While the situation is improving with on-site vaccination,new walk-in clinics and vaccination events targeting priority groups,actual access to the vaccine has been limited for many. Bookings have been primarily online,which is difficult for many,and hard to find. There has been little choice about time and location. People with caring responsibilities,people without paid leave or sick leave,people who cannot comfortably line up for long,people with limited options for transportation have all faced barriers to accessing vaccine.
Mandates to vaccinate can be justified in certain higher risk settings where a vaccinated worker protects a person they encounter,like a patient,or as exemptions from certain lockdown restrictions. On Saturday,NSW Deputy Premier John Barilaroannounced a scheme for vaccinated workers from the hard lockdown LGAs to be allowed back on site next week if they meet certain vaccination requirements. This is a vaccine mandate,and it is reasonable given we need certain industries to continue to operate.
But as a strategy to get generally high community vaccination coverage,there will be harms from jumping to mandates without exhausting reasonable options. Poorly thought up “pop-up” mandates from any sector will lead to chaos and the kinds of harms that compete with the ultimate aim of vaccination – human wellbeing.
Community-based mandates have a slightly different aim to occupational ones – to get high vaccination coverage. Yet they suggest that people have to be forced,rather than accepting that for the most part people want to do the right thing.
Talk about mandates takes the focus of vaccination off its delivery and place it squarely on the shoulders of individuals. Mandates implemented too early and without just process will fail to account for the real concerns of some about AstraZeneca vaccine safety where a real but small risk lies,that have been augmented by inaccurate and mixed messaging. They risk unnecessarily politicising people who are on the margins of vaccine acceptance who just want to address their concerns well. We have seen adversarial responses overseas to mandating vaccination in order to fully participate in social life – and the “us v them” chasms that appear to be widening as a result.
The World Health Organisation sets out pre-requisites for vaccine mandates to be justifiable. The mandate must be necessary to achieve an important public health goal that can’t be achieved by using other reasonable means (e.g. mask wearing,distancing,testing). The vaccine must be safe,and it must be effective. As well as protecting the individual,it must also be able to prevent spread to some degree so that it protects the public. There must be enough vaccine for everyone who wants it,and mandating the vaccine must not undermine public trust. These last two points are where the problems of mandating vaccine lie in Australia.