by Abir Ballan, MPH
COVID-19 has been tragic for vulnerable populations. Many of us have lost loved ones and witnessed immense suffering brought on by the direct effects of the virus and the indirect effects of the pandemic response. The unprecedented measures that were implemented almost worldwide mark a drastic departure from pre-COVID-19 public health guidelines and pandemic preparedness plans. Lockdowns shift the burden of herd immunity to “essential workers”. They fail to protect the vulnerable and kill many people by denying treatment for other diseases and harming mental health. They destroy livelihoods and cause immense collateral damage, particularly to the young and the poor.
COVID-19 presents a serious risk of severe illness and death to the high-risk population (the elderly and individuals with multiple health problems) and a negligible risk to the vast majority of people. 95% of deaths occur in individuals with 1 or more existing health problems. As with many health issues, the social determinants of health -education, socio economic status, healthcare… have a pronounced impact on the risk from SARS-CoV-2. This is reflected in an increased risk of adverse outcomes among low income individuals, blacks and minority groups.
Looking at the cup half full, real-life data shows that the median age of death with COVID-19 is similar to that of natural mortality in most countries. The survival rate of individuals below 70 is 99.95%. This estimate includes individuals with comorbidities, which implies that it is significantly higher for healthy individuals. Children and young people have almost zero risk of death from COVID. In fact, children are at far greater risk from the flu than from COVID.
The epidemiological reality of COVID-19 lends itself to a focused protection approach that prioritises those most at risk while minimizing collateral harm to others. Consequently, vaccine deployment should also follow a focused vaccine approach by offering a safe and efficacious vaccine to high-risk individuals (mostly people above 50, with other health problems) when the benefit of the intervention clearly outweighs the risk. This strategy achieves the best outcome for all.
Mandatory vaccination has no place in a free society. Public health policy should never be coercive and should always be participatory. Decisions must be made by those who have skin-in-the-game and not by bureaucrats or a conflicted elite that will never have to live with the consequences of their actions. The role of public health agencies is to provide the public with accurate information and respect individuals and communities to make their own decisions.
Seven ethical principles of public health should be at the heart of any public health intervention: non-maleficence, beneficence, respect for autonomy, health maximisation, efficiency, justice, and proportionality. Human rights, scientific facts and common sense should also be applied.
Ten reasons why COVID-19 vaccination should never be mandatory:
- Non-maleficence – the Hippocratic duty of ‘first, do no harm’. There is mounting evidence of serious adverse events, particularly myocarditis in the young, following COVID-19 vaccination. Adverse events reporting systems act as a signalling system so immediate action can be taken to prevent greater harm. There are currently strong enough signals to warrant an investigation. Vaccines are also contraindicated for individuals with certain health conditions. Vaccination of pregnant/breastfeeding women must be approached with great care – pregnant women were excluded from the vaccine trials; COVID-19 risk is low in healthy women of child-bearing age, while vaccine risks to the foetus/infant cannot be determined yet.
- Beneficence – the duty to produce benefit for the individual. Health interventions should be based on individual needs. Vaccination is only indicated when the intervention clearly represents a greater benefit than risk for the individual. This criteria is not met for children and young people, individuals below 60 with no existing health problems, and individuals with past SARS-CoV-2 infection (including asymptomatic infection).
- Respect for autonomy – allowing individuals to pursue their wellbeing as they perceive it. “Every person has a high value and cannot merely be treated as a means to the end of others’ good”. This entails seeking the individual’s informed consent before any medical intervention: informing them of the risks and the benefits of the intervention and getting their voluntary consent without “any element of force, fraud, deceit, duress, overreaching or other ulterior form of constraint or coercion”. Currently, individuals cannot be provided with full information on vaccine side effects as no long-term data exists yet. The results of the vaccine trials should be replicated by independent scientists prior to vaccine rollout to the high risk group. Public transparency of all efficacy and safety data is necessary.
- Health Maximisation – maximizing the health of all members of the general public requires a holistic and multi-layered approach: educating the public about a healthy lifestyle to improve their chronic illness, the importance of Vitamin D in fighting respiratory infections, the importance of home-based early treatment, the availability of life saving treatment protocols, safe and effective drugs (such as Ivermectin), as well as vaccines for the high-risk group. Vaccinating individuals who incur greater risk from the vaccine than benefit increases total harm.
- Efficiency – the duty to produce as many benefits to as many people given limited resources. Vaccinating individuals who do not benefit from the intervention diverts valuable resources away from the vulnerable as well as from far more devastating global health issues like TB, HIV, diabetes, cancer and cardiac diseases.
- Justice – all humans have equal worth and no one should be discriminated against based on their health choices. Unfair practices such as denial of services, requirements for employment, restrictions on travel, higher insurance premium for the unvaccinated create a two-tiered society. It breaks social solidarity and cohesion.
- Proportionality – the reasonable balance between the benefits and costs of an intervention in terms of individual welfare versus collective benefit. Vaccines are designed to confer protection on the vaccinated. It is unethical for a person to incur any vaccine risk or lose personal freedoms for the sake of somebody else.
- Transmission of SARS-CoV-2 can result from both vaccinated and unvaccinated individuals. The virus can also be transmitted among animals. Even if everyone is vaccinated, transmission will continue and variants will keep on evolving. A Zero COVID strategy is unrealistic and unachievable.
- Herd immunity can be reached through a combination of natural infection and vaccination. Natural immunity to SARS-CoV-2 is broad and long-lasting – more so than vaccine-induced immunity, especially in combating variants. Recovery from infection prevents serious illness if reinfected. It is not necessary to vaccinate the entire planet for the ‘greater good’ of society.
- Non-derogable rights as stated in Article 58 of the The Siracusa Principles on the Limitation and Derogation Provisions in the International Covenant on Civil and Political Rights (1958) apply under all circumstances, even under threat of ‘national security’:
“No state party shall, even in time of emergency threatening the life of the nation, derogate from the Covenant’s guarantees of the right to life; freedom from torture, cruel, inhuman or degrading treatment or punishment, and from medical or scientific experimentation without free consent; … and freedom of thought, conscience and religion. These rights are not derogable under any conditions even for the asserted purpose of preserving the life of the nation.”
We face two scenarios. Either the vaccines work, delivering protection to the vaccinated and eliminating the claim that everyone needs to be vaccinated. Or the vaccines don’t work, and therefore no one should get vaccinated. On both counts, vaccine passports are a pointless ‘public health’ tool that will undermine trust in the medical profession and vaccination programs. They seem to serve economic, financial, political and ideological agendas. Most fundamentally, they are unethical. They swing the gate wide open for totalitarian rule through a digital social credit system.
Vaccine passports represent the epitome of the greater evil of society. This is the inch we must not yield.
Photo by Levi Meir Clancy on Unsplash
Abir Ballan has a Masters in Public Health and a background in psychology, and education. She is a member of the Executive Committee at PANDA. She is a passionate advocate for the inclusion of students with learning difficulties in schools. She has also published 27 children’s books in Arabic.