Should anti-vaxxers have access to public health care?

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A healthcare worker hangs their head and looks at their hands. Image: Jonathan Borba/Unsplash

The Delta variant is causing a fourth wave of the COVID-19 pandemic. Currently, the unvaccinated represent well over 90 per cent of those hospitalized with severe COVID. They require aggressive medical intervention and they account for the vast majority of deaths from the virus.

Until vaccines are approved for babies and children, the only other people who should not receive vaccines are those who are allergic to them.

It is unlikely that vehement anti-vaxxers can be convinced to receive shots, although some do express regret after being hospitalized. How can we encourage the remaining unvaccinated -- aka the vaccine-hesitant -- to receive shots?

We have already learned that it takes both incentives and disincentives to succeed at changing people’s minds about vaccinations. In Quebec, those without COVID passports, are barred from entering restaurants, gyms and entertainment/sports venues. The announcement of the passport resulted in large increases in appointments for shots.

This pattern repeated in B.C. There, the announcement of vaccine passports triggered a greater-than-fourfold increase in vaccine appointments. Ontario has just announced a similar passport; a surge in vaccinations has already begun.

The carrot approach suggests that being fully vaccinated would make life much easier. The stick approach suggests that penalties and restrictions might work. How extreme could the negative consequences be? What if the children of the unvaccinated were barred from attending day cares and schools? What if the unvaccinated were prohibited from seeking care at hospitals?

In Canada, health care is treated as a right, though it is not actually a legal right in this country. Canadians are generally unwilling to deny health care to anyone who presents at a hospital. However, there are many situations in which we do challenge patients’ rights to hospital care.

One example: women who turn to Catholic hospitals for abortion and family planning services will be turned away. Another example: the occasional legal steps taken to transfuse a minor when the parents do not agree to this treatment. A third: the right of health-care professionals to refuse to perform work that they believe puts them at risk or conflicts with their beliefs.

What if treating the unvaccinated is one of these situations?

Is there no balance of responsibilities to the perceived rights to health care? At the outset of the pandemic, the goal to flatten the curve was to keep hospitals from being overwhelmed. The goal has not changed. With the demographic of health-care providers mirroring that of the boomers, many retired physicians and nurses were called back to work to treat the huge influx of very sick people. Other physicians and nurses were reassigned from their particular specialties to work in emergency rooms and ICUs, both filled with people suffering from COVID.

What is the obligation of front-line workers dealing with the intentionally unvaccinated? The question is now being addressed by various professional associations. However, the discussion is inconsistent across the country and it does not address the role of patient-facing workers who are not caregivers, such as cleaners and administrative staff in care settings. What we do know is that many of these people have been working almost non-stop since the beginning of the pandemic. They have put themselves -- and thus, their families -- at risk to continue to serve COVID patients. They are exhausted, not just physically, but emotionally as well.

But that was before vaccines were here. Now that vaccines are available to just about anyone who wants one, how much longer can we expect health-care and allied workers to continue to put themselves at risk because people are unwilling to be vaccinated? The level of empathy for these patients is decreasing. After 18 months of intense and emotionally draining work, health-care service providers are beginning to talk about quitting. Can we blame them for their enough-is-enough thoughts?

We may never be able to convince adamant anti-vaxxers. But what about the vaccine-hesitant? There are potential options:

  • For people who are afraid of missing work or cannot afford to do so, create a 1-800 number that would dispatch trained vaccination staff to the workplace.
  • For shut-ins or others who cannot negotiate on-line appointment booking or their own transportation to a vaccination site, use the 1-800 number to have trained vaccination staff come to the home.
  • To ensure that the elderly at home are vaccinated, take advantage of pharmacy records to contact people, in order to send the jab to the patient, rather than the reverse.
  • In high-risk communities, create targeted communication programs advising that shots are available at home or in a recognized safe community space, to be provided by trained vaccination staff from the community.

These solutions come with a price tag, but compared to the cost of treating a patient in an ICU, they are cost-savers. In March 2021, data from the Canadian Institute for Health Information (CIHI) showed COVID-19-related hospitalizations in Canada cost about $23,000 per stay, some four times the average hospital stay. CIHI says the average length of stay for a COVID-related hospitalization in Canada was two weeks. How much more could be done with those resources and funds, not just by vaccinating the hesitant, but by reopening hospitals to people requiring non-COVID care?

These suggestions also have potential legal and privacy issues. But they could accomplish a major goal, i.e., to reduce the transmission rate of new variants and to keep the vast majority of the population out of hospital. Is it not worth pursuing out-of-box solutions, even when they require crossing jurisdictional boundaries, when so much is at stake?

We are in the midst of a federal election campaign. What are the parties and the candidates saying about vaccination programs? Not much.

Thus far, the Liberals have focussed on federal civil servants as well as employees of federally regulated transportation, including planes, trains and cruise ships. Details are scarce, although the deadline for implementation is October 1. There has been no mention of programs to bring the shots to people, rather than the reverse.

The Conservative plan relies heavily on persuading more Canadians to get vaccinated by providing incentives and by developing a public information campaign that will "appeal to Canadians' patriotism."

The NDP would immediately tackle the fourth wave of the COVID-19 pandemic with a billion-dollar plan to increase vaccination rates and would target remote parts of Canada and vaccine-hesitant groups.

And while the Greens profess to be very concerned about vaccinations, they have yet to announce a platform on the topic.

In the interim, the fourth wave rages on, oblivious to the federal election.

Evelyn H. Lazare is a retired health-care planner, strategist and executive. Currently living in Ottawa, she now devotes her writing primarily to novels.

Image: Jonathan Borba/Unsplash

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