In the face of government inertia, pressure from civil society has led to action on the procurement of Covid-19 vaccines. It appears that the first Oxford/AstraZeneca vaccines may arrive from the Serum Institute of India by the end of January 2021. This is fantastic news, but the unfortunate reality of the Covid-19 global vaccine roll-out is limited initial supply. Assuming we use the two-dose regimen this vaccine was trialled with, this will mean that an initial 750,000 healthcare workers will receive the vaccine, a little more than half of those targeted. Prioritisation will be required.
According to the national Department of Health, prioritisation of the 1.25 million targeted healthcare workers will depend on their contact with Covid-19 patients. However, despite increasing detail on the planned roll-out, there is little to no mention of where clinically training health sciences students fit into these plans. Should health sciences students be considered healthcare workers and prioritised for vaccination?
Clinically training health sciences students occupy an unfortunately overlooked blind spot within the hospital and regulatory setting. They are integral members of clinical teams, and are often actively involved in patient management. In teaching hospitals, medical students examine patients, draw blood, assist and perform basic procedures (generally under the supervision of senior members of staff).
At the University of Cape Town (UCT), for example, medical students have participated in Covid-19 electives – working in contact tracing or testing centres. Moreover, as the second wave places increasing pressure on hospitals and testing laboratories, the private health sector has started recruiting clinical health sciences students to work in their facilities.
Whether they are in their required clinical rotations or volunteering, these students have similar exposures to qualified healthcare workers; they are exposed to the same occupational settings and hazards when carrying out their duties and performing procedures. Even prior to the Covid-19 pandemic, students have been known to be at high risk for infectious diseases such as tuberculosis.
Although official university policies have been to avoid placing students in areas with known Covid-19 patients, the reality is that the clinical environment is fluid: the status of undiagnosed patients is often not known, and only found out after a student or healthcare worker has actively interacted with a patient. UCT has reported that at least 12 health sciences students had contracted Covid-19, and a final-year medical student from Stellenbosch University tragically died from the disease.
Despite their labour and exposure, students do not have formal contracts with the facilities in which they work. Therefore, they have little formal legal or regulatory protection. Moreover, as they are not employees of the facilities in which they train, there is uncertainty on where they sit in terms of occupational safety regulations. As a result, they are largely reliant on their higher education institutions for support. For example, personal protective equipment provision for medical students was largely a responsibility of educational institutions, rather than provincial health departments.
Clinical training is experiential, and cannot be performed remotely. It is in the clinical environment that student procedural skills are developed, their knowledge contextualised and their clinical acumen honed.
Unfortunately, this is also where they will be at increased risk of contracting Covid-19. While students are typically young and low-risk, infected students could act as vectors of Covid-19 within the healthcare setting, potentially putting vulnerable patients at risk. Although the ability of vaccination to prevent infectiveness is still unclear, it is likely that it will provide some form of protection.
Soon, health sciences students will be required to return to the clinical platform, and face the risks of Covid-19, whether they work directly or indirectly with Covid-19. They might also participate in administering vaccines as the national roll-out expands. Adequate training and personal protective equipment provision might mitigate these risks but, ultimately, vaccination will be required.
While we are optimistic that health sciences students are implicitly included in the term ‘healthcare worker’, historical trends and global debate indicate this is not always the case. Health sciences students are important components of the healthcare system, and should be explicitly included in the prioritisation discussion. Failure to do so will represent both a public health failure and a failure to protect future healthcare workers. DM