Demonstrators hold anti-vaccination placards at a protest against Covid-19 restrictions and the vaccine mandate in front of Hofburg Palace in Vienna, Austria, 11 December 2021. REUTERS/Lisi Niesner

Government approaches to mandatory vaccination have shifted markedly in the past year. Global Insight assesses the reasons and implications.

The cover feature of the April/May 2021 edition of Global Insight examined the issue of compulsory vaccination. The majority of Western governments were shying away from the idea of introducing ‘vaccine passports’ to access public spaces. Many proclaimed that they would never create two classes of society or discriminate between their citizens. But, less than a year later, those still unvaccinated against Covid-19 are facing an increasing raft of government-imposed restrictions on social life and travel, not to mention access to the workplace or education. So what happened to cause such a marked shift? 

By now medium-term knowledge of the likelihood, type and extent of serious side effects from Covid vaccines is certainly greater, though longer-term data is still lacking. With the passage of time, as ever-growing numbers of people have been vaccinated and with vaccines shown to be highly effective, some of the ‘wait and see’ vaccine-hesitant have decided to jump on board. But it also seems that push factors can be influential. 

In France, a historically vaccine-hesitant country, the introduction of a passe sanitaire (health pass) in the summer of 2021 to access restaurants, cafés and cultural venues led to a rush to book vaccine appointments. Within six months, the double-jabbed percentage of the population had increased from 49 to 89 per cent. Though this naturally includes some willing to be jabbed anyway, there was a significant increase in vaccinations. But what of the remaining vaccine resisters? France is now doubling down on this strategy, with the notorious promise of the French President, Emmanuel Macron, to emmerder les non-vaccinés (politely translated as hassle the non-vaccinated), and the decision to remove the option of testing, rather than vaccination, to access certain public places. 

Mandatory vaccination

The trend to push people towards vaccination is also evident in other countries. For example, Singapore has decided that the unvaccinated should pay their own healthcare costs, while both Greece and the province of Quebec in Canada are imposing a health tax on the unvaccinated. Austria is in the process of passing a law mandating vaccination for all adults from February 2022, which will be the first in Europe, with fines for those who don’t comply.

But are these steps too far? There is already talk of legal challenges to such measures. And it is not clear whether making life uncomfortable will sway the most obdurate, particularly when enforcement of vaccination has been shown, in some instances, to simply increase existing distrust of governments. The World Health Organization (WHO) advises against coercion, recommending measures like the provision of more information, particularly by health workers and other figures respected by vaccine-hesitant communities.  

But in a 2020 report, the WHO noted that scientific facts alone are unlikely to override a decision that may be driven by emotion. In these cases, simple and practical steps are more likely to be effective, such as locating vaccine centres conveniently, proactively contacting the unvaccinated, sending reminder texts of appointments or making vaccination an ‘opt out’, rather than an ‘opt in’, measure.

How many governments can claim to have done the maximum to persuade those hesitant to get the vaccine? They may legitimately argue that in the early days of the pandemic they had their plates full. That excuse is now less viable, yet it is difficult to find muti-faceted campaigns of the type recommended by the WHO to persuade the vaccine-hesitant. Some individuals are so strongly opposed to vaccination that they are willing to relinquish their jobs to protect what they see as their ‘freedom’. Though it may seem counter-intuitive, these people include some health workers. Why would those who witness suffering and treat sickness on a daily basis object to a simple treatment which can prevent serious illness and even death? At the very least it seems necessary to ask why, and then try to address the reasons. 

More broadly, how does a government deal with a person reluctant to be vaccinated because a child, spouse or friend has suffered proven life-changing injuries from a Covid – or indeed another – vaccine? Is the position of such people even acknowledged, or are they simply to be cut off from certain aspects of normal life as more coercive measures are introduced? Also, has enough consideration been given to ethnic or religious groups who may have particular concerns about the vaccine? With Covid still a serious risk to even the vaccinated, do we have the time for gentle persuasion? Such are the dilemmas facing governments.

The choice of some governments to move towards imposing restrictions on the unvaccinated seems to have been, at least partly, a political calculation. Now, when high percentages of citizens have been vaccinated in most Western countries, governments can be more confident that they are riding a wave of majority public opinion. Without sufficiently high vaccination rates, the threat and imposition of new lockdowns or tougher rules on social mixing is likely to increasingly be seen as the fault of the unvaccinated. 

Evidence from hospitals, where the majority of seriously ill Covid patients are unvaccinated, is also helping to harden attitudes. Speaking anonymously to the UK’s Guardian newspaper, a respiratory consultant working for the British National Health Service, who has uncritically treated smokers with lung damage for years, found his ‘patience wearing thin’ with the unvaccinated: ‘If everyone got vaccinated, hospitals would be under much less pressure; this is beyond debate. Your wait for your clinic appointment/operation/diagnostic test/A&E department would be shorter. Your ambulance would arrive sooner […] Even if you are not worried about your own risk from Covid, you cannot know the risk of the people into whose faces you may cough; there is a dangerous and selfish element to this that I find hard to stomach.’

Freedom is a word which is frequently used by those who reject Covid vaccination. But limitations on freedom have long been accepted as a necessity for living in safe, law-abiding democracies. This is why we may all be obliged to do something as simple as, for example, not smoke in public spaces to protect the health of others. Many human rights laws grant the freedom to do, or not do, something, but acknowledge that individual freedom may need to be limited for the good of the majority.

It should not be forgotten that there looms a potentially greater problem. The issue of persuading a small and diminishing percentage of unvaccinated people in the population to get a jab is a problem for wealthy countries. In large regions of the world only a tiny, privileged proportion of the population are even able to access a Covid vaccine. The unvaccinated majority in low-income countries is increasing the risk of new, possibly vaccine-resistant, variants developing.

Daniel Altmann, Professor of Immunology at Imperial College London told CNBC: ‘This isn’t altruism or aid or anything, this is the global escape strategy from something that we’re all suffering together. Unless we can share out the vaccines and produce enough vaccines for everybody, the next variant is just around the corner.’

New vaccines may always be developed to defeat new variants. But we could end up trapped in an ever-desperate game of catch up, facing continual disruption to normal life, unless we ensure effective worldwide distribution of vaccines. Until then, it is likely no-one will be able to enjoy long-term ‘freedom’. 

Anne McMillan is a freelance journalist and author. She can be contacted at basestation2011@gmail.com