Monday, September 13, 2021

The case against vaccine passes

Opinion: Why vaccine passports won't slow COVID spread, will hurt the poor and threaten medical ethics | National Post -  Alanna Golden, Gil Nimni, Sandra Rao & Neil Rau:

September 09, 2021 - "COVID-19 ... Vaccine certificates have been rolled out across [Canada] with participation from Quebec, British Columbia, and now Ontario. The federal government has earmarked $1 billion for their implementation. Individuals will be required to demonstrate proof of vaccination status in order to access 'non-essential' services. While it is an important societal goal to maximize vaccination coverage in adults, it is also important to consider whether the end justifies the means....

"Vaccine certificates impose a significant burden on the population. There will be ongoing costs to taxpayers to maintain this system, and businesses will bear costs for implementation and oversight, and may be subjected to fines. The additional uptake in vaccination rates in those who are either unvaccinated or without natural immunity from previous infection is unclear.... In a rush to implement this system, governments have been unclear about how they will measure efficacy, which implies there may not be a clear plan on when to scale back.... With the precedent for vaccine certificates established, there may be a desire to include other seasonal viruses, excluding increasingly larger segments of society from 'non-essential' services.

"Can we stop transmission with vaccine certificates? Probably not. The latest data suggest that vaccination reduces transmission by around 50 per cent at six months with evidence of further waning thereafter. Vaccines may help to slow spread of the virus, but they will not achieve the kind of herd immunity we see with such diseases as measles. Vaccine certificates may offer a false sense of reassurance to those who are vaccinated, if the belief is that they cannot contract or transmit the virus.... Vaccine certificates for 'non-essential' services will not touch industries hit hardest in previous waves, such as warehouses and factories. Implementation of targeted approaches in at-risk workplaces makes more sense, with the deployment of mobile vaccination units, regular point of care testing and protected pay for those with symptoms or high-risk exposures....

"Those who are fully vaccinated may be amongst those denied access if they do not have a printer or mobile device, or if they have forgotten their documentation at home. This will especially impact the poor, those who are homeless, those with developmental delays or those who suffer from cognitive impairment. Newcomers will be subject to another set of vaccines if those approved in their home country are not recognized here. Businesses will be asked to deny services, sometimes to long-standing, loyal customers, at the expense of lost income desperately needed after months of forced closures. In addition, we can expect the workloads of numerous providers (ie. doctors, religious leaders) to grow exponentially with the additional tasks of proving vaccination status or providing exemptions....

"What are the unintended consequences? Let’s take the example of fitness gyms, which have been deemed 'non-essential.' One of the most important risk factors for severe COVID-19 illness is obesity. Many people rely on gyms, especially during the winter months, to access physical activity and maintain their ideal body weight. Those who live in apartment dwellings may not have access to green spaces for exercise. Thus, by barring access to gyms, we are restricting physical activity, which in turn contributes to increasing rates of obesity and greater risk for severe disease.

"Ironically, by excluding the unvaccinated from common social institutions, we run the risk of congregation of unvaccinated individuals outside of these institutions. When this does occur, it is more likely to be without mitigation measures. COVID-19 is spread through social networks, meaning that this action could increase the number of infections circulating amongst unvaccinated people, increasing adverse outcomes.... The unvaccinated are disproportionately of lower socio-economic status, ethnic minorities and children. Many minority groups have legitimate reasons to distrust the medical establishment.... Some are unable to get vaccinated because they cannot afford time off work for vaccination and post-vaccine side effects. It is imperative that we understand the unintended potential health equity impacts of vaccine certificates on specific population groups....

"Perhaps the greatest oversight with vaccine certificates is the lack of recognition of natural immunity. Those who have been previously infected may not wish to receive vaccination. This conviction is supported by recent data that natural immunity is as good [as] or better than vaccine-induced immunity. If this is true, why are we excluding those with durable protection from society? Moreover, a lack of acknowledgement of protection by way of natural immunity may serve to reinforce the optics of pharmaceutical involvement in policy-making.

"Are vaccine certificates ethical? One of the most sacred principles in medical ethics is autonomy, meaning that an individual has the right to decide what happens to their body.... Even the most well-informed individual cannot provide informed consent if their 'choice' is coerced. Vaccine certificates render the individual in an impossible place of having to choose vaccination or loss of employment and exclusion from society. This impossible 'choice' forces the hand of those in this predicament and ultimately results in consent under duress.... Given that we have exceeded numerous vaccine targets and offered protection to those at greatest risk, we should make every effort at this time to maintain patient autonomy and guide with openness rather than exclusion."

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