On November 23, in Paris, I told a European colleague that the epidemiological situation in Quebec was enviable. The vaccination campaign for those aged 12 and over was more advanced than in most northern countries. The vaccination passport was required to participate in non-essential activities. In addition, we had just made an appointment for the administration of the first dose of the pediatric vaccine to our two children.
If the variant that will eventually succeed Delta can give us two or three more months, I added, we can probably live with the virus without too much inconvenience. The next day, I heard about the Omicron variant for the first time. Less than a month later, the INSPQ tells us that its prevalence in Quebec already exceeds 80%. The shower is freezing cold.
It’s hard not to be shot. Hospitalizations are on the rise as healthcare workers run out of steam. Gatherings indoors with friends and family during the Christmas holidays should be avoided. My heart shatters when I imagine myself announcing for the second year in a row to my tween – a social beast – that she probably won’t be able to celebrate her birthday at the end of January the way I wanted.
The Omicron wave
Are there still (rational) reasons to hope to be able to reconnect with a richer social life in the relatively near future? What can be done to limit the damage of the Omicron wave?
We know that the new variant, due to mutations affecting the spike protein of SARS-CoV-2, manages to infect adequately vaccinated people in addition to unvaccinated people. People who are vaccinated, however, are much less likely to have a severe form of COVID-19.
At the time of this writing, those who were not adequately vaccinated were 15 times more likely to be hospitalized with an infection than those who were properly vaccinated.
However, our main collective problem is the risk that our health system can no longer properly treat people hospitalized due to COVID-19 or other health problems. Omicron’s extraordinary contagiousness puts both inadequately vaccinated and fully vaccinated people at risk with weaker immune systems (and who have not yet received a booster dose).
Compulsory vaccination
It is in this context that Austria, for example, will in principle impose vaccination from February, and that President Macron and Chancellor Scholz are juggling the idea of compulsory vaccination. What should we think of it, from an ethical point of view?
Vaccination is largely responsible for the impressive improvement in the ratio between daily cases of infection and hospitalizations. Increasing this gap is critical as the pandemic ends and the era in which SARS-CoV-2 will be endemic begins. But does this make compulsory vaccination ethically acceptable?
Let’s start by trying to understand what compulsory vaccination is. It seems likely to me that many of its defenders have more in mind an extension of the fields of application of the vaccination passport. I guess no one wants to live in a country where state agents forcefully inject a vaccine into the bodies of recalcitrant people. Even the less outrageous proposal to impose tickets on the unvaccinated seems overly overbearing. It appears more measured to require proof of vaccination in a greater number of contexts, including, for example, workplaces and classrooms in post-secondary institutions.
I am one of those who, very early in the pandemic, argued that the use of a vaccination passport was ethically justified. I have proposed, however, that proof of immunization be used only in the context of non-essential activities in order to reduce the harm to unvaccinated people, who would not be able to avail themselves of the same set of possibilities as their vaccinated fellow citizens.
Public health decisions have had a tragic dimension since the start of the pandemic in that they generally have a significant ethical cost. Even the best decisions have negative impacts on certain categories of citizens. Has the time come to extend the scope of the vaccination passport? Unfortunately, it is time to think about it. We must wholeheartedly hope that the measures announced in the last days, combined with the administration of the booster doses and the vaccination of children under 12, will be sufficient to reduce transmission and, above all, hospitalizations. If they prove to be insufficient, more muscular measures will be necessary. Avoiding hospital capacity overrun is a categorical moral imperative.
The post-pandemic
There will be a post-pandemic. The combination of vaccination campaigns and natural infections will one day ensure that very few people are left with entirely naive immune systems. In addition, the discovery of effective drugs should reduce the average length of hospital stays. Unfortunately, unvaccinated or immunocompromised people will succumb to the virus by then.
In short, we have to stick together and hold on. Unvaccinated people should know that the noose will tighten on them if Omicron defeats us. The logic of this tightening is not punitive. Rather, it aims to restore reciprocity in the contribution of citizens to exiting the crisis. A situation in which the unvaccinated benefit from the choice of the vaccinated, while the latter must suffer the negative consequences of the choice of the former, is not fair.