Coronavirus

In the Anti-Vaxxer Era, Will Countries Make a Coronavirus Vaccine Mandatory?

In 2019, the World Health Organization listed vaccine hesitancy as one of the ten gravest threats to global health. Now, public health agencies are trying to figure out what to do next.
26 May 2020, 10:47pm
Nurse administering a vaccine
We're at least a year away from a COVID-19 vaccine, but people are starting to wonder how governments will administer one, should it come. Photo by National Cancer Institute (Unsplash)

After months of isolating from friends and family, it seems like most people are desperately hoping for a COVID-19 vaccine that’ll put an end to the pandemic. But in an era of misinformation and lockdown protests, often touted by anti-vaxxers, there’s an open question on how much uptake there will be for the vaccine, should one arrive. And that leads to a second question: should governments consider making a COVID-19 vaccine mandatory?

“Making vaccines mandatory is the last tool in the toolkit of public health,” said Lynora Saxinger, a professor with the University of Alberta department of medical microbiology and immunology.

Vaccination rates for most diseases are quite high, which suggests public health agencies won’t have to force people to take a COVID-19 vaccine, Saxinger said.

For example, according to the World Health Organization (WHO), as of 2018, an estimated 84 percent of the global population was immunized for Hepatitis B; about 86 percent of children received a measles vaccine before their second birthday; and 84 percent of infants were immunized for polio. (Rates tend to be higher in North America and Europe than elsewhere largely due to unequal access.)

But there's been a lot of misinformation spreading about the coronavirus, Saxinger said, so she’s worried it could sway Canadians away from vaccines.

Both Saxinger and another expert told VICE they’re particularly worried about people who don’t identify as anti-vaxxers, but express hesitancy when considering vaccinations, because they’re likely more susceptible to misinformation.

Last week, Alberta Premier Jason Kenney said he has no intention of making a COVID-19 vaccine mandatory. However, if a safe and effective vaccine is found, the government will “strongly encourage people to use it as we do in flu season,” Kenney said.

Laval University medical anthropologist, Ève Dubé, said she’s noticed a lot of people express “a perception that the government will force people to get vaccinated.”

“These are rumours...it’s really unlikely,” she said.

According to Dubé, it might not be feasible to mandate inoculation.

When a vaccine is finally found, mass production will take a while, which means there won’t be enough doses at the start to make it mandatory, Dubé said.

Past government practice across the country also makes it difficult to enforce inoculation, she said.

Alberta’s public health act allows the province to make vaccines mandatory, but that’s never been pursued.

Provinces like Ontario, New Brunswick, and Manitoba have implemented some mandatory vaccines, but Quebec, for example, hasn’t, Dubé said. That would make it a lot easier for Ontario than Quebec to impose a mandatory COVID-19 vaccine.

Yet studies have shown that just as many people in Quebec get immunized as in Ontario, Dubé said, so making vaccines mandatory likely isn’t necessary.

Plus, less than one percent of Canadians identify as anti-vaxxers.

The anti-vaxxer movement is stronger in the U.S. where groups are well-funded, heavily organized, and enjoy more influence, she said.

“Trust is key with governments and public health,” Dubé added. “If you look at France, there is much more distrust in authorities and government than in Canada—this goes along with more distrust about vaccines in France.”

Three-quarters of surveyed Canadians are already saying they intend to receive the COVID-19 vaccine once it’s available, Dubé said.

Public health is more worried about people who express some level of vaccine hesitancy—typically mothers who are well educated and middle class or upper middle class, Dubé said. This particular demographic tends to be very invested in the lives of their children, so they exercise skepticism when deciding whether to expose their kids to a number of things, vaccines included.

When a COVID-19 vaccine is finally available, family physicians and nurses need proper training, so they can recommend the vaccine to their patients and answer questions about associated risks and benefits, Dubé said.

Saxinger agrees: strong public education campaigns are key to combating misinformation and alleviating vaccine-related fears, she said.

According to most estimates, the world is still at least a year away from a COVID-19 vaccine. When the time comes, however, public health will have to gauge whether enough people are getting vaccinated to develop a herd immunity, Saxinger said.

If not, mandatory vaccines are a good option, she said.

In 2019, the World Health Organization listed vaccine hesitation as one of the ten gravest threats to global health, with several countries toying with the idea of making vaccines mandatory, Nature magazine reported. Countries like France, Italy, and Australia have already limited school access for kids who haven’t received vaccines.

“In a better world, we wouldn’t need mandates,” Paul Offit, an infectious disease specialist, told Nature. “People would educate themselves about vaccines and make the best decision for their children and for themselves. Assuming there’s not a medical contraindication, they’d get vaccinated every time.”

Public health’s ability to enforce vaccination is a good thing, Saxinger said, adding that she assumes most people will be lining up to get a COVID-19 shot.

“Most people are pretty reasonable, they're watching the theatre, but they're not buying into the extreme (anti-vaxx) messaging, so I'm hoping that’s the case here,” Saxinger said.

But if the messaging somehow manages to crack the public’s trust in vaccines, and too few people get the shot, then public health will have to step in, she added.

“Public health was created for a reason. It’s set up to compel things for the public good.”

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This article originally appeared on VICE CA.