Monday 22 March 2021

Declining a Covid-19 vaccine risks penalties in some countries

 Indonesia levies fines, while other governments warn of restricting access to travel and public places

Some countries are sharpening their Covid-19 vaccination pitches to the public: Get a shot or face a potential penalty.

With vaccination campaigns ramping up globally and some supply shortages easing, governments are looking for ways to make sure that holdouts don’t undermine efforts to vaccinate enough people to achieve herd immunity.

The penalties range from fines and restricting access to public places to threatening the loss of priority access to vaccines.

Indonesia has said authorities may impose fines on residents who refuse to get vaccinated. The capital, Jakarta, has threatened fines of up to $356—or more than a month’s salary on average, according to the country’s per capita gross domestic product.

A woman receives a vaccine in Jakarta, Indonesia. Officials in the country say sanctions are a last effort to get people inoculated. PHOTO: ZULKARNAIN/XINHUA/ZUMA PRESS

Israel, home to the world’s fastest Covid-19 vaccine rollout, drew a firm line between those who had and hadn’t received shots as it unveiled plans on Sunday to reopen society. Those with what are called green passports, which verify a vaccination, could enter gyms, hotels and eventually travel without quarantining. Holdouts, Israel’s health minister said, “will be left behind.”

The European Union and Australian officials have considered travel restrictions for those without vaccination proof. Brazil’s Supreme Court ruled those who reject a Covid-19 vaccine could be banned from certain public activities and spaces. Brazilians have protested against mandating Covid-19 vaccines.

For other countries, the penalty will be restricting access to the vaccine itself. Singapore has threatened to not reserve doses for those who decline to be inoculated, and South Korea has said those who skip will be booted to the back of the line.

More people expressed an intent to get a Covid-19 vaccination in an Ipsos survey released earlier this month, with the sentiment rising from late last year. The survey polled adults 75 years old and younger from 15 major countries. 

But in the majority of polled countries, at least one in five people remained wary of being vaccinated, citing side effects, accelerated clinical trials and efficacy as the main reasons for their hesitation.

Officials are dealing with how best to compel citizens on the fence. Health experts warn that being too prescriptive could be ineffective, pointing to backlashes against government efforts to reduce smoking decades ago and getting people to wear face masks during the pandemic. The World Health Organization has cautioned that making Covid-19 vaccinations mandatory could discourage people from getting vaccinated.

“In public health, it is generally best to work with carrots rather than sticks,” said Dr. Ranit Mishori, a senior medical adviser at Physicians for Human Rights, an advocacy group. “We need to meet people where they are.”

The U.S., Japan and much of Europe have so far made taking vaccines voluntary. To encourage citizens, politicians have received shots on live television, while governments have unrolled aggressive campaigns seeking to get the word out.

Fears about Covid-19 vaccines might be only part of the reason for lower participation rates. The barriers to get inoculation for many vulnerable citizens remain too high, beyond shortfalls in supply, because of a lack of outreach, complications in making an appointment or even getting time off from work to get a shot, said Dr. Mishori, who also teaches family health at Georgetown University.

Still, officials in Indonesia say they expect to encounter resistance to vaccines. According to a mid-December poll by Saiful Mujani Research and Consulting, an Indonesian polling firm, 37% of respondents say they would take a vaccine for Covid-19, 17% said they wouldn’t and 40% said they were undecided.

“Sanctions are our last effort to encourage people’s participation,” health ministry official Siti Nadia Tarmizi said, according to a Reuters article.

Other countries in Asia aren’t facing as much resistance, but relative success in containing Covid-19 has left people with less urgency about getting vaccinated. Less than half of South Koreans, or about 46%, are willing to be vaccinated right away, according to a poll by the Korea Society Opinion Institute released on Monday. Nearly half of the other adult respondents preferred to monitor the situation.

South Korea, which begins its vaccine rollout on Friday, wants to vaccinate 70% of the population by November—or the equivalent of everyone but those pregnant and 18 or younger, who are likely to be prioritized last because of a lack of clinical trial data for those groups.

People who don’t register when it is their turn to get vaccinated will be put at the back of the line, including healthcare workers who are first in line, Seoul officials have said. “We ask that you trust them and fully participate in receiving inoculation of the vaccines,” Prime Minister Chung Sye-kyun said on Sunday.

In the coming months, as vaccinations become more widespread, employers, schools and other institutions might look to enforce vaccine requirements of their own, health experts say.

The Vatican said it would explore alternative solutions for workers refusing to get Covid-19 vaccines, after getting blowback from a decree earlier this month that suggested employees could lose their jobs if they skipped inoculations. The Feb. 8 decree from the Vatican City’s governor said those turning down vaccinations without a health reason could be given another position.

Countries with higher intentions to be vaccinated against Covid-19 tended to be Asian nations with strong trust in the government, such as China, Singapore and South Korea, according to a study published by Nature Medicine, a medical journal, in October. But people were less likely to accept a vaccine if it is mandated rather than recommended, according to the study’s author, who surveyed people in 19 countries.

“In some Asian countries where people are more acquainted with the government being more assertive, obligating citizens to get vaccinated may be more accepted,” said William Schaffner, professor of preventive medicine at Vanderbilt University School of Medicine. “But it’s an entirely new technology, made very rapidly, so you have to respect people’s skepticism and hesitancy.”

(Source: WSJ)

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