The unintended consequences of COVID-19 vaccine policy: why mandates, passports and restrictions may cause more harm than good | BMJ Global Health 7:5 - Kevin Bardosh, Alex de Figueiredo, Rachel Gur-Arie, James Doidge, Trudo Lemmens, Salmaan Keshavjee, Janice E Graham, Stefan Baral:
Abstract
Vaccination policies have shifted dramatically during COVID-19 with the rapid emergence of population-wide vaccine mandates, domestic vaccine passports and differential restrictions based on vaccination status. While these policies have prompted ethical, scientific, practical, legal and political debate, there has been limited evaluation of their potential unintended consequences. Here, we outline a comprehensive set of hypotheses for why these policies may ultimately be counterproductive and harmful. Our framework considers four domains: (1) behavioural psychology, (2) politics and law, (3) socioeconomics, and (4) the integrity of science and public health.
While current vaccines appear to have had a significant impact on decreasing COVID-19-related morbidity and mortality burdens, we argue that current mandatory vaccine policies are scientifically questionable and are likely to cause more societal harm than good. Restricting people’s access to work, education, public transport and social life based on COVID-19 vaccination status impinges on human rights, promotes stigma and social polarisation, and adversely affects health and well-being. Current policies may lead to a widening of health and economic inequalities, detrimental long-term impacts on trust in government and scientific institutions, and reduce the uptake of future public health measures, including COVID-19 vaccines as well as routine immunisations.
Mandating vaccination is one of the most powerful interventions in public health and should be used sparingly and carefully to uphold ethical norms and trust in institutions. We argue that current COVID-19 vaccine policies should be re-evaluated in light of the negative consequences that we outline. Leveraging empowering strategies based on trust and public consultation, and improving healthcare services and infrastructure, represent a more sustainable approach to optimising COVID-19 vaccination programmes and, more broadly, the health and well-being of the public.
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Conclusion
The adoption of new vaccination policies has provoked backlash, resistance and polarisation. It is important to emphasise that these policies are not viewed as ‘incentives’ or ‘nudges’ by substantial proportions of populations especially in marginalised, underserved or low COVID-19-risk groups. Denying individuals education, livelihoods, medical care or social life unless they get vaccinated — especially in light of the limitations with the current vaccines — is arguably in tension with constitutional and bioethical principles, especially in liberal democracies. While public support consolidated behind these policies in many countries, we should acknowledge that ethical frameworks were designed to ensure that rights and liberties are respected even during public health emergencies.
Vaccination policies can be an important tool in the promotion of the right to health, but they need to be proportionate and designed to achieve a clearly defined goal. Some of those supporting current restrictions based on vaccination status seem to accept too easily that these measures are indeed proportionate; that they are not more restrictive than necessary; that they are effective in preventing transmission and protecting the healthcare system from collapse; and that there are no options available other than punitive mandates, passports and segregated restrictions. As illustrated above, we believe that current vaccine policies have failed on these fronts and are no longer fit for purpose.
We encourage social and behavioural scientists, bioethicists, epidemiologists, legal scholars, and others to assess the benefits and harms of COVID-19 vaccination policies, along with wider open multidisciplinary discussion and debate. Empirical assessments may or may not validate the concerns presented in this paper—but their generation is critical in engagement with politicians, scientists, and organisations to reconsider current policies affecting those who remain unvaccinated as well as those who vaccinated due to threats and pressure. COVID-19 will not be the last public health emergency and it remains critical that we understand the reasons these approaches were adopted and provide robust evidence to improve future policymaking in times of health emergencies.135 If not, the proclivity for mandates, passports, restrictions, fines and punishments is likely to become an accepted policy response for the next pandemic irrespective of whether such policies are truly effective, ethical and socially harmful.
If current policies are to continue, public health-associated bureaucracies and society will have to increase coercion to address current and future resistance and, in the process, come to leverage strategies more consistent with policing than public health. We may also see political forces double down and use people who have chosen not to get vaccinated as a collective, psychological and political tool to scapegoat and reinforce a false notion of safety among vaccinated people as they yearn to resume social and economic life. Policymakers should reflect on the necessity of enforcing what is essentially a new two-tier, segregated social system and how this will affect different social groups now and into the future—behaviourally, politically and socioeconomically—as well as the impact of such policies on the integrity of science and public health itself.
There are other options to address the pandemic and it is not too late to return to non-coercive public health measures, including pro-social language and community leadership for vaccination, especially to protect high-risk groups. Future investments in public health capacity, especially health providers who build relationships of trust working in communities, will be essential to engage in positive reforms. Improving data transparency, media independence and broad public debate and scrutiny about COVID-19 vaccine policies will also be essential to maintain population trust, help people better understand the risks and benefits of the continued use of current vaccines, and to inform research on improvements and future policies.
Read more: https://gh.bmj.com/content/7/5/e008684
http://dx.doi.org/10.1136/bmjgh-2022-008684
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