Faced with this pandemic caused by COVID-19, Médecins québécois pour le plan public (MQRP) reiterates the importance of vaccination as a public health measure. Vaccination is a useful and effective measure. However, we must denounce the idea of an additional financial contribution to unvaccinated adults. This measure seems unacceptable to us as a means of managing the current crisis.
By the time the pandemic hit Quebec, we were already seeing how the health system was at the end of its rope, following many years of austerity and centralization reforms. The last thirty years of erratic management and chronic public underfunding of health care leading to difficult working conditions for caregivers, staff shortages and service disruptions cannot be an argument for imposing such a measure. Blaming today’s health system problems on the unvaccinated population is a dubious shortcut. In other words, a better supported system would manage to treat more easily a population with an immunization coverage of 88%.
We fear a slippery slope towards an even greater commodification of health. Our health financing model is not based on the burden of a patient’s risk factors, including their vaccination status, but on the taxation of their income. Thus, several factors make people at risk of becoming ill and needing to be treated in the public health system – sedentary lifestyle, substance use, etc.
These are often seen as poor individual choices, while behind them lie complex social structures. Asking for a “health contribution” according to this risk factor opens the door to initiatives of this ilk and possibly invites private insurance and its lucrative model in health care. To have strong public services, governments are implementing progressive taxation in line with their public missions. These revenues should only be used in the service of the public interest and the common good. Medicine is not a business relationship, it is a human relationship.
Also, who are the unvaccinated? Have we reached this subgroup of the population, which is anything but homogeneous? Some people may choose not to be vaccinated out of belief or conviction, but we believe that many people are not vaccinated because of a lack of adequate access. For example, awareness and education in certain settings are not optimal due to the lack of resources devoted to them and their adaptation. Services are also limited to reach the most disadvantaged populations: people in a situation of homelessness, elderly people with reduced mobility, those with an immigrant background who do not speak one of the official languages, those who do not have access to the Internet, those with mental health problems, those who suffer from cognitive disorders, who are illiterate or who have a loss of autonomy, etc. The shift to ambulatory care that began in the 1990s has not been matched with sufficient funding and support for care provided outside of hospitals. Universality and equity of access to health care has been eroded rapidly, and we are now suffering the negative repercussions.
Finally, whatever the reasons underlying the vaccine refusal of a small part of the population, and whether we consider these reasons to be correct or not, we believe that imposing a financial burden on this population as a measure punitive is discriminatory, unfair and would set a dangerous precedent.
The solution to the current crisis is not an additional taxation of a sub-group of the population, but a thorough reform of our health system and an enhancement of public services. We remind the government that the fight against the pandemic is targeting a virus, not our fellow citizens, and that in the face of this virus we are not all equal.