Vaccinations, mandatory or required?

To the economic and health dilemma, so much debated throughout the pandemic, a new conflict between law and health is now added with all its force around the obligatory or not of vaccination. Indeed, we are already in year two of the pandemic and the coronavirus is still circulating, making us sick and killing us. Especially in middle and low income countries. In high-income countries, we, the incidence is being controlled little by little thanks to a series of preventive measures, including, most importantly, the vaccine. In many of these countries we have already passed 60% of the population fully vaccinated, and we are moving towards the initial goal of 70% of the desirable herd immunity. In Spain, in particular, this goal can be achieved, as Salvador Illa predicted when he was Minister of Health at the end of August. A forecast, not an occurrence, based on data provided by experts from the Ministry, as he himself has commented.

But this final stage of the pandemic, hopefully, is not turning out to be a bed of roses. New obstacles are appearing on this long march. Among them, without being exhaustive, it is worth mentioning the increased transmissibility of the delta variant of the coronavirus that makes it necessary to increase the percentage of vaccination coverage to achieve herd immunity to at least 90% or the very durability of acquired immunity after vaccination, which raises the need for a booster dose, at least for people with compromised immune systems. Of course, the effectiveness of the vaccine, which is not 100%, must also be mentioned. In this context, the resistance of certain people to be vaccinated emerges as a major obstacle to get out of the labyrinth.

However, not everyone among those who have not yet been vaccinated is anti-vaccine. It is a mistake to classify all the unvaccinated in this group that questions the scientific evidence and believes, as 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, because of the marginality in which they live or because they do not prioritize among their many tasks to get vaccinated. In order to increase the percentage of vaccinated people in the coming months, it is necessary to focus on these groups, providing them with information they can understand 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 long queues that have been observed, especially of young people, are admirable.

However, whether for one reason or another, public health, which has among its functions that of health authority, must take clear decisions 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 authoritative voices tend to propose that vaccination should be compulsory -according to the RAE, to force something to achieve an effect-, especially for health workers. Others equally authoritative speak of demanding -according to the RAE, to ask, by its nature or circumstance, some necessary requirement- to be vaccinated to perform certain activities, such as traveling from one country to another.

The debate has its edges, but possibly demanding is better than forcing. For, on the one hand, forcing generates a victimising discourse that reinforces the anti-vaccine ideology and, in addition, if there are side effects, which there may be, the responsibility may fall on the authority that forced the administration of a drug such as a vaccine. Which is not the same as forcing people to put on a mask to enter a restaurant. On the other hand, to demand that the decision to be vaccinated is passed on to the individual if they want to enter a restaurant, go to a concert or visit a museum or, more importantly, if they want to work – or continue to work – in a nursing home or hospital. They can decide about their health, not to be vaccinated, but they cannot put the health of others at risk, especially if they are patients in a hospital, residents of a nursing home or students. It is their decision, their responsibility. Not getting vaccinated means not being able to work or continue to work 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.

P.S., the sooner we resolve this situation, the sooner we will be able to cede the vaccines we don’t need to low and middle income countries. They don’t vaccinate there mainly because they don’t have vaccines.

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