Matías A. Loewy
Instead of debating whether the COVID-19 vaccine should be mandatory, we must work to ensure that people who decide to get it have access to this tool to save lives and cut off transmission, the Pan American Health Organization (PAHO) said.
“The decision of whether or not vaccination is mandatory is a decision for each country, according to its vaccination laws. In many countries, vaccinations are mandatory for children. But I believe that the important thing today is not to discuss making the vaccine mandatory, but rather to discuss making the vaccine available,” said Dr. Jarbas Barbosa, PAHO Assistant Director, this Wednesday, the 9th, during the organization’s weekly briefing.
In that regard, Dr. Barbosa urged the strengthening of mechanisms such as COVAX and called on wealthy countries and donors to contribute the necessary funds to provide vaccines to the poorest countries.
On Monday the 7th, Kate O'Brien, a senior official at the World Health Organization (WHO) and director of immunizations and biologics, stated that it is better to encourage and facilitate vaccinations "without making them mandatory. We cannot imagine any country forcing people to get vaccinated," she said.
His colleague Mark Ryan, the agency's emergencies director, added: “We need to convince and persuade people and talk to them about this. There are specific circumstances in which governments will have to require these vaccine requirements, but all of us who work in public health would like to avoid this becoming a blanket means of getting people immunized. We'll be much better off presenting people with the data, the benefits, and letting them decide for themselves.” World leaders, including French President Emmanuel Macron, had also advocated this position. Last week, US President-elect Joe Biden said that vaccination in his country would not be mandatory and that he would “do everything possible as president to encourage people to do the right thing,” as quoted by the BBC .
In Latin America, a region where vaccines on official immunization schedules are traditionally mandatory, officials in most countries (from Mexico and Panama to Colombia and Argentina) have also expressed support for voluntary COVID-19 vaccination. An extreme case is that of Brazilian President Jair Bolsonaro: on October 24, he tweeted that the vaccine is only mandatory for Faísca (spark), the name of his dog.
"A tremendous effort"
Although governments and health authorities see vaccines as the "light at the end of the tunnel" that will allow them to contain the pandemic ("we are eager for widespread vaccine availability," said Dr. Carissa Etienne, PAHO director, during the press conference), some fear that public resistance or apprehension will affect coverage levels and undermine the effectiveness of this strategy.
Dr. Barbosa emphasized that, in every country, it is crucial to properly inform the public and demonstrate that COVID-19 vaccines are the result of a tremendous effort by hundreds of centers, technology companies, academic institutions, and vaccine and drug manufacturers. He added that these vaccines meet all safety and efficacy requirements.
"All governments, as part of their national vaccination plans, must have direct, transparent communication, with all the data, for health professionals, for families, for people, so that everyone can make their decision to have access to the vaccine when it is available," said Dr. Barbosa.
The official added that PAHO was providing information about vaccines to social media, the press, and health professionals. "That's how we're going to achieve high vaccine uptake, first to save lives and second, to control transmission," he emphasized.
Other specialists agreed that persuasion is better than imposition. Infectious disease specialist Eduardo López, head of the Department of Medicine at the Ricardo Gutiérrez Children's Hospital in Buenos Aires and one of President Alberto Fernández's scientific advisors during the pandemic, told Argentine Public Television on Wednesday, the 9th, that "it's good to persuade people that it's advisable for them to get vaccinated, especially vulnerable groups: the elderly, healthcare workers, security personnel, and teachers. But it ultimately depends on the individual's willingness to receive the vaccine."
"I agree that it should not be mandatory because it is a new vaccine, because it is not on the (immunization) schedule, and because, as in all countries, it will not have final approval, but rather a request for authorization of use linked to an emergency," Dr. López pointed out.
But if persuasion fails and no one is to be forced to receive a vaccine against their will, an ethically acceptable alternative in this public health emergency could be to offer a reward to those who get vaccinated, either with money or with certain privileges, such as permission not to wear masks, argued philosopher and bioethicist Julian Savulescu, Ph.D., director of the Oxford Uehiro Centre for Practical Ethics at the University of Oxford , in Oxford, UK, in the Journal of Medical Ethics . [ 1 ]
If people are paid for getting vaccinated against COVID-19, doesn't that open the door for those receiving other vaccines to demand the same? It's not the same, Savulescu told Medscape in Spanish . "Most vaccines have decades of safety data. People don't need to be paid because there's minimal risk. COVID-19 is different. There's more uncertainty, and people should be paid for the risk, just like they are for hazardous construction jobs," he said.
To date, according to The New York Times Coronavirus Vaccine Tracker , there are 14 vaccines in Phase 3 clinical trials worldwide, six approved for early or limited use, and one with full approval. Dr. Barbosa believes that during 2021 there will be enough vaccine doses in the region to cover the most vulnerable groups, which represent one-fifth of the total population. "We're going to proceed step by step, and each step will be enormous," he said.