In the northern hemisphere, the arrival of winter has brought concerns about COVID-19 back to the forefront, with multiple countries reporting high case rates and warning of increasing pressure on hospital services.
The situation prompted Austria, a small EU member state where the daily infection rate neared 15,000 in mid-November, to go for the nuclear option – it not only reimposed a three-week lockdown, but also made vaccines mandatory for adults from February 2022 in an attempt to increase its national vaccination rate, which currently stands at 66 percent.
The emergence of the latest COVID-19 variant of concern, Omicron, further ramped up the pressures on governments to make decisive interventions before their health systems are overwhelmed. With its unusually high levels of mutations, the Omicron variant might mean faster transmission and higher resistance to our current crop of vaccines. Thankfully, initial research from South Africa suggests that existing vaccines and boosters should still provide some measure of protection from hospitalisation or worse. Moreover, modern development and production methods should allow for the creation of an adjusted vaccine in a matter of months rather than years.
But many developed countries where vaccines are readily available have seen a relatively modest uptake. EU members Romania and Bulgaria, for example, have under 40 percent of their populations fully vaccinated. Dr Anthony Fauci, chief medical adviser to the President of the United States, reckons lasting community protection can be reached only after nearly 90 percent of the population is jabbed.
Thus, as they try to mitigate the threat posed by high case rates and the spread of Omicron, governments are introducing new policies to increase vaccination uptake in their countries.
The relatively politically palatable option of requiring vaccine passports for entering certain venues and shops, and thereby making the lives of unvaccinated people more restricted, has already been used extensively across Europe, despite it triggering significant protests in many countries, including Italy, Croatia and the Netherlands.
Policymakers in many countries may, therefore, be tempted to follow Austria’s lead and introduce vaccine mandates in the near future to reduce hospitalisation rates and avoid more economically damaging restrictions. EU Commission President Ursula von der Leyen has already called for a debate on mandatory vaccines and Germany’s new chancellor, Olaf Schulz, also voiced support for vaccine mandates.
Yet, government-imposed vaccine mandates can have serious long-term consequences – they can brew social unrest, increase mistrust in government, and scar societies as severely as the pandemic itself.
In Austria, draft legislation has suggested that those unvaccinated would be “summoned” to some administrative authority and could eventually incur fines of up to 3,600 euros (about $4,060). With millions still unvaccinated, it may not take long for hundreds of thousands of Austrians to be reprimanded. Tens of thousands of Austrians have already been protesting, sensing a government overreach.
Most people who are hesitant to take the COVID-19 vaccine are not loud, somewhat unhinged anti-vaxxers who worry about being implanted with tracking chips through the jab. Many of them are sincerely concerned about introducing something new into their bodies, or simply want to understand the risks and benefits of the jab better. But vaccine mandates can change that. If governments impose vaccines on vaccine-hesitant people in a heavy-handed way, they may become more vulnerable to fake news or conspiracy theories, and end up joining more extreme anti-vax movements.
Rather than forcing the vaccine on people, policymakers should try to understand why people might be hesitant to take it, and focus their efforts on changing minds. This could help drive longer-term vaccination uptake, which will be crucial especially if annual COVID-19 vaccine boosters are needed.
The moment a government recommendation becomes a forced requirement, it changes the power dynamic between the state and the individual. Government-imposed mandates feel inherently sinister, even when the intentions behind them are wholly well-meaning. This is why even the World Health Organization (WTO) has cautioned against implementing COVID vaccine mandates, unless every other feasible option has been tried to convince people to get jabbed.
Vaccine mandates may make some people trust institutions less, which can in turn further reduce vaccine uptake. A study on attitudes to vaccination in Europe, published in Social Science & Medicine Journal in 2014, has shown that those who trust institutions involved in the vaccination process are more likely to be jabbed, and those who do not suffer an information deficit and become more vaccine-hesitant.
The continuing debate on vaccine mandates in wealthy nations also feels jarring in the face of poorer countries’ continuing lack of access to vaccines. Indeed, the share of people who received one dose of COVID-19 vaccine is already more than 76 percent in high-income countries, but stands at just 6 percent in low-income ones.
COVAX – an initiative led by WHO to reduce vaccine disparity between high- and low-income countries – initially aimed to distribute 2.2 billion COVID-19 vaccine doses to countries unable to independently procure them by the beginning of 2022. But this lofty ambition has since been revised to 1.4 billion doses, partly due to supply issues. WHO is now concerned that the emergence of Omicron will lead to richer countries hoarding more jabs, which will exacerbate the inequality of vaccine distribution.
On the bright side, the toolkit for tackling COVID-19 is constantly growing, which can help countries with low vaccination rates. Antibody treatments, including the UK’s recently approved Xevudy drug from GSK, has been found to reduce hospital admission and death by nearly 80 percent in high-risk adults. The easily consumed oral anti-viral drug molnupiravir has also been found to reduce the risk of serious illness by at least a third.
In an ideal world, everyone who has access to a safe vaccine that can protect them against COVID-19 and help mitigate the spread of the virus would take it. But in the real world, where many people have existing fears about vaccines and are routinely exposed to misinformation, getting everyone to accept the jab is not an easy task.
Forcing people to get vaccinated by imposing harsh penalties and restrictions, however, may do more harm than good. It can confirm people’s fears that the “government elite” is against them, or that they are losing their rights and liberties. All this could result in those who are vaccine-hesitant today becoming even more reluctant to follow the advice of authorities during future health crises.
Public health programmes require public consent to succeed. Governments that are currently considering imposing COVID-19 vaccine mandates should therefore be aware that, while tempting in the short term, such policies can have grave consequences for us all in the long term.
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