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According to the Department of Tourism, South Africa plans to introduce a vaccine passport. The notion of vaccine passports and mandatory vaccination – for all intents and purposes, the two go hand in hand – seemed like a distant reality just yesterday. Today, however, is another story. This article on mandatory vaccination was authored by Abir Ballan who has a Masters in Public Health and a background in both psychology and education. Ballan, who is a member of PANDA, looks at mandatory vaccination and outlines ten reasons why COVID-19 vaccination should never be mandatory. With less than a year of vaccine ‘trials’ from which data can be gathered on the long-term efficacy and safety of the vaccines, Ballan argues that, ‘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.’ – Nadya Swart
Mandatory vaccination: The greater evil of society
By Abir Ballan, MPH*
COVID-19 presents a high risk of severe illness and death to a few and a negligible risk to the majority of the population. The median age of death with COVID-19 is similar to that of natural mortality in most countries. 95% of deaths occur in individuals with 1 or more existing health problems. 99.95% of individuals below 70 survive. Survival is even higher for healthy individuals. Children and young people have almost zero risk of death from COVID.
The epidemiological reality of COVID-19 lends itself to a focused vaccine approach: 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 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 – maximising 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 benefits and costs of an intervention in terms of individual welfare versus collective benefit. Vaccines are designed to confer protection to 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.
- 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 (Pandemics—Data & Analytics). 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. Twitter handles: @abirballan, @pandata19
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