The Legault government intends to table a bill imposing a health contribution on Quebecers not vaccinated against COVID-19. On the eve of the return to Parliament, two regional directors of public health and doctors in preventive medicine have reservations about this tax of more than $100, with its punitive approach.
“This health contribution, I don’t know exactly in which direction it will go, but my prerequisite is that I have a lot of reservations about making people pay for health decisions”, says the regional health director public of Estrie, the Dr Alain Poirier, in interview with The duty.
The former national director of public health recalls that the Quebec health system is “universal, free and accessible to everyone”. “We will see in terms of ethics and values, continues the Dr Pear tree. […] But we’ve been saying for a long time that we don’t want to charge one way or another for essential medical services. »
Nearly three weeks ago, Prime Minister François Legault announced his intention to impose a financial penalty on people who have not yet received, for non-medical reasons, a first dose of vaccine. He then argued that the unvaccinated occupied 50% of intensive care beds, when they represented 10% of the population.
“It is not up to all Quebecers to pay for that, he then launched. It’s very shocking. »
The acting national director of public health, Dr.r Luc Boileau, did not want to comment on this health contribution Thursday, during his first national press conference held without the presence of elected representatives of the government. He argued that this tax is a “fiscal measure” which “does not fall within the expertise of Public Health”.
In interview at Dutythe Nunavik Regional Director of Public Health, Dr.D Marie Rochette, says “not seeing how” this health contribution “could be useful”. She explains that the proportion of Inuit living with food insecurity is “really staggering”. According to a survey conducted in 2017 by the Nunavik Regional Board of Health and Social Services, 52% of people aged 16 and over say they do not have enough money to meet their needs. Among them are unvaccinated, reports the DD Rochette.
“So to what extent could they contribute to any health contribution? she asks. I don’t think it’s beneficial to penalize them and I don’t see how it could change their perspective on vaccination. »
For the Association of specialists in preventive medicine of Quebec (ASMPQ), this health contribution “is more a political choice than a medical decision”. “It is certain that doctors in preventive medicine, we are more in the [mesures] to convince that constraining, then understanding the determinants of vaccine hesitancy in order to act on these determinants”, says the DD Marie-Claude Letellier, vice-president outreach and public relations at the ASMPQ.
The doctor, who practices at the Direction de santé publique de la Gaspésie–Îles-de-la-Madeleine, believes that “we must ensure that we do not contribute to increasing social inequalities in health”. She points out that “vulnerable people,” such as the homeless, individuals with mental health issues and seniors without internet access, are unvaccinated.
The regional director of public health for Saguenay–Lac-Saint-Jean, Dr.r Donald Aubin, for his part, believes that Public Health does not have to give its opinion on this tax. “I still make a pretty good distinction between the powers that belong to one and the powers that belong to the other, precisely to maintain independence in the powers,” he says. Because if we give opinions on things on which we don’t have to give an opinion, we end up losing our independence. »
The health contribution is the subject of group fire from the opposition parties.
An effective measure?
The effectiveness of a health tax to improve the vaccination rate of a population has not been demonstrated, according to Ève Dubé, scientific advisor and medical anthropologist at the National Institute of Public Health of Quebec (INSPQ), specialist in vaccine hesitancy.
“What we know in the literature is that compulsory vaccination measures work,” she says. A bit like the vaccine passport, there are still different studies that show an impact. »
Despite everything, “strong coercive measures” do not make it possible to achieve 100% vaccination coverage. Ève Dubé cites Australia as an example, where parents are obliged to have their children vaccinated according to the national immunization program (vaccines against diphtheria, tetanus, rotavirus, measles, etc., but not COVID-19), under penalty of losing their family allowances. Not to mention that unvaccinated toddlers cannot attend daycare in many Australian states.
Thanks to these measures, the Australian authorities have noted a 1% increase in the vaccination rate for children, which has now reached 96%, according to Ève Dubé.
In light of these results, the researcher strongly doubts that the health contribution will increase Quebec’s vaccination coverage by 5% (currently 90% for the first dose in children aged 5 and over). “We know that people who are very opposed to vaccination, the more we put coercive measures, the more we can point them, therefore strengthen their attitude against vaccines”, she observes.
According to a Web survey conducted by the INSPQ between January 7 and 19, 59% of Quebecers are for the health contribution, 35% are against and 6% have no opinion. Of the respondents, 92% are vaccinated.