Why (most) Vaccine Mandates are a Distraction 

At the present moment Australia’s Federal and State governments are racing to vaccinate their citizens. Whilst it was initially criticised as more of a stroll-out than a rollout, the arrival of the Delta variant of COVID-19 in Sydney seemed to provide an impetus to the vaccination programme. Certainly, significant problems remain, not least the apparent inclination to vaccinate those whose risk level is relatively minimal whilst those who are in priority groups, including Aboriginal and Torres Strait Islander communities, continue to have low levels of vaccination. Nevertheless, the programme now has some momentum and there is an expectation that a fairly high level of vaccination—around the 70-80% mark—can be achieved before the end of the year.

As the pandemic has unfolded there have been ongoing discussions about whether or not vaccination should be mandated in some way. On the face of it, the Prime Minister has been fairly clear that individuals will be able to choose for themselves whether or not to get vaccinated. Nevertheless, he has also refused to rule out the idea that employers might mandate vaccination for their employees. Furthermore, facing growing criticism of the vaccination programme and the levels of vaccination amongst those who work in Residential Aged Care Facilities (RACF), the National Cabinet (which is to say the Prime Minister and all state and territory first ministers) agreed to mandate vaccination for those who work in this setting. State Legislation to this effect has followed and, those who have not received their first vaccination by mid-September will likely be unable to continue to work in RACF. Indeed, at the time of writing the AMA called for all those who work in healthcare to be subject to a mandatory vaccination whilst others are seeking to extend the mandate to those working in other areas of the care sector.

Since the policy mandating vaccination for all those working in RACF was adopted the percentage of those who have been vaccinated in the sector has sharply risen. At least in part this is a respond to the mandate. However, it is also related to other initiatives that have sought to promote, encourage and facilitate vaccination amongst those working the sector. In some cases, this has included the provision of vaccinations in the workplace whilst in others is that involved a day of paid leave to attend a vaccination centre. It may have also been related to the increased availability of the preferred Pfizer vaccine. Indeed, the publicity surrounding low rates of vaccination amongst those working in RACF may have pricked the conscience of some individuals and prompted them to follow one of the many moral reasons we all have to get vaccinated.

Given the threat COVID-19 represents to older people, it may be that the RACF mandate is justified. However, it is not clear that the other kinds of mandates that now seem to be emerging in Australia are equally justified or even justifiable. For example, in late August the Capital Airport Group (CAG), the company that owns and operates Canberra Airport, announced that it was making vaccination mandatory for its employees, a policy that seeks to reassure travellers that passing through the airport is safe. However, the CAG employs around 150 individuals across its Aviation, Property and Corporate Services divisions. Further reflection leads one to suppose that passengers using the airport are unlikely to directly encounter employees of the CAG and most of those they will encounter will likely be employed by an Airline or one of the retail or refreshments outlets with a presence in the terminal. Clearly, the CAG cannot formally mandate the vaccine for all those working at the airport even if they might seek to promote it via other means, such as by encouraging other companies with a presence at the airport to adopt a similar mandate.

The actual implications of the CAGs vaccine mandate aside, one might wonder if such a move would justified if it applied to all those working at the airport. Certainly, airports are places where a high number of people pass through and that may make them potential infection hotspots. However, infection is more likely to result from those using the airport than it is from those who are working at the airport. After all, one queues up with fellow passengers and not airline or airport employees. Equally, airports are generally large, airy and well-ventilated places. They are not ideal transmission sites. Furthermore, we should also bear in mind the fact that vaccination does not mean an individual will not contract COVID-19. It does not inhibit infection and although it will likely reduce transmission, it will not prevent it entirely. Finally, we should also bear in mind that vaccine mandates for those working in RACFs are not only related to the vulnerability of those they care for, it is also a response to lows levels of vaccination, and concerns that a high percentage of workers might be hesitant about getting vaccinated. This is not the case in the travel industry where, according to industry surveys, high levels of vaccination are expected to be achieved on a voluntary basis.

Consequentially, one might wonder if the ends of employer mandated vaccination—which, lest we forget, transgresses the principle of employers not being able to compel their employees to undergo medical treatment—is the right means by which we might seek to reduce the transmission of COVID-19. Of course, the fact that one is more likely to be infected by a fellow passenger than by those working in an airport or for an airline does not mean we should not worry about those who work in airport terminals or at 10,000 feet. They remain potential sources of transmission. However, given high levels of voluntary vaccination, adopting a mandate will do little to change reality. Indeed, before rushing to adopt such policies, it would be advisable to consider the future of COVID-19 in Australia. For example, it seems increasingly clear that the highly infectious nature of the delta strain means COVID Zero is unlikely to once again be achieved. This certainly appears to be the case in Sydney and NSW, but it seems likely to be the case in Melbourne and Victoria, as well as Canberra and the ACT. Given they have their own consequences, lockdowns cannot continue indefinitely and, as spring begins to unfold, we should at least begin considering a suppression strategy.

The simple fact is that COVID-19 is here to stay, there is no future in which it is does not eventually become endemic to Australia. The question we face is how to manage this process. Until now we have sought to delay it until the population had been vaccinated. Whilst this has been a successful approach it has also engendered a degree of complacency, contributing to the aforementioned stroll-out of the vaccination programme. Nevertheless, now that the numbers of vaccinations are increasing, the federal government has indicated that travel restriction and the use of lockdown will be reduced. Whilst it would be a mistake to adopt an uncontrolled approach, the number of infections will (continue to) increase. The question that should concern us are the available tools that might abate the rate of transmission. As well as lockdowns we have thus far made use of masks, social distancing, and hygienic measures like handwashing. We have also invested in our test and trace response, including apps that allow us to record where we have been.

Until now the testing that is done in Australia use Polymerase Chain Reaction (PCR). This is a highly effective and accurate way to detect viral infections and almost no incorrect results are produced. However, it takes time to produce a result as tests must be sent to a lab for processing. Other forms of testing, such as Lateral Flow Tests (LFT), can produce quicker results, and whilst they are over 99.5% reliable, they are less accurate that PCR testing. When one is engaged in high levels of testing in a largely uninfected population the differential in accuracy is problematic; too many false positives will be produced and there is a greater risk of a false negative. However, in populations with higher levels of infection the inaccuracy is less concerning. Once we move to a situation where ongoing community transmission is an accepted fact, then there is no need to identify every single case. Furthermore, whether PCR or LFT, subsequent testing can be used to reveal any false positives. In short, once there is some degree of ongoing transmission it becomes reasonable to make use of LFT to mitigate the risks of infection, particularly those posed by individuals working in locations with high numbers of individuals passing through, such as airports.

In this context rather than pursue vaccine mandates that change little, employers would be better advised to institute a testing regime. The production of rapid results means that individuals who test positive can remain at home until they produce a negative test. In essence, simply testing positive should be enough to trigger a sick day or days. Employees can go home with pay, and employers can protect themselves, their staff and their customers. Of course, those who are vaccinated will be less likely to experience a serious illness and will likely recover faster than those who remain unvaccinated. Interestingly this provides an opportunity for employers to positively encourage, rather than negatively mandate, staff to get vaccinated. There is a limit to the number of paid sick days individuals are entailed to. However, employers could increase this by a fairly small number for those who have been vaccinated, thereby encouraging those who have yet to get vaccinated to do so.

The same sort of reasoning applies more generally. Whilst it is important that we achieve the highest possible level of vaccination amongst the population and sub-populations of Australia pursuing formal mandates, with negative consequences for those who continue not to get vaccinated, is not necessarily the best way to go about ensuring this. Equally, vaccination is the not the only way to reduce the possibility of transmission, the use of LFTs will enable the development of COVID-19 in Australia to be subject to some degree of management. As we move beyond COVID Zero, this kind of management will be indispensable as we transition to an era where COVID is something that we learn to live with