For Virginia Mason Franciscan Health, a medical centre in the US state of Washington, 18 October 2021 was the day of reckoning. Ten weeks earlier, the centre had declared that all of its staff would be required to be vaccinated against Covid-19 by that date in order to protect both those working at the medical centre and their patients from the disease. It was a potentially risky requirement, given the shortages of medical staff and the resistance to vaccination rocking other parts of the US medical sector.