The Ontario COVID-19 Science Table issued a brief earlier this week laying out the arguments in favour of some kind of “vaccine certificate” system for domestic use in Ontario: a more rigorous kind of proof of vaccination than the receipts people are currently issued that could be used to exclude the unvaccinated from the highest-risk non-essential places, such as bars, restaurants, gyms, and theatres.
There is one problem — one expressly conceded in the document: the authors note that they can’t say with scientific confidence that such certificates would reduce COVID-19 transmission or increase vaccination uptake. It’s still a novel pandemic, after all.
“You also have to remember this is a new virus, and population-wide coverage of these vaccines is also new,” says co-author Karen Born, an assistant professor at the University of Toronto’s Institute for Health Policy, Management and Evaluation. She acknowledges that the case for certificates — more commonly known as vaccine passports — can’t cite peer-reviewed literature to make the case yet, because it doesn’t exist. But, she says, “just because there’s no evidence to date doesn’t mean we can’t make that pragmatic case.”
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In the absence of iron-clad, gold-standard evidence, we can look to other provinces, such as Quebec and Manitoba, and to other countries — both Italy and France have announced they intend to implement a vaccine-certificate system.
But the most compelling case might be Israel, where the government relied on a form of vaccine certificate, the “Green Pass,” earlier this year to control access to some non-essential places while implementing a comprehensive vaccination of its population. The Green Pass was suspended on June 1. But on Thursday, in the face of a higher rate of new cases, the government announced it would return, terming it a policy of “soft suppression.”
(For those people who insist that we need to “learn to live with the virus”: that’s exactly what Israel says such measures are in service of: we’re allowed to choose how we live, intelligently, with a new endemic virus.)
While Israel has a higher share of its population fully vaccinated than Canada or Ontario, it’s still vulnerable to new pandemic waves. Although Ontario is currently seeing low numbers of cases and falling hospitalizations, it’s not hard to sketch out how a resurgence of COVID-19 could happen here in the next few months: the province will likely enter whatever comes after Step 3 in August, and both public schools and post-secondary education will resume in September. Many employers will start calling their workers back to offices in the fall, and all of these things will lead to increased spread of the disease.
Kieran Moore, the chief medical officer of health, has said he expects a new wave of infections in the fall. That’s in part why he repeatedly urges people to get their shots — to try to minimize the severity of a potential fourth wave.
True, the vaccines mean that cases are far less likely to turn into hospitalizations and deaths. But they haven’t changed one crucial thing: it takes only 300 or so people in Ontario’s intensive-care units to start delaying hospital procedures, and we’ve barely started to dig out from the procedure backlog that built up over the past 18 months. There are more than 4.5 million people currently unvaccinated in Ontario as of today; nearly 275,000 of those are over the age of the 60, according to the province’s daily data release. COVID-19 could still throw a wrench into our hospital system if spread isn’t controlled.
And what would the government do if ICU cases were to start creeping north of 200 again in the fall and show no sign of slowing? (Friday’s number is 136.) Another round of broad-spectrum lockdowns would overwhelmingly punish the large majority of people who’ve done the right thing and gotten their shots. It would also rightly enrage businesses that are just starting to get their customers back after a brutal year. Born cites gyms as an example of the kind of business that could be saved by a vaccine certificate in the event of a fourth wave. Movie theatres, already chafing under what they call “arbitrary and unreasonable” restrictions, are another example.
“This could allow for a faster reopening and also allow for increased capacity in those settings,” Born says. “We’re looking at places where certificates should be used and also where they shouldn’t — lower-risk settings and essential settings.”
It doesn’t make sense to let needed medical care be postponed once again in this pandemic because we didn’t maximize our vaccination coverage, especially given that a vaccine certificate could be implemented relatively quickly — we know that the province did the work to develop a digital pass before deciding to abandon the idea.
“It’s either, let’s do a shutdown, let’s close businesses and schools, or let’s lean into this kind of framework,” says Born. “The alternative is closures that we’re all familiar with at this point.”
Not only has the government failed to implement any kind of rigorous proof-of-vaccination policy; it also hasn’t clarified the legal rights of businesses or employers with respect to unvaccinated customers and employees, creating a fog of confusion that helps nobody (except anti-vaxxers).
Vaccine passes raise legitimate civil-rights concerns, and they should obviously be implemented carefully and thoughtfully; the science table’s brief has important advice on how to do that. When Premier Doug Ford says that it’s a constitutional right to take the vaccine or not, he’s not wrong. But the freedom not to be vaccinated should not require the rest of us — or the province’s hospital system — to be held hostage to people’s refusals. And it’s difficult to believe that a government that has compelled the speech of businesses to attack the federal Liberals and prohibited the speech of unions for its own electoral advantage is making a sincere defence of Ontarian’s Charter rights here. In any event, a vaccine certificate is arguably a less intrusive public-health measure than broader lockdowns.
That, then, is the logic behind calls for a vaccine passport: the government shouldn’t let a fourth wave delay needed medical care in our hospitals, and it shouldn’t use the blunt instrument of new lockdowns again. A vaccine certificate would give the Tories a smarter, more targeted alternative — if they’re willing to use it.
So far, Ford has made his position clear: he isn’t considering a vaccine passport. But events could very well press the issue by October, and then he and his cabinet would have a choice. Since I think they’ll end up flip-flopping on this issue out of simple necessity, it would be best if they’d do that sooner rather than later.