Across Europe the spectre of hospitals overwhelmed with unvaccinated patients has led to a slew of anti-Covid measures, with reactionary street riots everywhere from Amsterdam to Vienna.
On Wednesday, Ursula von der Leyen noted that with 150 million people in the EU unvaccinated, mandatory vaccination should at least be discussed.
Such a suggestion led to waves of derision and rhetoric about freedom, but with the unvaccinated now driving the crisis how we respond is an urgent vital question.
Hospital Report
Much opposition to vaccination frames it as a solely personal choice. In this vaguely libertarian argument the central thrust is that those who wish to get vaccinated should avail, and those with reservations abstain. This seems superficially reasonable, but fails to understand what vaccination truly is: a critical public health measure.
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Ireland's long-standing shortage of ICU capacity means it is simply too easy for Covid surges to upend our national ability to care for the sick
Vaccination has undeniable life-saving individual boons, yet the rationale behind campaigns is to reduce incidence and ultimately the burden of disease at a population level. More than just a personal insurance policy against the ravages of Covid, vaccination protects the vulnerable, providing a firewall against mass infection.
Firstly, vaccination substantially reduces the chances one will become infected upon exposure. Even in cases of breakthrough infection, the vaccinated are much less likely to endure life-threatening consequences.
This reality is reflected in Ireland’s ICU statistics – since late June almost 60 per cent of ICU admissions were unvaccinated, contrasted against a population uptake rate of about 90 per cent. This suggests the unvaccinated are about 13.5 times more likely to end up in ICU relative to the fully immunised.
This rough calculation is likely an underestimate given the vaccinated who fall ill are likely older with more health complications than the unvaccinated needlessly-ill cohort.
Similarly grim statistics manifest worldwide. The UK's ICUs are clogged with unvaccinated patients, leading Sir Andrew Pollard to comment last week that
"... this ongoing horror, which is taking place across ICUs in Britain, is now largely restricted to unvaccinated people".
Resources
This has ramifications far beyond the immediate patients – utterly avoidable Covid infections not only put healthcare staff at risk, they also massively strain the resources of public health systems.
Every bed occupied by a Covid-stricken patient reduces the capacity for others needing urgent critical care or vital surgeries. Ireland’s long-standing shortage of ICU capacity means it is simply too easy for Covid surges to upend our national ability to care for the sick.
This consideration underpins the stringent national lockdowns Ireland has been forced to implement, and the straining of ICU capacity now by unvaccinated individuals. Further restrictions have now been announced.
That a small cohort would effectively hold society hostage seems profoundly unfair to many, and how this should be tackled is an open question.
This, of course, isn’t solely an Irish problem – Austria’s decision to impose lockdowns on the unvaccinated in mid-November was motivated by alarming strain on ICU capacity, driven almost entirely by those shirking vaccination.
Measures must be taken to reach populations who may not be receiving the messaging on the importance of vaccination
In Slovakia, Greece, and the Czech Republic similar restrictions have been imposed on vaccine-refusing cohorts for the same reason. Germany has also now introduced strict curbs on unvaccinated people.
Such measures, however, raise passionate ire, frequently decried as an infringement of liberties. But such arguments fail to recognise that others have a reasonable expectation that they should not be needlessly exposed to avoidable dangerous pathogens, nor should selfish stances be allowed imperil the freedom of others.
Such arguments also fail on another level – the unimmunised ultimately reduce the efficacy of vaccination, effectively functioning as human petri dishes. As the virus runs through them, random mutations eventually endow it with the ability to evade vaccines. The dominance of Delta and the emergence of Omicron variants are a sad testament to this reality.
Important history
Nor are vaccinate mandates unprecedented or even new – they have a long, important history. Prior to its successful eradication Smallpox was such a virulent and devastating illness that measures were enacted worldwide to halt its spread.
In England and Wales the Vaccination Act of 1853 mandated universal vaccination, fining those who chose not to comply. Vaccine mandates for schools in several US states were introduced by 1827.
Nor are examples only historical. In August this year US judge Frank Easterbrook upheld Indiana University’s right to mandate vaccination for returning students. This judgment echoes a 1905 supreme court decision on Jacobson vs Massachusetts, where the court ruled that the requirements of several states to be vaccinated or risk being fired was not an imposition on individual freedoms.
That anti-vaccine activists still use the same old tired and debunked canards about liberty suggests their grasp of history is on par with their understanding of medical science.
Blame for sub-par uptake, however, cannot be solely placed upon all those reluctant to vaccinate. The pandemic has seen a dark renaissance of anti-vaccine propaganda, as virulent and infectious as the virus itself.
Vaccine hesitancy is a spectrum, and exposure to disinformation has a proven effect to nudge people towards fear and distrust. Such people are themselves victims of anti-vaccine disinformation, and need compassion and encouragement to vaccinate.
Measures too must be taken to reach populations who may not be receiving the messaging on the importance of vaccination. Since the time of Jenner, however, a core of ideological vaccine-rejectors have been eager to spread fear and falsehood over an extremely life-saving endeavour. This anti-vaccine fringe constitutes a small but vocal minority, but one with a disproportionate impact on public health which must be vehemently resisted.
For all the sound and fury around the topic, rights are not absolute and must be balanced with the rights of others.
Just as we accept the imposition of speed limits on public roads to protect everyone, vaccination is similarly crucial not only for individual wellbeing but the very functioning of health services. No measure to protect this should be off the table.
Dr David Robert Grimes, a physicist and cancer researcher, is the author of The Irrational Ape: Why We Fall for Disinformation, Conspiracy Theory and Propaganda