Should Ontario make a COVID-19 vaccine mandatory?

OPINION: This week, we got the first signs of when a vaccine might become available in Canada. That means the province has to start thinking about whether Ontarians will be required to get it
By John Michael McGrath - Published on Aug 07, 2020
The federal government announced this week that it had signed two agreements with major drug makers to procure millions of doses. (iStock.com/kiattisakch)

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This week, we got the first serious indication of when a vaccine might become available for COVID-19: the federal government announced it had signed two agreements with major drug makers to procure “millions” of doses and is working on other agreements that could secure more. Not every company that’s currently working on a vaccine will bring a safe and effective product to market, so it’s sensible for Ottawa to cultivate numerous prospective partners on this front.

But, lest anyone be tempted to pop champagne corks, Canada’s chief public-health officer, Theresa Tam, reminded reporters that there are still many unanswered questions about a possible vaccine and that we can’t be certain about what one would mean for the battle against this 21st-century plague — certainly, nobody should be confidently predicting a return to normalcy in 2021.

“Really, honestly, we don’t know, at this stage, how effective the vaccine is going to be, whether it’s going to prevent serious illness and hospitalizations,” Tam said Tuesday. “Some vaccines — the influenza vaccine, for example — protect you from serious outcomes but don’t necessarily prevent you from getting the infection altogether. These questions remain unknown.”

As for how long the pandemic could last, even once a vaccine becomes available, Tam said, “We’re planning, as a public-health community, that we’re going to have to manage this pandemic for the next year, but planning for the long-term for the next two to three years during which the vaccine may play a role. But we don’t know yet.”

It's an important reminder that there’s still so much we don’t know about this virus and how we’ll be able to treat or defeat it. The best-case scenario right now is that, sometime late this year or early next year, we’ll get a vaccine that’s certified as safe and effective, and it’ll go into mass production. If we’re very lucky, it will be something more like the measles vaccine — something that lasts years, with only occasional boosters required — than the influenza vaccine, which requires regular annual shots.

But even that best-case scenario would involve months of waiting for stocks of the vaccine to be developed and distributed. The announcement this week was from the federal government, but it’s going to be the provinces that decide how the vaccine will get into actual people, since they operate the health-care systems in this country. At least initially, there will likely be a period of rationing. Understandably, there’ll be a desire to get front-line health-care workers — doctors, nurses, and (perhaps most especially) workers in long-term care — inoculated first.

And, then, when there are sufficient stocks of vaccines for the general population to start getting stuck in the arm, the government will need to make a pretty hard decision: whether to make the vaccine mandatory or not. This isn’t fanciful prediction; governments across Canada, including the feds, are already being asked this question. They’re going to need an answer.

There’s a pretty easy argument for making it compulsory: if you are now or have ever been in one of Ontario’s schools, public or private, you’ve been subject to mandatory vaccines under the Immunization of School Pupils Act, which requires a person to prove they’ve been vaccinated or face potential suspension from school. There are, of course, exemptions under the act; that’s why, before COVID-19, one of our public-health problems in Ontario was anti-vaxxers creating pockets of vulnerability where once-vanquished diseases, such as measles, could spread again. But the legal principle is reasonably sound: if the government can force students to take a vaccine — and it clearly can — then this could be a reasonable part of the government’s COVID-19 response.

So far, however, the province isn’t thinking along these lines.

“There are no plans currently to make the COVID-19 vaccine compulsory for students,” Alexandra Hilkene, spokesperson for Minister of Health Christine Elliot, told TVO.org in an email. “Once we get the COVID-19 vaccine, we'll have to see what it consists of and how it has been developed by manufacturers before we can make any decision on whether to make it mandatory.”

“That said, any COVID-19 vaccine that’s approved by Health Canada will be proven to be safe and effective and as such we highly recommend that people get the shot,” Hilkene added.

The province’s chief medical officer of health, David Williams, explained Thursday that the vaccines required for students under current law share some factors that might not be apply in the case of a COVID-19 vaccine.

“The mandatory vaccines are ones that we give, they’re for lifetime qualification,” Williams said at Queen’s Park. “The ones we’re talking about, these are the childhood vaccines, the ones for measles, mumps, rubella, chickenpox, pertussis — there are various ones, other ones that are part of the childhood series that equip them for longer-term life immunity that are useful as they go into the school world and beyond that.”

If the government is disinclined to make a COVID-19 vaccine mandatory, the good news for it is that most Ontarians are interested in getting one. According to an Angus Reid poll released this week, 46 per cent of Ontarians would want the vaccine as soon as it becomes available, and a further 35 per cent plan to take it “but would wait a while first.” (Not an unreasonable position for a brand-new medical intervention!) Only 13 per cent of respondents in this province say they wouldn’t take the vaccine at all; that number is 20 per cent in Saskatchewan and 22 per cent in Alberta  — men are over-represented in the “no” column in all age groups.

Again, the problem for the government is that there’s still so much we don’t know about this virus. One big question mark is whether leaving 10 or 20 per cent of the population unvaccinated would be compatible with resuming some kind of pre-pandemic normal life. Maybe public-health experts will say that’s doable; maybe they won’t. Before decisions can be made about any of that, we’ll need the vaccine.

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