COVID vaccination should not be coerced

Vaccination against COVID-19 is a key element in this stage of the pandemic fight, together with adherence to public health guidelines, and adequate testing, contact tracing and isolation.

When it comes to government’s vaccination drive, it is important for the Minnis administration to both recognize and respect the difference between encouraging vaccination through educational campaigns based on actual science, and utilizing tactics aimed at pressuring individuals to be vaccinated.

Perspective is not of the view that Bahamians ought to be coerced into being vaccinated, or that they ought to be subjected to punitive conditions should they choose not to take the jab at this time.

At the end of the day, vaccination is a medical decision, not a political statement, a patriotic imperative, or a non-invasive action such as social distancing or mask-wearing.

We agree with leading voices including infectious disease specialist and Clinical Director of Infectious Disease at Doctors Hospital Dr. Charlyon Bonimy, who in a recent interview with us stressed that vaccination is a medical decision that is best undertaken via a patient-centered approach with one’s healthcare provider whenever possible.

One of the foundational differences between vaccines that have been administered to children and adults in The Bahamas for decades and COVID-19 vaccines is that the latter are still in the experimental phase, and have not yet received full regulatory approval.

This fact understandably creates hesitancy in people worldwide, including in The Bahamas, who question what the long-term effects of COVID-19 vaccination might be, and who continue to monitor reports of serious adverse side effects confirmed or suspected to be connected to both the viral vector vaccines such as AstraZeneca, and to mRNA vaccines.

Research points to a reduced risk of severe illness and death from COVID-19 for those who are vaccinated, though it remains inconclusive on the ability of COVID-19 vaccines to stop transmission – an essential factor in the development of herd immunity through vaccination.

Though not yet concluded by peer-reviewed research, Prime Minister Dr. Hubert Minnis continues to make declarations that vaccination will stop COVID-19, and in so doing, has recently gone further to call for what would amount to financially punitive conditions for those who choose not to be vaccinated in what is supposed to be a voluntary process.

If a medical decision is made out of fear of discrimination, loss of employment, financial penalty or odious social consequences, it is arguably not a voluntary medical decision.

Article 6 of the Universal Declaration on Bioethics and Human Rights states, “Any preventive, diagnostic and therapeutic medical intervention is only to be carried out with the prior, free and informed consent of the person concerned, based on adequate information.”

It is, therefore, vital that the prime minister, the minister of health, and other government officials stick to the science on COVID-19 and COVID vaccination.

The Minnis administration ought not branch into requests and edicts – some already based on dodgy arguments – that can be viewed as elements of overreach or coercion in the vaccination effort.

Putting private employers on the spot

While on Grand Bahama last week, Minnis told the business community, “I want to again encourage you to advise all your employees to become vaccinated. And for those who are not, I encourage you to have them take a COVID test, PCR test, weekly so as not to jeopardize the remainder of your employees.”

It is curious that the prime minister chose Grand Bahama, an island with double-digit unemployment, a sluggish economy and thousands suffering financial insecurity prior to the pandemic, to call on employers to have their unvaccinated workers to submit to weekly testing that would cost upward of $150 to over $200 per test.

But what is noteworthy in the context of the vaccination effort, is that he chose to send this message to the private sector, as opposed to taking the lead by first delivering this message to the public sector.

The government is the country’s single largest employer.

If the presumed goal is increased vaccine uptake nationwide, then government ought to take the lead, but here again we see where politics appears to be taking precedence, since Minnis almost certainly does not want a fight with public sector unions.

Avoiding that political pressure, Minnis has transferred that pressure to private sector employers, who are being called upon not only to advise workers on vaccination, but to compel them to submit to exorbitantly priced testing in lieu thereof.

The thought clearly appears to be that compelling workers to pay a price they cannot afford for regular testing would push them to take the jab, but again, those who submit to COVID-19 vaccination ought to do so voluntarily, not out of fear of losing a large segment of their income if they do not comply.

Section 7(a) of The Health and Safety at Work Act states: “It shall be the duty of every employee while at work to take reasonable care for the health and safety of himself and of other persons who may be affected by his acts or omissions at work.”

However, Section 9 states: “No employer shall levy or permit to be levied on any employee of his any charge in respect of anything done or provided in pursuance of any of the provisions of this Act.”

The general duty of employers under the act is to ensure, so far as is reasonably practicable, the health, safety and welfare at work of all his employees.

Minnis’ statements raise questions about how provisions of this act ought to be interpreted, in respect of a requirement for regular PCR testing at the expense of workers in pursuance of a safe working environment.

It should be noted, meantime, that even if every worker in the country wanted to be vaccinated, there would be insufficient supply to meet the demand.

In seeking to make his message more attractive to employers, the prime minister said, “If one of your employees is not vaccinated and has COVID and the remainder of your employees are vaccinated, you need not close your premises. Your business can continue.

“However, if your employees are not vaccinated, and an individual enters your premises who has evidence of COVID, then your business is subsequently closed temporarily for a cleaning, thus jeopardizing your economic progress.”

This pitch is dodgy in a number of ways.

Cleaning a premises after confirmation of a COVID-19 case is not only for the safety of staff but members of the general public, so if such a business place does not conduct cleaning and sanitization based on the vaccination status of workers, how then is that business providing protection for its incoming customers?

Furthermore, fully vaccinated people can still contract and transmit COVID-19, and it is currently unknown how long immunity via COVID-19 vaccination lasts.

The United States Centers for Disease Control and Prevention (CDC) advises fully vaccinated people to watch for symptoms of COVID-19, particularly if they have been around someone who is sick, and to get tested and isolate if symptoms develop.

Encouraging vaccination based on the science is good. What is not good is to do so based on unsubstantiated arguments.

Blood clot risks and vaccination

Regulators have determined that there is evidence of a link between the AstraZeneca vaccine and a rare form of blood clots, though investigations are still ongoing.

While in Eleuthera last week, Minnis pointed out that women who take hormonal contraceptives or women who are pregnant, are at a higher risk of developing blood clots than incidences reported after AstraZeneca vaccination.

This currently appears to be true, but as a gynecologist and obstetrician, what Minnis overlooked in his pitch to residents is most glaring.

Since both the use of hormonal contraceptives and pregnancy predispose women to blood clots, risk stratification conducted by one’s healthcare provider is essential to determine whether the risk of vaccination for such women, outweighs the potential benefits.

The rare blood clot complication is experienced by more women than men, and scientists are currently probing the reasons for this, including any potential link to the use of hormonal contraceptives.

Factors such as these underscore why COVID-19 vaccination with agents still under clinical trials, is a decision best made in consultation with one’s healthcare provider, as opposed to a decision made at the prompting of others.

Minnis went further to say that for those who will either take hormonal contraception or become pregnant, there is “no risk” of taking the vaccine – a wholly unsubstantiated statement at this time.

Pregnant women were not included in initial large scale COVID-19 vaccine trials; therefore, limited information currently exists on the effects of COVID-19 vaccination in pregnancy.

More Bahamians are opting to be vaccinated, which is encouraging to health officials.

As the vaccination effort continues, we reiterate our position that providing Bahamians with vaccination information based on the science as it is known today, is good practice.

What is not good practice is to do so based on claims not supported by the current science, or to seek to coerce vaccination on any basis.

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