A group of scientists and academics from the Universities of Oxford, Harvard, Johns Hopkins, London School of Hygiene and Tropical Medicine and more has published a paper setting out why coercive vaccination policies are “counterproductive and harmful”. Covering behavioural psychology, politics and law, socioeconomics, and the integrity of science and public health, the authors – two of whom are funded by the Wellcome Trust, a major funder of medical research led by Sir Jeremy Farrar with close ties to the pharmaceutical industry – set out why the “risks and harms of punitive public health strategies far outweigh the benefits”.
The full list of authors is as follows:
- Dr. Kevin Bardosh, Applied Medical Anthropologist, University of Washington
- Dr. Alex de Figueiredo, Research Fellow, Vaccine Confidence Project, London School of Hygiene and Tropical Medicine
- Dr. Rachel Gur-Arie, Postdoctoral Fellow, Bioethics, Johns Hopkins University
- Dr. Euzebiusz Jamrozik, Fellow in Ethics and Infectious Diseases, Wellcome Centre for Ethics and Humanities, University of Oxford
- Dr. James J Doidge, Senior Statistician, ICNARC
- Professor Trudo Lemmens, Health Law and Policy, University of Toronto
- Professor Salmaan Keshavjee, Global Health and Social Medicine, Harvard Medical School
- Professor Janice Graham, Medical Anthropology and Infectious Diseases, Dalhousie University
- Professor Stefan Baral, Department of Epidemiology, Johns Hopkins University
In the paper, the authors point to the backlash against coercive vaccination policies and the breaching of important ethical norms and the implications for public health in the future.
The adoption of new vaccination status policies has provoked a multilayered global and local backlash, resistance and polarisation that threaten to escalate if current policies continue. It is important to emphasise that these policies are not viewed as ‘incentives’ or ‘nudges’ by substantial proportions of populations, especially in marginalised, underserved, or low COVID-19-risk groups. Denying individuals education, livelihoods, medical care, or social life unless they get vaccinated does not appear to coincide with constitutional and bioethical principles, especially in liberal democracies. While public support appears to have consolidated behind these policies in many countries, we should acknowledge that human rights frameworks were designed to ensure that rights are respected and promoted even during public health emergencies.
They argue the coercive policies are ineffective on multiple fronts and not fit for purpose.
While we recognise that vaccination policies can be reconciled with, and are an important tool in, the promotion of the right to health, they need to be proportionate and designed such that they achieve a clearly defined public health goal. Those supporting current restrictions based on vaccination status seem to presume that these measures are indeed proportionate; that they are not more restrictive than strictly required; that they are effective in preventing transmission and protecting the health care system from collapse; and that there are no options available other than punitive mandates, passports and segregated restrictions based on vaccine status. As we have shown, we believe that current vaccine policies have failed on these fronts and are no longer fit-for-purpose.
The absence of a proper empirical assessment of the benefits and harms of the policies lies at the root of the problem, they argue.
We encourage social and behavioural scientists, bioethicists, epidemiologists, legal scholars, and others to urgently empirically assess the benefits and harms of COVID-19 vaccination policies. Empiric assessments may or may not validate the concerns presented in this paper – but their generation is critical in engagement with politicians, scientists, and organisations to reconsider current COVID-19 policies affecting those who remain unvaccinated. COVID-19 will not be the last public health emergency of international concern and it remains critical that we understand the policy mechanisms and governance inclinations that have so quickly adopted these approaches and provide robust evidence to improve future policy-making in times of crises. If not, the proclivity for mandates, passports, segregated lockdowns, fines, and punishments are likely to become a normative de facto feature for the next public health emergency, especially if they are institutionalised in the International Health Regulations (IHRs).
They express concern for the future if the precedents set in the past 12 months are not reversed.
Are we now experiencing a paradigm-shift into a permanent annual cycle of mandatory COVID-19 vaccines, with ever-changing criteria depending on the latest booster? Will unvaccinated people face exclusions in society for years to come? Will we return to new mandates, and street battles between protesters and police, each time a new variant emerges? Will influenza vaccines and other vaccines now become mandatory, including for low-risk groups? If unvaccinated people continue to refuse to be vaccinated in countries with strict punishments, what happens next? What is the end-goal and where is the policy off-ramp? Most importantly, what will this do for trust in global immunisation programs and other public health measures?
Raising worries about scapegoating and the effect on trust in public health strategies of the present heavy-handedness, they call for data transparency, media independence and public debate and scrutiny about COVID-19 vaccine policies.
Public health associated bureaucracies and society now risk having to increase coercion to address current and future resistance and, in the process, come to leverage strategies more consistent with policing than public health. Political forces may double-down and use people who have chosen not to vaccinate for myriad reasons as a scapegoating class while continuing to neglect much needed health and social system strengthening. Without appropriate empirical and ethical justification, current COVID-19 vaccine policies are a fundamental reflection of the failure of trust in public health strategy, something that is certainly rooted in decades of neoliberalism, austerity social policies and the growth of social media. Future investments in public health capacity, especially health workers who can work in communities to build a relationship of trust, will be essential to engage in positive reform if mandates are not to become the new global strategy for addressing all future epidemics and pandemics. Data transparency, media independence and public debate and scrutiny about COVID-19 vaccine policies will be essential to maintain population trust, help people better understand the risks and benefits of the continued use of current vaccines and to inform research on improvements and future policies.
They conclude with a call for a return to non-coercive public health measures and an end to “punitive” policies which appear to be “fulfilling a collective, psychological and political need for scapegoating and to reinforce a false notion of safety among vaccinated people as they attempt to resume social and economic life”.
It is time for policy to regain a focus on non-coercive public health measures, including pro-social language and community leadership for vaccination, especially to protect high-risk groups. There are other options to address the pandemic and it is not too late to return to empowering, transparent, and community-informed policies based on equity and non-discrimination that many public health practitioners have been calling for since the outset. As we have argued above, the scientific case for punitive COVID-19 vaccine policies, given the proprietary nature of our current vaccines, no longer fits with pre-pandemic bioethical norms and public health ethics. Rather, it appears to be fulfilling a collective, psychological and political need for scapegoating and to reinforce a false notion of safety among vaccinated people as they attempt to resume social and economic life. Policy makers should reflect on the necessity of enforcing what is essentially a new two-tier, segregated social system and how this will affect different social groups now and into the future – behaviourally, politically and socio-economically – as well as the impact of such policies on the integrity of science and public health itself. As we have attempted to show, it may very well be that the risks and harms of punitive public health strategies far outweigh the benefits.
This is a significant intervention by scientists and academics taking a principled stand against the coercive policies that have been normalised in the past year. It is worth reading in full.