Covid-19 vaccination should be obligatory for frontline healthcare workers and they should be moved elsewhere if they refused, a group of ethicists said.
The verdict, published in the Journal of Medical Ethics, comes as the UK carries out consultations on whether care-home staff should have mandatory shots.
Italy became the first country in Europe to require vaccines for health workers in March, in a measure it said was intended to protect medical staff.
Meanwhile, Saudi Arabia's government said on Friday that all employees working in the public, private and non-profit sectors must be vaccinated before they can return to the workplace.
The ethicists said making healthcare employment conditional on a vaccine was a reasonable compromise between a voluntary system and measures such as fines or imprisonment.
They said that while unvaccinated healthcare staff could choose to work somewhere else, sick patients had no alternative but to be treated by a medical worker who could pose an infection risk.
“In our view, this strikes the best balance between the various ethical principles at stake,” they said.
The UK said in April that only 53 per cent of care homes met a key threshold for preventing outbreaks, which was for 80 per cent of staff and 90 per cent of residents to be vaccinated.
Some care-home operators had already brought in similar policies, the government said.
“Making vaccines a condition of deployment is something many care homes have called for, to help them provide greater protection for staff and residents in older people’s care homes and so save lives,” UK Health Secretary Matt Hancock said.
“We have a duty of care to those most vulnerable to Covid-19, so it is right that we consider all options to keep people safe.”
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Vaccine requirements stir debate in Europe
The ethicists said it would be acceptable to make vaccines a condition of employment or to move people who were unwilling to be vaccinated.
They rejected more coercive options such as fines, imprisonment or even forcing staff to get a vaccine.
Options rejected as not stringent enough included naming and shaming teams with a low vaccination rate, or requiring dissenters to sign a statement explaining the reasons for their refusal.
“Within healthcare settings, vaccine choices can have even greater ramifications which, when coupled with the seriousness of Covid-19, justify at least a mild form of mandatory vaccination policy,” the ethicists said.
"We believe that this should take the form of conditional employment or conditional professional registration, although temporary redeployment could be adopted if this does not entail significant costs to patients, to vaccinated colleagues and to the healthcare system.”
The UK government said any requirements would not apply to people who have a medical exemption for vaccination.
In Italy, the decree approved by Prime Minister Mario Draghi’s Cabinet provided for dissenters to be suspended without pay for the rest of the year.
It caused controversy among critics of the government who questioned the legality of forcing only some categories of workers into having a vaccine.
In Germany, Bavarian premier Markus Soeder stirred a similar public debate in January when he said that too many care-home staff were refusing vaccines.
But German Health Minister Jens Spahn rejected the idea and Bavaria did not make the shots compulsory.
In Austria, the Health Ministry said there was a moral obligation for healthcare workers to get vaccines but there is no legal compulsion.
“Staff in hospitals and other health facilities who have contact with patients or infectious materials should be vaccinated against preventable illnesses in order to protect themselves and their patients,” the ministry said.
The European Court of Human Rights upheld the principle of mandatory vaccinations last month in a case in the Czech Republic, although it was not specifically about Covid-19.
Mandatory vaccines for children against tetanus, polio and other diseases were fulfilling a legitimate goal of the Czech government, the court said.
