Thursday, 14 May 2020

COVID-19: Civil liberties and the role of the state

Mandatory vaccination and COVID-19

Katie Attwell

As the race for a COVID-19 vaccine continues and much hope is placed in it to return our lives back to normalcy, Katie Attwell discusses balancing civil liberties and compulsory vaccinations and the role of public trust in ensuring sufficient coverage across the community.

As Western Australians enjoy reduced restrictions on social gatherings and outdoor activities, it’s easy to feel that normal life is returning. Within our state borders, schools have already reopened. Businesses, universities and social events may not be too far behind. However, the opening of interstate and international borders for travel seems far more remote, since the only way to avoid the high-level devastation of COVID-19 is by minimising exposure. In our highly globalised world, freedoms within state or national borders will look quite different from the internationalised freedoms of ‘before’.

A COVID-19 vaccine will likely be the game-changing step in allowing Australians to once again board planes and cruise ships (yes, apparently some people still want to !) and begin globe-trotting for business and pleasure. Vaccinated individuals would be able to travel with confidence to places where the virus remains endemic. Governments would be able to allow their return with the confidence they are not bringing the disease back with them.

Currently, the Australian Government recommends that travellers, especially those visiting exotic places, receive a number of vaccines for diseases that the rest of us tend not to worry about: yellow fever; tuberculosis; rabies. However, these vaccinations are not required (although host countries may demand them), and the traveller must pay for them. Soft expectations and cost barriers mean that not all travellers do vaccinate as recommended .

A COVID-19 vaccine would need much stronger enablers. It’s almost certain that the vaccine would be free, funded by the government. But it may also be required as a condition of re-entry to Australia, unless there were medical reasons why the traveller could not be vaccinated. It is hard to imagine governments being willing to put up returned travellers in 5-star hotels for mandatory quarantine, since the hotel’s owners would hope to have filled them with tourists – who themselves would need to be vaccinated before arrival. There may also be concerns about whether unvaccinated travellers – returning Australians and foreigners – would comply with home quarantine . Evidence of COVID-19 vaccination is likely to be a very significant passport item in our strange new futures.

Within our own borders, state and national, COVID-19 vaccination may also come with stronger requirements. Many Australians are likely to eagerly accept a vaccine as a ticket-of-leave to normality. However, as there is no published research on this yet, we cannot be sure. Distrust around the COVID-19 phone-tracking app indicates that some Australians are unwilling to put their liberties at risk in exchange for lifted social restrictions – or are unwilling to participate in this constructed bargain. But the bargain itself is interesting because it works at an aggregate level – if enough people download the app, the government feels safe enough to lift restrictions for all of us. What kind of reasoning would accompany the vaccine? Would we similarly be told that once a certain number of us are vaccinated, further restrictions can be lifted? Or will benefits and costs accrue to individuals instead, with vaccination becoming our personal golden ticket back into the world?

Either way, the numbers of people who will need to be vaccinated are likely to be extremely high. Vaccination works through the principle of community protection (also known as herd immunity) whereby extremely high levels of vaccination prevent the disease from getting a foothold and circulating. For some diseases, this threshold is as high as 95%. True normality may not be possible until or unless we get that kind of coverage for COVID-19 vaccination. And it will need to be an ongoing process, not merely a static job-done. Influenza mutates every year, which is why we need new vaccines every year. Even if we are not facing that problem with COVID-19, children are born or adults come of age every single day, and one day our borders will again open to migrants. The newest population group to receive the vaccine will need constant refreshing.

The Australian Government has a mechanism of tracking which vaccinations an individual has received. We have the oldest electronic register in the world, and in 2016 it was extended from children to the entire adult population. Understandably, its adult data remains patchy but it will be a verifiable record of who is vaccinated, and (if properly updated) how many COVID vaccines have been administered.

Vaccine-rejecting Australians are concerned that the COVID-19 vaccine would be mandatory, and such concerns may be playing into their depictions of the disease as mild and unworrying. However, when people talk about mandatory or compulsory vaccination, it is not always clear what they mean.

The very first vaccines, including smallpox, were administered around the world in compulsory settings, with fines for non-compliers. For newer vaccines, a formal or informal voluntarism prevailed in most developed world settings until very recently. However, today’s governments are imposing consequences on those who refuse to vaccinate, while still leaving individuals the option of copping the consequence and remaining unvaccinated. In the childhood setting, Australia, Italy, France, California and Germany have recently imposed strict consequences including welfare reduction, daycare exclusions, school exclusions and fines. Several jurisdictions and healthcare organisations also require health workers to be vaccinated against specific diseases or face not being hired, redeployment or termination.

With COVID-19, it is unlikely we will have health authorities going door-to-door fining people who don’t vaccinate, although New York did not rule this out during a recent measles outbreak. However, if our coverage rates of the COVID-19 vaccine are not sufficient to attain community protection and keep the virus out, governments may need to employ further measures. Mandatory vaccination for travellers will be easily justifiable, since travellers pose an elevated risk of infecting themselves and others. But this may not be enough. Large employers such as governments and corporations could be forced to make COVID-19 vaccination a condition of return to work or to the office (with exemptions for those who cannot be vaccinated). Similar conditions could apply to schools, childcare centres, swimming pools and gyms. With many Australians currently receiving welfare, these payments could become conditional on vaccination, as some payments are for other childhood vaccines. The problem with all these mechanisms is that they tend to apply unevenly. Those with economic means end up being able to remain unvaccinated with little consequence. It would be highly undesirable for vulnerable Australians to carry the can for everybody, when they have already been through so much.

All vaccines come with very small risks. Any kind of requirement accompanying the new COVID-19 vaccine once again raises the issue of Australia’s lack of a no-fault compensation regime for the very rare event of vaccine injuries. We will need to ensure that anybody who suffers a serious adverse event from the vaccine is adequately compensated. This is important not only as a matter of moral duty, but also to maintain public trust and confidence. There has never been a better time to set up a system to protect the tiny proportion of Australians who might receive a vaccine injury. There has also never been a better time to ensure that this risk is equally borne by all Australians – unlike our current childhood mandatory policies, which allow wealthy families to avoid consequences.

More than anything, we should be mitigating against the need for mandatory COVID-19 vaccination. Investment into research preparing communities and governments for a COVID-19 vaccine could ensure that the community’s attitudes and information needs are understood, communications are appropriately managed, and that the likely high demand for the vaccine in the community is met quickly and fairly. There will inevitably be those who do not wish to accept the vaccine. However, every effort should be made to encourage voluntary acceptance in the first instance. When it comes to vaccine hesitancy, the old maxim rings true: prevention is better than cure.

Katie Attwell is a political scientist and public policy scholar. Her research project on mandatory childhood vaccination policies in international settings is funded by the Australian Government.

The author thanks Leah Roberts for her research assistance with writing this article.


UWA Public Policy Institute