Counties Manukau District Health Board has been grappling with the potential legal and ethical ramifications of dealing with staff who refuse to be vaccinated against Covid-19, a new report shows.
South Auckland has been at the epicentre of the two most recent outbreaks and there has been debate about people in the area getting the jab first.
The Ministry of Health's nationwide vaccination campaign began on 19 February, with border workers and managed isolation and quarantine (MIQ) staff and their household contacts the first to start receiving the vaccine. Non-border frontline healthcare workers are expected to be the next in line.
But how do health providers deal with staff who refuse to be vaccinated?
A report to this week's Counties Manukau DHB meeting shows the issue has been a topic of discussion.
According to the minutes from a committee meeting last month, board member Garry Boles asked what the legal ramifications were for staff who declined the Covid-19 vaccination.
Fellow board member Elizabeth Jeffs said a group representing the human resources divisions of the country's health boards was seeking a legal opinion on the ability of DHBs to require staff to be vaccinated.
"Once this is received, there will be national engagement with union partners and then it will need to go back through the CEOs for an agreed position nationally."
Jeffs said staff who refused the vaccination could be redeployed to other areas where "they are not exposed if that is in everyone's best interest".
The Association of Salaried Medical Specialists (ASMS) is the union which represents many of the doctors working in the country's hospitals.
Executive director Sarah Dalton said the organisation did not support compulsory vaccination of its members.
"While we fully support the roll-out of the vaccine, we do understand some people may decline the vaccination. We don't think employers should dictate whether people should receive it," Dalton said.
She said staff members may have an underlying health condition, or other reasons for refusing to be vaccinated.
Dalton said if the DHB required staff, who refused the vaccination, to be moved to other areas to work it wouldn't be a problem for the association.
"I think if that was deemed appropriate thing to do for everyone's health and safety that would be reasonable. But we would consider that to be the exception rather than the rule. I think the number of frontline staff who refuse the vaccine would be low," she said.
"The bottom line is all staff in hospitals already have to work with PPE and follow good hygiene guidelines due to Covid-19 and we see the vaccine as a further line of defence."
New Zealand Nurses Organisation manager of industrial services Glenda Alexander said it was an issue that was no doubt being discussed by other health authorities around the country.
She said it was not uncommon for nurses to be required to get certain vaccinations.
"But the idea that the DHB would want to force anyone to undergo a medical procedure is a bit out there. It would be better if people did it of their own volition and weren't forced to do it."
Like Dalton, Alexander said she thought the number of DHB staff who would refuse to be vaccinated would be low.
"But at the end of the day we want our members to make the decision on whether or not to get vaccinated on an informed basis and not based on misinformation," she said.
"I think it's much, much better to have people getting it willingly. We don't have enough people in the health workforce to make it a hard and fast rule."
Last month it was revealed that all new employees working for retirement village and aged care provider Arvida Group would need to consent to vaccination against Covid-19, as well as the flu.
The company operates 32 facilities nationwide and employs about 2500 mainly frontline workers. Chief operating officer Jeremy Nicoll said the new requirement was being introduced to protect its 5000 residents, who are considered some of the country's most vulnerable.
Susan Hornsby-Geluk, managing partner at Dundas Street Employment Lawyers, said stories of employers introducing "no jab, no work" policies were already surfacing in the UK.
She said similar policies were likely to become an issue in New Zealand as vaccines became available.
Wellington-based lawyer Chris Scarrott is a senior associate with employment specialists Cullen Law. He said the issue of compulsory vaccination was a hot topic.
"It's certainly come up increasingly in the last month or two, with the vaccine being rolled out it's on a lot of employers' minds," Scarrott said.
Scarrott said the biggest hurdle for employers was the Human Rights Act which would prevent discrimination against someone refusing the vaccination on ethical or religious grounds.
"So it would be quite difficult to enforce compulsory vaccination," he said.
Scarrott said employers could require new employees to agree to be vaccinated as part of their employment contract.
"I think that's a sensible approach for employers. But then the biggest problem is existing employees."
He said one way for employers to get around that was to require employees to show proof they had been vaccinated before entering into an employment agreement.
"It's a lot easier to deal with these things before someone is employed."
But Scarrott said the Human Rights Act would still apply and employers should exercise caution if a prospective employee objects on religious or ethical grounds.
In a statement, Ministry of Health said it was offering the first vaccinations to the country's border and MIQ workforce, followed by the people they live with.
"Over the next few months, we'll continue to expand the vaccine programme to a broader range of people, and by mid-year, everyone will have the opportunity to protect themselves, their whānau and our communities by getting vaccinated.
"Within the month, we will also be expanding our vaccination programme to include approximately 57,000 non-border frontline healthcare workers like GPs, pharmacists and people working in our testing centres, to further protect the health of New Zealanders and help contain the spread of Covid-19."
It said further sequencing and roll-out announcements would be made in due course.
The ministry was keen to highlight that the government has previously announced that the Covid-19 vaccine will not be mandatory and people can choose whether or not to get vaccinated.
"The ministry has a communications and engagement approach to support the vaccine and immunisation programme roll-out, which will focus on providing information to those people who are about to be offered the vaccination.
"The ministry will support DHBs to engage with people that may be hesitant about getting a vaccine."
Local Democracy Reporting is a public interest news service supported by RNZ, the News Publishers' Association and NZ On Air.