Should a COVID-19 mass vaccination program be mandatory?

As the rollout of COVID-19 vaccine begins, one bioethicist says we can achieve herd immunity in the country without vaccinating all Canadians.

“There’s no need to impose vaccines on people in a condition of scarcity,” Francoise Baylis, a bioethicist and research professor at Dalhousie University, said in an interview with The Signal.

“We have limited doses available.”

Canada’s death toll is expected to hit 15,000 by Christmas Day, according to national modelling released Friday as overall cases of COVID-19 in Canada surpass 450,000.

Last week, Prime Minister Justin Trudeau announced that 249,000 doses of the coronavirus vaccine will be available this month, starting with the most vulnerable populations. Federal health officials expect to have enough vaccine to inoculate all Canadians by the end of 2021.

Baylis said she won’t advocate for a mandatory vaccination program. Education is key, she said, particularly when it comes to clearing up any misunderstanding about how the vaccine works.

“I’d like to start with a collaborative approach to this rather than thinking the way to achieve what I think is a laudable goal which is to achieve herd immunity for the benefit of the community that you would do by overriding individual freedom,” she said.

Ji Li, a consumer psychologist and a professor at Dalhousie University, said there is a need to appeal to convince people about protecting themselves and each other in this pandemic situation.

“There will be a backlash if you make it mandatory,” he said, noting it will be a political change.

Katherine Fierlbeck, a professor of health-care politics at Dalhousie University and a policy expert, also dismissed the premise of immunizing everybody to achieve herd immunity. She said there is a need to think about a “political cost” of making vaccines mandatory.

Make sure enough people are immune or will not be developing the disease so you can preserve the capacity of the health-care system, Fierlbeck said.

“You don’t want to penalize people with bad reactions without determining who can be exempted,” she said. “It seems a bit peremptory and paternalistic to impose vaccination on everybody.”

Fear of side effects

The Pfizer-BioNTech vaccine was approved for people 16 years of age and older. Three other vaccine candidates, including one from Moderna, are under review.

Both Pfizer and Moderna said their vaccines can induce possible side-effects similar to the symptoms of COVID-19 infection, including fatigue, chills and joint pain.

Baylis said some side-effects are always anticipated and that should be widely known.

“There will be some complication and people need to understand that as part of a consent process,” she said.

She added that people will get over these early symptoms in a short period of time.

“That’s always true with a new product. As we develop science we learn, and as we learn we continue to improve and modify,” she said.

Fierlbeck said people should learn to evaluate the risk of taking somewhat unknown products for the still somewhat unknown effects of a disease.

“Probably it’ll be fine, probably it’ll have an effect. These are all question marks,” she said.

She noted that Canada has a plan to compensate people who do have severe adverse reactions.

The Public Health Agency of Canada is implementing a pan-Canadian no-fault vaccine injury support program. Many countries, including all other G7 countries, have a vaccine injury support program for routine immunizations.

Efficacy vs. effectiveness

Studies suggest the Pfizer-BioNTech vaccine is approximately 95 per cent effective a week after the second dose, according to Health Canada.

Fierlbeck said many experts are “extrapolating from what we assumed the case” without clear, evidentiary basis.

She said the vaccine has not been decisively tested on the “frail 80-year-old in long-term care.” She also noted one of the reasons four FDA panel members voted against the Pfizer vaccine was because of limited data on younger participants.

“It could prevent symptoms, but the question is can you still spread it?” Fierlbeck said.

The U.S. Centers for Disease Control and Prevention recommends wearing masks, hand washing and physical distancing even after getting a second dose of the vaccine.

Baylis said it is important to implement a followup plan with people taking the vaccine and periodically monitor the effects. She said several months of data collection and experience are needed for research and continuous improvement of the vaccine.

“Once it (vaccine) is out in the real world, the data collection needs to continue.”