Friday, June 18, 2021

Make COVID-19 Vaccination Mandatory at Universities?

By Kai Chan [Improved 2021.6.19]

With COVID vaccine policy, Canadian governments and universities risk sleeping at the wheel, unfairly endangering vulnerable individuals in the name of a wrong-headed protection of personal freedoms. Governing effectively might—but doesn't necessarily—mean mandating vaccination.

As we contemplate finally returning to in-person instruction, now is the time to make this right.

Governments have been reticent to mandate vaccinations. For example, B.C.'s Return-to-Campus Primer states that “The COVID-19 vaccine will not be mandatory.” A recent editorial in the Globe and Mail argues forcefully against this policy, pointing out that "there is no constitutional right to put other people’s health at risk."
British Columbia's "Return-to-Campus
Primer"
: "The COVID-19 vaccine will
not be mandatory"


As a university professor, I've seen these dramas play out first hand. I've had students contract long-COVID, and almost fail out of my course. One student was in tears for an hour as we tried to work out a plan to complete the course.

And that was not a case contracted in class. I teach a course where students are expected to attend class and to participate (last year was on Zoom). Their grades depend on it. Sure, most students will probably get vaccinated, but some will choose not to. Imagine three hypothetical students.

A is unable to get the vaccine, perhaps due to severe allergies to vaccine components or—worse—due to an autoimmune disease that also puts them at additional risk should they contract COVID. They are extremely careful about their own exposure and are deathly afraid to go to any indoor place where some people are unvaccinated (and not nearly as careful as they are).

B is able to get the vaccine, but lives with immunocompromised individuals (perhaps like A), who are understandably hyper-vigilant about any source of exposure to COVID. B understands that the vaccine provides a strong degree of protection against them getting severely sick with COVID, but they worry about the unquantified risk that they might pass COVID from classmates to others, perhaps even without getting symptoms.

British Columbia's Guidelines document
doesn't even mention "vaccine".

C
is a healthy young adult. They're not afraid of COVID, and they won't get the vaccine. Perhaps they think (contrary to abundant and diverse forms of evidence) that COVID is just a conspiracy. Perhaps they have been told that they need to trust in God's will to protect them, rather than vaccines. Because they are not afraid, they're not at all careful about limiting their own exposure.

Is it fair that C should be able to subject A and B (and their families and friends) to the risk of COVID-19 in the classroom?

I don't think so. And at first, I couldn't see how anyone could argue otherwise. (This was a classic case of cultural cognition, by which my views were inordinately shaped by those I was reading and hearing.) But there are worthy counter-arguments. 

The first is that it is unfair for a government to force an individual to do something that entails side-effects and risks. Vaccination does have risks. Some of the rare side-effects don't emerge until after a large-scale roll-out, like the current concerns about rare heart inflammation associated with Pfizer in young people (fortunately most have recovered quickly, with no apparent deaths). So, on fairness, the arguments for mandatory vs. voluntary vaccination seems to depend on cultural context and political leaning.

Second, there is very little vaccine hesitancy here, and early polls suggested that most people didn't favour mandatory vaccination (only 39% of Canadians did in late 2020; although with vaccine-hesitancy shrinking, views about mandatory vaccination may also be changing). In this context, it's important to consider (a) effective alternatives to mandatory policies; (b) back-fire effects, where anti-vax folks might double-down on their position and cheat (e.g., Savulescu 2020); and (c) blowback in the form of widespread resentment of mandating authorities (e.g., Meier et al. 2019). Risks of back-fire and blow-back are substantial in some contexts (although fortunately, vaccine polarization in Canada is not like the US). 

So let's consider some alternatives to mandatory vaccination. One possibility is that individuals could be left to enforce a social contract by pressuring each other to get vaccinated (e.g., Korn et al. 2020). This might sound attractive. But this means governments leaving the burden of persuasion on the vulnerable and the proactive. To me, that sounds like governments reneging on their responsibility to govern.

A second possibility is incentives, offering rewards for vaccination. There's a question of fairness here, though, with any incentive program that only targets new vaccination once most of the population is vaccinated. Why should the hold-outs get rewarded? This also risks encouraging people to wait until rewards are offered. If instead everyone gets a reward, it's costly. And by rewarding people for basic pro-social actions, we may undermine altruistic and civic motivations.

A third possibility is to shift the default (a form of 'nudge'). Make it expected (not mandatory) for students to be vaccinated. Those who can't be vaccinated safely can supply a doctor's note, etc. Those who don't wish to be vaccinated can show up to provide their reasons for health officials. The decision can be automatic (e.g., without judgement about legitimacy). As long as we shift the burden of effort to those seeking not to be vaccinated, we reflect public priorities for herd immunity in the choice structure that individuals face.

If people requesting exemption have to show up to a vaccine clinic, this solution might be even more elegant. Resistant folks would be surrounded by folks getting vaccinated, and they could change their mind at the last moment to receive a vaccine instead.

For public policy, the choice isn't simply between mandatory vs. purely voluntary. There are other smart alternatives that might be both fair and effective (particularly switching the default).

This is a message for every province, and for every university where provincial governments continue to sleep at the wheel.

Don't mistake a purely voluntary approach for a good solution. It's just the easy one, not the right one.

If you found value in or agree with this post, please share it widely. KC

This post has been modified substantially since first publication, to better reflect a range of views and alternatives, thanks to an exchange with a colleague.

1 comment:

  1. Thanks for the post. I am also very concerned with the "going back to normal" plan in Set. when 1) vaccines are not giving 100% immunity but a very good protection to not get sick/hospitalized/etc, 2) people can still transmit the virus even if vaccinated, 3) new variantes such as Delta are coming to us, and 4) we will all be in the best place for wide transmissions: enclosed spaces for hours w/ not-so-sure ventilation system that could (?) renew our shared air. There was a good section on The Current talking about Western University making vaccination mandatory (https://www.cbc.ca/radio/thecurrent/the-current-for-may-31-2021-1.6046642/mandating-vaccines-at-universities-could-set-dangerous-precedent-says-bioethicist-1.6047417) and some people were more in favor of positive/alternative options than a negative reinforcement (no vaccine, no classes). It may also set a bad bioethical precedent with other medical conditions or situations in the future. More food for thought.

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