‘Mandatory vaccine policy is in the public interest’ – Professor Keymanthri Moodley

“A mandatory vaccine policy is absolutely critical,” says Professor Keymanthri Moodley, a bioethicist and director of the Centre for Medical Ethics and Law at Stellenbosch University. Professor Moodley joined BizNews to explain exactly why she believes that a mandatory vaccine policy is necessary for ‘high-risk environments’. She says that healthcare workers are exhausted and will soon develop compassion fatigue, a dangerous prospect for anyone who needs urgent medical attention. She also says it’s the only way to ensure an increase in economic activity and prevent further lockdowns. “It’s in the best interest of the government and the country to have a good mandatory policy in place and to ensure that people are healthy and safe and can return to employment and other activities as soon as possible,” she says. – Claire Badenhorst

Professor Keymanthri Moodley on why she believes in a mandatory vaccine policy:

I think the sheer number of deaths that we’ve been experiencing globally, including in South Africa, has been particularly concerning. As a healthcare practitioner, having served in the public health system for more than 20 years, I’m very familiar with the limited numbers of ICU beds and Covid ward beds that we have currently. I know that the strain on the health system is simply untenable. Our healthcare workers are exhausted. They’ve been working tirelessly through waves one, two, and now again in wave three, and nobody’s looking forward to a fourth wave. In order to reduce the number of people with serious illness, to reduce the number of deaths and hospitalisations, we need to ensure that vaccine rollout occurs really quickly.

Although vaccines are not perfect, they are the best tool we currently have in our box of prevention tools. I think you’ll remember from the HIV days that we spoke about a box of prevention tools to protect people from developing HIV and also to minimise transmission and to minimise illness. So likewise, during Covid, it’s important to consider the fact that we do have a toolbox of prevention items that includes vaccines, masking, hygiene measures, physical distancing, etc. And it’s really important that we apply all of these prevention measures as soon as possible and that everybody participates in this process. So having vaccines is critical.

Many different methods are being used to encourage vaccination – education, counseling, incentives – but vaccines are ultimately what we need, and we need as many people vaccinated as soon as possible. This is why a mandatory policy is essential in high-risk environments and in all communal settings because that is where we as individuals start to put other people at risk. And so to a large extent, the need to get the disease under control as quickly as possible, to prevent the virus from mutating, and to ensure that we do not have more vicious variants than the ones we currently have, a mandatory vaccine policy is absolutely critical.

On why it is legally possible:

That’s the first thing I looked at. You know, ethically, I was quite clear that it is justifiable. A mandatory policy is justifiable on the basis of public interest and saving as many lives as possible during this pandemic. We know individual rights need to be limited, so we need to be clear about this. I’m not suggesting that individual rights must be violated. I’m suggesting a limitation on individual rights, which is critical during a public health crisis. Now, legally, even the Constitution allows for a limitation of rights, provided the limitation is based on law and it’s reasonable and it’s the least restrictive limitation we can impose, etc. So the law in South Africa makes provision for a limitation of individual rights as do a number of international declarations like the Siracusa principles developed by the United Nations. So globally, it’s an accepted phenomenon that under special circumstances such as a public health emergency, we may limit individual rights.

We’ve already done this in South Africa with the Disaster Management Act, and we’ve had lockdowns, mandatory mask-wearing, etc. So mandatory vaccination policies would also fall within the law in that respect. There’s also an important part of the Constitution that talks about the fact that everyone has a right to a safe working environment. This means employers, employees, clients who visit the business premises – so everybody has a right to a safe environment. That means that vaccinated people in the work environment will not be comfortable having unvaccinated people working with them as they would perceive them to be at higher risk of contracting Covid and transmitting Covid within the workspace. So the Occupational Health and Safety Act, the National Health Act, in terms of communicable diseases – we have numerous pieces of legislation and the Constitution that will allow limitation of rights under these circumstances and that will support a mandatory vaccination policy.

On the feedback she has received: 

When my article was first published on mandatory vaccination in The Conversation over a week ago, I had a tremendous amount of positive feedback from members of the health profession, other bioethicists in the country, [and] members of the legal profession who are experts in Constitutional law. So the positive feedback has been tremendous – support from the public as well, from people who desperately want everyone in society to be vaccinated.

Now, needless to say, there has been some negative feedback as well from a wide variety of anti-vaxxers and mostly, none of them are able to advance clearly formulated arguments based on science to support their position. This is the type of misinformation that is circulated by people with low health literacy, poor understanding of science, poor understanding of drug development and clinical trial regulations, who also have paranoia around the pharmaceutical industry. Yet many of these people are also using a wide variety of medication manufactured by the very same manufacturers of Covid vaccines today. So a great deal of confusion coming through, so it’s important that we continue with education initiatives that correct the misinformation that is circulating widely on social media in a very irresponsible manner.

To a large extent, [it’s] a matter of some people in society simply wanting to have their own way and not wanting to be guided or told that certain health measures need to be implemented for their own good. The funny thing about the anti-vax movement is that as long as they continue resisting and encouraging others to refuse vaccines, the virus is just going to spread rampantly. We are going to go into vicious cycles of a fourth wave, a fifth wave, a sixth wave, etc. Not only is this having a negative health impact on all in society – so those with Covid and those with other non-Covid illnesses in terms of access to healthcare – but it is also having a negative impact on the economy, driving unemployment.

So these multiple effects in terms of health and the economy are simply being perpetuated by the very people who are fighting against lockdown and who are fighting against the economic impact and against the ability that Covid imposes in terms of socialisation. So if we all want a better future, it’s in the interest of all to try as much as possible to adopt the prevention measures that are available in terms of vaccines and masking, etc., and to assist in bringing this pandemic to an end. At the end of the day, it will be a win-win situation for all of us.

On how it would work:

So I think we need to look at specific environments where risk is important, such as hospitals. So all healthcare workers in hospitals, if they have not yet accepted a vaccine on a voluntary basis and they’ve had more than six months to do this, to ensure that we enforce some kind of mandatory vaccine policy at that level. So for healthcare workers who have a duty to themselves, to society, to their patients, [and] to their families to ensure they have a vaccine.

Then there are people who work in homes for the aged and the disabled and here again, these are high-risk populations, so we need employees in those environments to have a vaccine. Then there are a number of different communal settings like gyms and restaurants, university campuses, where people congregate, shopping malls, etc. and wherever there are many people that need to be in the same space at the same time, we need prevention measures in place. So requiring vaccines at those particular venues is important.

It’s not really difficult to implement. It’s been done around the world and yes, there has been some pushback. So we’ve seen the protests in France, etc. but they die down after a while and people accept that in Europe, you need a green pass in France to enter a restaurant or to enter other similar venues. People accept and adopt it. So there will always be some pushback but one needs to persist with the implementation of a mandatory policy as long as it’s in the public interest, and with Covid, we know that it is in the public interest.

On why it hasn’t happened yet:

Well, there’s a vaccine MAC (Ministerial Advisory Committee) that is in place and this is exactly the type of discussion that ought to be happening at the level of the vaccine MAC. Whether the Department of Health will accept the advice of the vaccine MAC is a different matter altogether, but there’s absolutely no reason why we don’t have a mandatory vaccine policy in place already for specific high-risk environments. It didn’t take too long for the UK to implement this type of mandatory policy for all health workers in the National Health Service. So in other parts of the world, the ethical issues were resolved, the legal issues were resolved and policy was simply implemented.

So in South Africa, we sometimes suffer with a bit of decision paralysis and it’s because many people do not correctly understand the Constitution. They fail to see that the right to life is a significant right that must be balanced against other rights, like the right to bodily integrity and the right to religious freedom, and that in a crisis, the right to life takes precedence. This is really important that there must be a good understanding of the Constitution, because if we fail to understand the Constitution correctly, then we are hesitating to implement policy for the wrong reasons.

The hesitancy is understandable to a certain extent, given the history of the human rights agenda in South Africa, the history of apartheid, etc., but it is the responsibility of the current government to understand that there’s a public health crisis. We’re over the apartheid days in South Africa now for many decades, we are dealing with a public health crisis, we need to see it for what it is and choose the correct strategies to bring this pandemic to an end. If it requires limitation of rights, then there must be no hesitation in doing that. We had no hesitation in implementing lockdown, isolation, quarantine. There was the Disaster Management Act. So simply to include vaccines where necessary in terms of high-risk environments and communal settings is simply an extension of everything else we’ve done to bring our pandemic under control.

The government has done a great job in procuring vaccines, so we now have a very good supply of vaccines, but we need to ensure that we do not waste even a single dose of those vaccines, that we ensure that they get into arms as quickly as possible and that people get on with employment and rebuilding the economy. So it’s in the best interest of the government and the country to have a good mandatory policy in place and to ensure that people are healthy and safe and can return to employment and other activities as soon as possible.

On the impact on healthcare workers: 

We must not forget the terrible negative impact at the moment on the healthcare system and our healthcare workers. You know, we’re getting into a position now where healthcare workers who decided to serve humanity by providing healthcare are developing compassion fatigue. That is a huge threat to, you know, future health, our access to health services, and the quality of healthcare that we may receive. People are simply exhausted within the healthcare setting and that is a major threat to all of us. So we need to ensure that we have some level of respect for the healthcare providers who have made innumerable sacrifices for the past 18 months, and we need to play our part by getting a vaccine, cooperating, continuing with our prevention measures, masking included, and hope that we will all be in a better place in the months to come.

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