Mandatory Covid-19 vaccination is the issue that refuses to go away.
It remains under consideration by the National Public Health Emergency Team (Nphet), according to minutes of its meeting in mid-December. Nphet will discuss the issue "at a later date" in tandem with a paper from the Department of Health on the ethical and legal considerations involved, these note.
Across Europe, the issue is a hot topic. In Italy, over-50s are obliged to get vaccinated against Covid-19. Austria plans to introduce mandatory vaccination for all citizens from April. A combative French president Emmanuel Macron says he wants to "piss off" the unvaccinated.
The trend reflects a growing frustration among some policymakers at the disproportionate resources over-burdened health systems are having to devote to treating unvaccinated patients. In countries historically disposed to mandatory vaccination schemes, this has resulted in hardline proposals.
Ireland, though, has different traditions, is in a different position and is unlikely to follow these examples.
The wording used about mandatory vaccination in the Nphet minutes of December 16th is the same as was used at their meeting the previous month, and was reported by The Irish Times at the time.
The same wording appears in the minutes of a meeting on December 2nd, where members also “voiced the need for caution regarding mandatory vaccination”, given the potential impact it could have on social solidarity.
So while the issue is still under consideration, it is not being prioritised. The agenda item has been rolled over from meeting to meeting, probably because officials were more immediately preoccupied with the surge in cases.
Barring a major deterioration in the pandemic – something that is within the bounds of possibility, but not on the horizon currently – mandatory vaccination is not going to happen in Ireland.
The main reason is the one mentioned in the minutes quoted above. Any attempt to force people to get vaccinated risks damaging the solidarity that has been the “bedrock of Ireland’s response to Covid-19 to date”. Unlike other EU states, we have no vaccine mandate for children, for example.
But another reason is that so many people are vaccinated already. So far, 95 per cent of our adult population and 92.4 per cent of those aged 12 and over are fully vaccinated; 57.9 per cent of adults have received a booster. The resulting “vaccine wall” is keeping ICUs relatively empty despite record case numbers.
So less than 5 per cent of the population is unvaccinated – and a proportion of these will have some degree of immunity through prior infection. It is hard to see how society would benefit by forcing this small group to receive a vaccine in their arms against their will. It is easy to see how much we could lose by going down this divisive road.
We already make life difficult for the unvaccinated. They are excluded from many areas of the public realm, from restaurants to cinemas and gyms, as Covid-19 passes have been given wider and longer use than might have been envisaged originally.
There might be a stronger case for compulsory vaccination if the available vaccines worked better to prevent transmission of Covid-19. AstraZeneca and Janssen offer minimal protection against infection by the Omicron variant, preliminary research shows, though Pfizer and Moderna perform somewhat better.
Vaccines cut transmission of previous variants by up to half, some studies showed, but given the size of the Omicron wave they don’t seem to be having much impact this time around.
The vaccines continue to protect people against serious illness, but if they don’t stop one person passing on the virus to another, should we be penalising people for being a transmission risk, simply because they are not vaccinated?
Even in healthcare, Irish policymakers have opted not to require mandatory vaccination of staff. Instead, individual employees are taken off frontline duties following an individual risk assessment; managers can leave them in their clinical roles if it is judged their absence would create a bigger risk than that of Covid-19 transmission.
There are far bigger issues for Nphet to resolve around our vaccination policy. Officials are already concerned about the short duration of protection provided by booster shots against Omicron, which could be as low as five weeks.
Vaccinating the planet every four to six months isn't sustainable or affordable, the head of the UK's committee on vaccination and immunisation, Prof Andrew Pollard, noted recently.
While Irish pockets might be deep, it isn’t really an option for us either, unless perhaps vaccines can be developed that protect against all variants of Covid-19, present and future. And do we really want to continuously medicate healthy people at such short intervals?
For the future, we are likely to hear again of ideas that were touted earlier in the pandemic, such as personal responsibility and shielding the vulnerable. We’ll each have to decide what level of vaccine protection we want, when to wear masks, which masks to wear, and what other steps to take that might lessen our exposure to the virus. That will leave resources to be concentrated on those who most need protection.