The Quebec government recently announced plans for a vaccine passport system, which, in the event of a fourth wave of COVID-19, will prevent people who are not fully vaccinated from entering closed places such as bars, restaurants, gyms and events. of entertainment. Quebec is an outlier here: apart from Manitoba, which issues “immunization cards” to those who are fully vaccinated, but has not established any rules for their use, all other provinces have rejected vaccine passports or kept silent about the topic.
The direct benefit of vaccine passports is clear: They would allow us to safely lift restrictions on indoor gatherings, with all corresponding benefits for the economy, culture, sports, and education. They also incentivize people to get fully vaccinated.
So why are provincial governments generally opposed to the use of vaccine passports? The answer is not as clear or convincing as you might expect, given the high stakes. In the early stages of launching vaccination, there was concern that marginalized populations were overrepresented among the unvaccinated, and vaccine passports would exacerbate their marginalization. Whether this argument ever made sense is moot: avoiding vaccine passports simply prolongs the lockdown for everyone, imposing economic costs that are disproportionately borne by marginalized populations. In any case, these concerns about equity have faded as vaccines become available and, for the most part, are fairly distributed.
It has also been argued that vaccine passports effectively obligate people must be vaccinated as a precondition to escape pandemic restrictions, and that this violates the fundamental legal and ethical right to autonomy over medical decisions. This argument fails for several reasons. First, respect for the autonomy of the patient does not imply that people should incur without cost for their decision not to be vaccinated and share the challenge of achieving herd immunity. It has long been the case that students who have not received routine MMR vaccinations may remain out of the classroom, and that healthcare workers who refuse the flu vaccine may be denied work shifts during an outbreak. Grabbing people and vaccinating them against their will is a violation of rights; keeping unvaccinated people away from a gym or movie theater during a pandemic is not.
Concerns have also been raised about the privacy implications of vaccine passports. Our law takes the privacy of medical information very seriously; after all, the right to control your personal health information is an important component of patient autonomy. But, as with most legal protections, the right to privacy of medical information must be balanced with competing interests, and In fact, health information privacy laws generally allow public health exemptions. Some lawyers and ethicists have worried that vaccine passports become a mass surveillance tool, allowing government and private companies to track our comings and goings in perpetuity. But these are risks we can protect ourselves from broadly: designing vaccine passports that track only limited information, and regulating how and when they can be verified. Vaccination passports cannot be more intrusive, from a privacy perspective, than the requirement to show photo identification in a bar or carry a driver’s license when operating a motor vehicle.
A cynic might conclude that the government’s opposition to vaccine passports is not due to serious legal or ethical concerns, but to a short-term political calculation: given all the instinctive controversy surrounding vaccine passports, the safest option politically it is to postpone their adoption for as long as possible. Ontario, for example, just announced that it will not develop vaccine passports and instead focus on vaccination efforts, pledging to lift all restrictions once 80 percent of the population has received a dose and 75 percent of the population has received a dose. percent received two.
We need to recognize this for the unnecessary gamble it is. Other countries that have achieved high vaccination rates and removed restrictions, such as the UK and Israel, are already experiencing a resurgence in cases. As the reproductive number of the virus increases (Delta is almost twice that of Alpha), the percentage of the population that needs to be vaccinated to achieve herd immunity increases accordingly. While lax policies might have worked with the alpha version, stronger incentives are now needed.
We need a sophisticated way to track which vaccines people have received and when so that we are equipped to respond to changes in the virulence of diseases in a measured and proportionate way. Setting arbitrary and single thresholds for vaccination is not a durable solution. At a minimum, federal and provincial decision-makers should develop vaccine passport systems as an alternative option, rather than avoiding entirely in deference to resolvable concerns about fairness, patient autonomy, and privacy of health information.
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