Thread by @maxwellsmith

@WesternU has announced that it's implementing a #COVID19 vaccination policy for all students, staff, & faculty on campus. Prudent & smart. As a public health ethicist, I thought I'd address some frequently raised concerns about vaccination policies and #vaccinationmandates 1/13

https://twitter.com/WesternU/status/1425581805764284422

Vaxx policies/mandates do not force anyone to be vaccinated. It's erroneous to call this a forced medical intervention or to reference Nuremberg. Informed consent is still required and people can still choose to not be vaccinated. There are simply consequences to one's choice. /2

A key ethical question for mandates is whether the consequences of refusing to be vaccinated negate meaningful choice. If one feels strongly enough about not being vaccinated, a viable option remains to not be vaccinated, so this arguably does not negate meaningful choice. /3

There is a strong scientific rationale for vaccine requirements. COVID-19 represents a significant threat (esp. Delta), COVID-19 vaccines are effective at reducing risks of infection & severe outcomes, and mandates can increase vaccine coverage and protect at-risk populations. /4

There is a strong ethical rationale for vaccine mandates. Governments and institutions have an ethical (& legal) obligation to protect public health and well-being, and mandates are sometimes a necessary and effective tool to discharge this obligation. /5

Do mandates infringe on liberties? While mandates can in some ways (justifiably) limit liberties (much like other acceptable interventions), they can also be liberty enhancing as they facilitate businesses/schools staying open and make it less risky for people to enjoy them. /6

What about rights? Again, vaccination isn't forced, & absent from conversations is the right to not be put at greater risk of infection. Our rights cannot be stretched to protect whatever activity someone chooses to define as central to their lifestyle scc-csc.lexum.com/scc-csc/scc-cs… /7

Because we care deeply about rights, we should do things that promote them. This includes making individual sacrifices to prevent harm to others whenever doing so carries a minimal burden, like by being vaccinated. /8

What about the Charter? As @ColleenFlood2 @BryanPaulThomas & Kumanan Wilson argue, actions by nongovernmental actors [e.g. universities] are subject to the Charter much more rarely & only when acting governmentally (i.e. carrying out government policy) cmaj.ca/content/193/6/… /9

Those who are unable to receive a vaccine and who require an accommodation as the result of a medical condition or other grounds protected by the Ontario Human Rights Code should be accommodated, but should still take steps to protect public health (e.g., frequent testing). /10

With any vax policy, an ethical imperative exists to ensure everyone has a meaningful opportunity to be vaccinated, that we promote equity & trust by ensuring some populations are not disproportionately disadvantaged, & frequently evaluate the continued need for the policy /11

Questions of enforcement are key. It is infeasible & inappropriate to have people checking vax at university gates, but is straightforward for staff/faculty & settings like gyms, sports, etc. Enforcement should otherwise come from threat of sanction for fraud/violating policy /12

Some helpful resources on the ethics and legality of #vaccinemandates & #vaccinepassports:
- who.int/publications/i…
- cmaj.ca/content/193/6/…
- cdhowe.org/public-policy-…
- theglobeandmail.com/opinion/articl…
- universityaffairs.ca/opinion/in-my-…
@JacobShelley @ColleenFlood2 @picardonhealth /thread