Sunday, August 14

Vaccinations, mandatory or required?

To the economic and health dilemma, so debated throughout the pandemic, a new conflict between law and health is now being added with all its force around the obligation or not of vaccination. Indeed, we are already in for year two of the pandemic and the coronavirus continues to circulate, sick and kill. Especially in low and middle income countries. In high-income countries, we, the incidence is controlled little by little thanks to the set of preventive measures, among them in a very prominent way the vaccine. In many of these countries we have already passed 60% of the fully vaccinated population, and we are moving towards the initial goal of 70% of desirable group immunity. In Spain, in particular, this objective can be achieved, as predicted by Salvador Illa when he was Minister of Health, at the end of August. A forecast, not an occurrence, based on data provided by the Ministry’s experts, as he himself has commented.

But this final stage of the pandemic, let’s hope, is not turning out to be a bed of roses. New obstacles appear in this long march. Among them, without being exhaustive, it is worth mentioning the greater transmissibility of the delta variant of the coronavirus, which makes it necessary to increase the percentage of vaccine coverage to achieve group immunity to at least 90% or the durability of the immunity acquired after the vaccine, raising the need for a booster dose, at least for people with compromised immune systems. Of course, we must also mention the effectiveness of the vaccine, which is not 100%. In this context, the resistance of certain people to get vaccinated appears as a major obstacle to getting out of the labyrinth.

However, among the people who have not yet been vaccinated, not all are anti-vaccines. It is a mistake to qualify all the unvaccinated in this group who questions the scientific evidence and believe, it is a matter of faith, that everything is the result of a conspiracy that pursues money and power. No, there are also people who reasonably have doubts about the effectiveness of vaccines and the real risk of not being vaccinated. Others are simply people who do not have easy access to health services, due to the marginalization in which they live or because they have not just prioritized getting vaccinated among their multiple tasks. To increase the percentage of vaccinated in the coming months, it is necessary to concentrate on these groups, offering information that is understandable to them and facilitating access to the vaccine day and night, rain or shine. This is what has already begun to be done with the opening of some CAPs to go to get vaccinated without an appointment. The queuing loads that have been observed, especially of young people, are admirable.

However, whether for one reason or another, from public health, which has among its functions that of health authority, clear decisions must be taken to protect the health of the population as a whole. This means that the general interest must prevail over the individual. In this sense, some authorized voices tend to propose that vaccination be mandatory -according to the RAE, to force something to achieve an effect– especially health workers. Other equally authorized speak of requiring – according to the RAE, request, due to its nature or circumstance, any necessary requirement be vaccinated to carry out certain activities, such as traveling from one country to another.

The debate has its edges, but possibly demanding is better than forcing. Well, on the one hand, forcing generates a victimizing discourse that reinforces the anti-vaccine ideology and, furthermore, if there are side effects, which may exist, the responsibility may fall on the authority that forced a drug such as a vaccine to be administered. Which is not the same as forcing you to wear a mask to enter a restaurant. On the other hand, demanding makes its way after the success of the vaccination certificate, when passing the decision to vaccinate the individual if he wants to enter a restaurant, go to a concert or visit a museum or, more relevant, if he wants to work -or continue working- in a nursing home or hospital. They can decide about their health, not to get vaccinated, but they cannot put the health of others at risk, especially if they are hospital patients, residents of a nursing home or students. It is your decision, your responsibility. Not getting vaccinated means not being able to work or continue working in those places. The vaccine is waiting for you. At stake is the right of patients or residents to be treated safely according to the available scientific evidence.

Postscript, the sooner we resolve this situation, the sooner we can deliver the vaccines we don’t need to low- and middle-income countries. There they are not vaccinated mainly because they do not have vaccines.