Will discriminatory public health policies based on COVID-19 vaccine status cause social harm that exceeds the benefit?

This Journal, in an early publication from the pen of the Editor (1) and at a point prior to the availability of vaccines against SARS-CoV-2 infection during which lockdown of citizens was taken to be the only possible mechanism for reducing community spread of the virus, noted that the wider economic and social impacts of such measures had been overlooked.  I stated

“…The natural and expected political imperative is to prevent unnecessary infections and deaths.  However, this must be balanced against the adverse chronic consequences of economic shutdown, which will produce its own health hazards, especially in the area of geriatric medicine and mental health.  Thus one reaches the conclusion that reversal of restrictions in the interests of resuming normal life must be undertaken before the pandemic has been fully controlled.”

I also noted that the Premier and Chief Medical Officer of Western Australia made statements recognising that continuing social restrictions once a phase of COVID chronicity had been reached was untenable.

Omicron was then in the future, but since has become the dominant global strain.  It is highly virulent but produces mild disease in most cases, especially in vaccinated individuals, and is associated with lower hospitalisation and ICU occupancy rates, and reduced mortality rates.  Bearing these characteristics in mind Victoria, New South Wales and Queensland, have cancelled lockdowns and other social restrictions, initially while case numbers were still high.  Western Australia has sought to maintain its low infection rates, made possible by severe interstate and international border closures, by adopting a discriminatory policy of excluding unvaccinated and hence non-immune persons from all social venues except shops, and events.  The scientific shortcomings of this policy was described in our previous blog. What concerns me here are the less tangible long-term social consequences.

The unvaccinated minority has taken to the streets internationally to protest against discriminatory vaccine policies.  This has happened notably in Paris, in Canada at the US border and in Quebec, Germany, Austria, Italy, the UK, and in each of the State capitals of Australia.  I have felt instinctively that these demonstrations represent a predictable response from a sizeable minority whose rights and privileges have been severely compromised, though it is also clear that the demonstrations have attracted fellow-travellers from other grievance areas and regrettably have tended to become violent.  They are undoubtedly a manifestation of deliberate relative disenfranchisement of the minority based on fear of disease spread.  The ultimate cost of this government-sanctioned discrimination against the non-vaccinated is uncertain, but surely worthy of consideration.  I note that case numbers are now declining in the Eastern states, whereas in WA they are increasing rapidly (from a very low base).  This result has not been prevented (but perhaps has been delayed) by continuing border restrictions, vaccine policies, quarantine rules or mandatory mask-wearing in public indoor areas.

A paper relevant to these ideas has recently been posted on-line (4). Written by 9 authors from reputable Universities but not yet peer-reviewed, it reviews the policy of vaccine certification and consequential loss of privileges, and analyses them under four headings (Behavioural Psychology, Politics and Legal effects, Socio-economics, and integrity of Science and Public Health).  The discussion includes erosion of civil liberties, adverse effects on equality, reduced health system capacity owing to barring unvaccinated health workers from their place of work, exclusion from work and social life and erosion of informed consent and trust in public health policy.  It questions (with references) the motivating principles of some authorities.  For example the French President is quoted as saying “[It is] only a very small minority who are resisting. How do we reduce that minority? We reduce it by pissing them off even more…When my freedoms threaten those of others, I become someone irresponsible…someone irresponsible is not a citizen”.  Again, Justin Trudeau, the Canadian Prime Minister, is quoted as saying “They are extremists who don’t believe in science, they’re often misogynists, also often racists…It’s a small group that muscles in, and we have to make a choice, as a leader and as a country: Do we tolerate these people?”  Such illiberal statements from liberal democracies are disappointing to say the least.

The authors ask several pointed questions over the future implications of vaccine passports or certificates and related policies:

“Are we now experiencing a paradigm-shift into a permanent annual cycle of mandatory COVID-19 vaccines, with ever-changing criteria depending on the latest booster? Will unvaccinated people face exclusions in society for years to come? Will we return to new mandates, and street battles between protesters and police, each time a new variant emerges? Will influenza vaccines and other vaccines now become mandatory, including for low-risk groups? If unvaccinated people continue to refuse to be vaccinated in countries with strict punishments, what happens next? What is the end-goal and where is the policy off-ramp? Most importantly, what will this do for trust in global immunization programs and other public health measures?”

Though these issues are worthy of detailed investigation, the paper lacks mention of possible advantages of vaccine status-related regulations. It does not examine the possible advantages of such policies, for example that they appear to be essential in some industries to prevent spread of COVID-19.  For example mandatory vaccination of carers at aged care facilities prone to rapid spread of COVID amongst frail residents, once a case is established, appears unexceptionable.  The question is whether the obvious merit in such an industry and others can and should be extrapolated to the community at large. In addition, the paper does not examine the quandary faced by national or state leaders who have the heavy responsibility of protecting the state as a whole and must implement policies that appear to have the maximum possible effect on a potentially deadly disease, in a highly complex area of health care.  It does not record that in some but not all jurisdictions the policies have led to significant disease control. Thus the question it poses (do the regulations cause more harm than good?) is unanswered.

These questions represent extrapolations from our earliest comments on how we must consider economic and social consequences of the infection and our responses to it. They should be seriously considered by all decision-makers. According to the Premier of Western Australia in his announcement of 18 February 2022, the percentage of the adult population that remains unvaccinated in WA is less than 2% (stated as saying that the percent of the partially or fully vaccinated population is 98-100%). These figures suggests that the exclusion of the unvaccinated from social venues cannot have a significant effect on community spread of omicron, and that the policy should be abandoned.

J A Millar
Editor, Tasman Medical Journal

References

  1. Millar JA.  Modelling community spread of COVID-19 without complex mathematics.  Tasman Med J 2020; 2: 35-40.
  2. https://tasmanmedicaljournal.com/2022/01/omicron-strain-demands-new-terminology-to-describe-vaccination-status-against-sars-cov-2-infection/
  3. https://tasmanmedicaljournal.com/2022/02/wa-government-mis-steps-in-regulating-community-response-to-omicron-strain-of-sars-cov-2%ef%bf%bc/
  4. Bardosh K, de Figueiredo A, Gur-Arie R, Jamrozik E et al.  The Unintended Consequences of COVID-19 Vaccine Policy: Why Mandates, Passports, and Segregated Lockdowns May Cause more Harm than Good. https://ssrn.com/abstract=4022798  or http://dx.doi.org/10.2139/ssrn.4022798

Published 16/2/22; amended 19/2/22

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