 97%. “A vaccine mandate is only justified against a delta-like variant, if there is a booster shortly before the wave,” said Muller.

Under an omicron-style wave--with a variant that is more transmissible but less virulent--cases would drop by 9%. “Reality will lie somewhere between these two extremes,” said Paul Wilmes of the University of Luxembourg. “The impact of the vaccine mandate depends on the variant.”

Political decision

The World Health Organization has recommended a fourth dose for over-60s, hospital staff and individuals who are immunocompromised. Luxembourg last week said it would recommend a fourth dose to over 70s after previously making the extra jab available for older patients and those with pre-existing conditions.

While the expert group in January had firmly urged the government to introduce a vaccine mandate, it now said there are “political considerations” and that it is up to the executive to decide how it will take responsibility. “It’s a duty to be prepared,” said Schockmel.

While an updated vaccine against the omicron variant is under development and should become available in the autumn, the experts said vaccination should not be delayed until then but that booster shots will help provide additional protection before this new formula hits the market.

Healthcare sector

The vaccination rate in the healthcare sector is “excessively low,” said Muller. While nearly three quarters of staff living in Luxembourg are fully vaccinated, less than a third of cross-border healthcare staff have received their jabs. The rate could be higher but with no obligation for employees to reveal their vaccination status, there is a lack of data.

Muller said that with immunity from vaccination waning after about five months, a protection rate of more than 50% would only be temporarily achieved but that this isn’t enough evidence to suggest a sector-wide mandate. The professor said that the group “with a heavy heart” revised its initial position.

“I want to emphasise that we recommend other measures, and they should be taken as seriously as the vaccine mandate,” said Muller. These include the mandatory disclosure by healthcare staff whether they are vaccinated to their employer and an obligatory consultation with a doctor, with a signed declaration that the employee has been informed of the benefits and risks associated with a vaccination.

“It is unacceptable that the right to medical secrecy for a minority of healthcare staff stands above the right to bodily integrity of the persons in their care,” Muller said. The group also recommends that care home residents who refuse the vaccine sign a paper taking responsibility for their risk of infection.

Quicker measures

In the longer term, the group said there should be a law that can require healthcare staff to be vaccinated--not just against coronavirus but also other infectious diseases--as a prerequisite for starting their job. Muller described the situation in the healthcare sector as a “headache”.

Finally, the group also said that the government ahead of the next wave should give itself the tools to make fast decisions. Currently, all pandemic measures must be approved by parliament, a process that can take several weeks although it had been pared down to a matter of days during previous stages of the pandemic.

Policymakers should be able to take decisions from one day to the next, for example to re-introduce a mask mandate, in order to step up protections at shorter notice when the next coronavirus wave hits.