[H] mRNA Vaccine Mandates

Mandates are currently unjustified, primarily because the mRNA inoculant cannot prevent transmission of infection. The current policy and media environment carries with it no possibility for safe and nuanced debate. Academics, experts and the public should have capacity to draw attention to the ethical and moral dilemmas that surround vaccine mandates, particularly when efficacy and safety remain contested. This is impossible as those that attempt to broaden the debate - and draw attention to the issues that render vaccine mandates unwarrantedly coercive and insufficiently proportionate to the risk - themselves risk professional and personal attack. It is astonishing that despite decades of service to communities and the public sector those that have deviated from the narrative of the state have faced vilification. Yet a lack of balanced and safe places to draw attention to human rights implications and the evidence on waning will only perpetuate the current decline in institutional trust - and mandates may further erode existing goodwill.[i]

Good work to help management and employees facing vaccine mandates is being undertaken by the New Zealand-based advocacy organisation Voices for Freedom. Their information is underpinned by expert legal and scientific advice.

Necessary considerations in justifying a medical treatment mandate.

Mandates for vaccines have recognised the ethical dilemma of compulsory medical treatment, and have tended to focus on mandates for vaccines where the vaccine has a long history of safe use and is sterile. A 2021 Australian policy paper 'Policy considerations for mandatory COVID-19 vaccination from the Collaboration on Social Science in Immunisation' recognised this, stating that the prerequisites for vaccination included the following considerations:[ii]

The mandate should be legal – have legislative support;

Burden of disease should be high enough to justify a mandate: The heavier the disease burden, the more justifiable mandates may be to increase coverage. In a setting that poses a higher risk of transmission, particularly to people more likely to experience serious harm, imposition on liberties may be more justifiable, at least while the background disease rates are high and transmission thus more likely.

The mandated vaccines should be safe. Vaccines are an invasive intervention with risks of rare but serious side effects. Each required vaccine should have an acceptable safety profile, and where possible, the safest vaccine option should be available.. Governments need to operate a no-fault vaccine injury compensation scheme to compensate those required to vaccinate in the rare occurrence of a serious adverse event

The vaccines should reduce transmission. Ethically it's difficult to justify requiring someone to do something for their own good alone. A mandate is, however, more justifiable when vaccinating one person helps protect others around them. COVID-19 vaccines will prevent some degree of transmission because the vaccinated are less likely to acquire infection to begin with. In transmission studies, early evidence estimated a 40-50% reduction in risk of household transmission of the Alpha variant after at least one vaccine dose in an index case. Early evidence suggests the current vaccines may be less effective in reducing transmission from the Delta variant, 6 however published real world transmission studies are needed.

Vaccine supply should be sufficient and access easy. Prior to a vaccine mandate, governments must ensure a stable vaccine supply, effective distribution, equity of access, and convenient services. Australia’s vaccine supply has been limited to date and access remains challenging. People with disabilities and aged care providers have reported ongoing vaccine access challenges. 7 Early inequities in access have affected certain cultural groups disproportionately, such as Aboriginal and Torres Strait Islander communities and culturally and linguistically diverse groups. A penalty for not vaccinating when the government has failed to meet its service delivery obligations is unjust and may be ineffective without addressing the access barriers limiting uptake.

Less restrictive and trust promoting measures should come first. Prior to a mandate being introduced, there should be sufficient time for voluntary acceptance. Non-coercive measures targeting known causes of low vaccination should be exhausted, for example, on-site vaccination, reminders and incentives, 8 in concert with efforts made to understand and address other context specific barriers using available tools.

Establishing community trust and confidence is essential. People need opportunities to have their questions and concerns addressed. 9 Since mandates can undermine trust in voluntary vaccination programs, those imposing them should invest in tailored communications well in advance.

The failure to recognise that most of the population will benefit from natural immunity; that many treatments dramatically reduce the risk of hospitalisation and death; while implementing mandates that compels the population to ongoing inoculation (due to the short-term nature of the drug) is coercive, immoral and unethical.

In particular, the failure to address the safety profile of young people and children is evidence of a particularly disproportionate – and egregious – response that has failed the public interest. Legally, all government measures must be ‘proportionate to the public health risk sought to be prevented, minimised, or managed’ and not be made or taken in an arbitrary manner. [iii]

It is an established principle of English Law that ‘an individual with the capacity to consent cannot and should not be compelled to have any medical treatment against their wishes’.[iv] The Parliamentary Assembly of the Council of Europe passed a 2021 resolution[v] that stated that governments should:

Ensure that citizens are informed that the vaccination is NOT mandatory and that no one is politically, socially, or otherwise pressured to get themselves vaccinated if they do not wish to do so. (Paragraph 7.3.1)
Ensure that no one is discriminated against for not having been vaccinated due to possible health risks or not wanting to be vaccinated (Paragraph 7.3.2)

In September 2021, vaccine developer and viral immunologist and Associate Professor Byram Bridle in an open letter discussing the scientific data on immunity and how this contrasted with political decision-making at the Canadian university where he holds tenure. Bridle argued that vaccination mandates that did not test for nor consider the presence of natural immunity were not only morally problematic, but potentially increased health risk. Groups with prior natural immunity, when exposed to the vaccine were more likely to experience adverse events, including with the Pfizer vaccine.[vi] [vii]

The failure to develop or promote testing to confirm prior immunity has been a major failure of state responses to Covid-19. It is unclear why rapid response (rapid antigen screening) tests have not been promoted, particularly as a mechanism to check viral status for citizens when visiting the elderly or vulnerable. Current case identification through the testing of symptomatic people does not effectively prevent onwards transmission. It also does not draw attention to the health status of people who have COVID-19 but do not experience severe health-related effects. Rapid antigen tests (RETs) have adequate sensitivity in identifying cases of infection with higher viral loads. RETs should be government funded to ensure that all income groups have equal access. Rollout of RETs can be accompanied by public education.[viii]

In a recent presentation to the Association of American Physicians and Surgeons[ix] titled Winning the War Against Therapeutic Nihilism and the Rush to Replace Trusted Treatments with Untested Novel Therapies[x], Dr Peter McCullough drew attention to the censorship of scientific discourse and the narrowing of debate that excludes long-term evidential data concerning repurposed drugs and nutritional therapies. Controversially, McCullough stated that physicians have the authority to present the data ‘it’s pretty obvious that there has been a suppression of treatment to promote fear, suffering, loneliness, isolation, hospitalisation and death in order to promote the vaccine.’

He discussed, that in the absence of knowledge relating to therapeutics and risk, coercive lockstep measures have been more likely to work, resulting in a failure for many groups to recognise that a broader discussion.

Increasingly, scientists have discussed the potential for mass vaccination to drive antibody dependent enhancement (ADE) of infection[xi]. ADE has been recognised in the scientific literature for over 50 years and occurs when antibodies enhance virus entry and replication in cells. ADE is an ‘unavoidable problem’ in vaccine development and vaccine induced ADE is commonly recognised.[xii] Yahi and colleagues have commented how, in a study, infection enhancing antibodies not only still recognize Delta variants but displayed a higher affinity for the Delta variants than the original Sars-Cov-2 virus. They considered that there was potential for ADE to emerge in vaccinated individuals who are exposed to the Delta variant[xiii]

NEXT: [I] Controlling the scope - the cascading effects

REFERENCES

[i] González-Melado & Di Pietro 2021. The vaccine against COVID-19 and institutional trust. Enferm Infecc Microbiol Clin. 2020.

https://doi.org/10.1016/j.eimc.2020.08.001

[ii] Leask et al. Policy considerations for mandatory COVID-19 vaccination from the Collaboration on Social Science in Immunisation. The Medical Journal of Australia – Accepted Article – 13 September 2021

[iii] Health Act 1956. 92F Principle of proportionality https://www.legislation.govt.nz/act/public/1956/0065/latest/whole.html#whole

[iv] Lawyers for Liberty UK. Mandatory Vaccination. https://lawyersforliberty.uk/mandatory-vaccination/

[v] Parliamentary Assembly of the Council of Europe. Covid-19 vaccines: ethical, legal and practical considerations. Resolution 2361 (2021) https://pace.coe.int/en/files/29004/html

[vi] Raw et al 2021. Previous COVID-19 infection but not Long-COVID is associated with increased adverse events following BNT162b2/Pfizer vaccination. J Infect. 2021 Sep; 83(3): 381–412.

[vii] Monforte et al 2021. Association between previous infection with SARS CoV-2 and the risk of self-reported symptoms after mRNA BNT162b2 vaccination: Data from 3,078 health care workers. EClinicalMedicine 36:100914

[viii] Schwartz et al. Rapid antigen screening of asymptomatic people as a public health tool to combat COVID-19. CMAJ March 29, 2021 193 (13) E449-E452; DOI: https://doi.org/10.1503/cmaj.210100

[ix] Association of American Physicians and Surgeons. Sept. 30 to Oct. 2, 2021 – AAPS 78th Annual Meeting. https://aapsonline.org/event/sept-30-to-oct-2-2021-aaps-78th-annual-meeting/

[x] See: https://www.bitchute.com/video/kj4og8OaWvYm/

[xi] Tetro J.A. Is COVID-19 receiving ADE from other coronaviruses? Microbes and Infection 22 (2020) 72e73

[xii] Xu et al. Antibody dependent enhancement: Unavoidable problems in vaccine development. Advances in Immunology, Volume 151, Ch,3 pp99-133

[xiii] Yahi et al. Infection-enhancing anti-SARS-CoV-2 antibodies recognize both the original Wuhan/D614G strain and Delta variants. A potential risk for mass vaccination? Letter to the Editor. J. Infect. August 16, 2021

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