Sir, following our January 2020 survey assessing vaccine hesitancy amongst dental students,1 the Manchester Undergraduate Dental Research Society distributed another survey in mid-December 2021 about the COVID-19 vaccine mandate. We received 263 responses from 14 UK dental schools, including dentistry and dental hygiene and therapy undergraduate students throughout all clinical and non-clinical years. COVID vaccination status is shown in Table 1 and 85.9% of respondents had received at least one dose.

Table 1 COVID vaccination status in a survey of 263 dental students
Full size table

That nearly a fifth of respondents were not aware of the COVID-19 vaccination mandate was unexpected. We believe that students should be informed about decisions which affect them and that it is the responsibility of dental schools to ensure this.

A total of 69.2% of respondents agreed with the mandate and in a free-text question expressed arguments both in favour and against the mandate. In some cases, students showed a lack of up-to-date knowledge; eg some were not aware that vaccination is also mandatory in the CQC-regulated private sector, nor an awareness that vaccination has shown evidence of reduced transmissibility for some COVID-19 variants.2 This prompts the suggestion that dental schools have an open dialogue regarding vaccines to allow students the chance to express these thoughts whilst receiving evidence-based responses.

The theme of respecting autonomy was raised frequently by respondents and it is certainly pertinent to consider this given our duty as a profession to uphold ethical standards of practice. Autonomy, alongside beneficence, non-maleficence and justice make up the 'Four Principles' - a framework commonly taught to undergraduates for evaluating ethical issues. Much of its appeal lies in its simplicity, but the subtleties of this approach are often lesser known. The concept of Prima facie outlines the idea that the principles are obligatory unless they conflict with each other, in which case only one is binding.3 In this case, therefore, autonomy may not be the dominant principle if supporting it would infringe on the other principles, in this case, beneficence (protection against the virus) non-maleficence (ensuring the wider public are not harmed) and possibly even justice (protection of those who are medically exempt from vaccination).

Results revealed that six students will be refusing the vaccine and thus be withdrawing from their course. Assuming that COVID-19 vaccination will be necessary to enter dental courses, this may have lasting effects on the selection and retention of the future dental workforce.