Vaccine Passports -- The Debate

Vaccine passports/certificates. Photo by Getty

"Given the reduced/no effectiveness of two doses, depending when the last dose was, there is a risk of these people having an infection, perhaps unknowingly, and transmitting to someone else in such a setting [places restricted to those with vaccine 'passports'."

"[The vaccinated are much likelier to have mild illness], So they may be more likely to be out and about, despite being infected. By excluding all the unvaccinated people from these places, we are in essence keeping them safer from the vaccinated people, who may be asymptomatically or pre-symptomatically infected with     COVID, but still able to transmit, especially when everyone is unmasked."

"If we drop the vaccine passports, the unvaccinated are going to go into those spaces. Right now, they may be living the life of a hermit, and have managed to stay safe that way. But if we get rid of vaccine certificates, they're like sitting ducks."

Dr.Jeff Kwong, epidemiologist, senior scientist, ICES (Institute for Clinical Evaluative Sciences)

"But the passports? They may be a good stick, but I'm not sure how effective they are for slowing transmission."

"We've seen it affecting families, splitting families apart. [Once vaccines became polarized], all reason went out the window."

Professor emeritus David Streiner, psychologist, McMaster University

"Because it makes people think that they are in a safe space [vaccine certificates may be harmful]; they were, pre-Omicron, but no longer."

"Vaccine certificates may prove valuable again at some point, but the two main purposes -- motivating people to get vaccinated and protecting people by keeping spaces confined to those at low likelihood of infection -- are clearly no longer relevant."

Dr.Andrew Morris, infectious diseases specialist, Toronto

"In the fall, when people were talking about implementing mandates, and some of my colleagues who were unvaccinated were facing termination, I thought to myself, what, exactly, is the risk reduction gained by terminating unvaccinated health-care workers."

"And that just led to a broader exploration for the actual numbers behind that."

"We were in these in-between phases of the waves. Obviously now infection risks are rising. It's a totally different situation."
"But I think we should think very carefully about whether or not, in a pluralistic democracy, we are sure that the benefits we may extract from [vaccine mandates and passports] outweigh the harm of creating a class of citizens who are not allowed to fully participate in society."

"We are starting to look at our fellow citizens in a way that they are not equal citizens to us, because they have made decisions that we don't agree with. And I think that's a very dangerous thing to do."

Aaron Prosser, psychiatry resident, McMaster University

Ontario had previously indicated that requiring proof of vaccines in settings such as restaurants, bars and cinemas would no longer be required after Jan.17, but a senior official said the government is taking that end date off the table. (Evan Mitsui/CBC)

 

This is a debate on reducing the risk of transmission of COVID-19. The debate over vaccines is long past. Their well acknowledged capacity to prevent severe disease, hospitalization and death in vulnerable adults is no longer open to debate. The value of the COVID vaccines has been proven time and again; not a 'cure' but a means to prevent a worse-scenario response to the incursion of a predatory pathogen that has cut a wide swath through the world's population in illness and in a massive death count globally.

 

A new study produced in Canada explores whether vaccines reduce transmission risk. And according to the study results they do. For a limited time frame. Two doses, the world now knows, are not likely to protect against infections by a virus that is highly contagious as Omicron has proven to be. Six months following the second dose "it kind of wanes down to, like, zero", stated Dr. Kwong, lead author of the study.

 

Updated data examined by his team indicated effectiveness against infection can recover following a third dose with an mRNA vaccine to about 60 percent. A higher rate of protection, he agrees, "but still not great", certainly not as high as had been the case with the previous, Delta strain. Based on two objectives; prevention of transmission, and keeping people out of hospitals and alive, the concept of vaccine passports gained recognition and became an important part of the anti-COVID arsenal.

 

Vaccines proved their usefulness in diminishing the worst-borne-out threats of COVID, but it was soon realized that they don't stop transmission and infections; all the more so with particularly wildly contagious Omicron. An observation that led to questions over whether passports remain relevant, and why the controversial issue hasn't been more fully addressed by the governments mandating their use. 

 

Making life a little more difficult for people who decline the shots, passports were seen as a method of encouraging vaccine uptake; no vaccination, no entry to settings such as gyms, theatres, restaurants, sports events or liquor and cannabis stores. Once Quebec expanded its vaccine certification scheme to cannabis and liquor stores the number of first-dose bookings quadrupled.

 

It is Dr.Kwong's contention that vaccine passports serve to protect the unvaccinated, at this juncture. His views are not universally shared; many health professionals feel the coercive use of passports to try to force the unvaccinated to comply divides people, creating adversaries out of the vaccinated and the vaccine-hesitant or -defiant. The question of the percentage in the population required to achieve 'herd immunity' with COVID goes answered as yet -- and how many people need to be excluded to result in prevention of one transmission?

"I think we're in this stage of producing fatigue about it: Okay, I've got my two shots, my booster. Enough already. Let me go on with my life", observed Dr.Streiner, professor in the department of psychiatry and behavioural neuroscience, McMaster University. The risk of public pushback concerns him. Dr.Streiner's study estimated in the pre-Omicron era, at least 1,000 unvaccinated people would be needed to be excluded in prevention of one SARS-CoV-2 transmission in most settings.

New data envisages a surge in daily hospitalizations in coming weeks amidst signs the Omicron wave may be peaking,  just as it appears to be doing in Britain and the United States. The variant may be running out of people to infect, according to The Associated Press. "It's going to come down as fast as it went up", commented Dr.Ali Mokdad, University of Washington scientist.

Validating Confirmation in Vaccine Effectiveness

"What  it shows is that if you're vaccinated you'll definitely be in the minority of people who end up with an infection, end up in hospital or end up dying."

"It 's the prevention of bad outcomes like death that the vaccine does an amazing job at, upwards of 90 to 95 percent."

"The rate of infections in vaccinated people is extraordinarily low ... and you're not taking into account that it was a much larger number that contributed to those infections."
"That leaves about 46 percent or so who are people who are eligible for the vaccine, but aren't vaccinated yet. Getting that population -- the ones who are eligible and easily vaccinated -- would go a long, long way [to reaching a state of herd immunity]."

"There's a strong argument that 50 and older is where we want to look as we have enough vaccine [to administer the third, 'booster' dose for maximum efficacy against COVID]."

"Obviously the most important thing is to get everyone vaccinated. That's No.1, but we're reaching a threshold where trying to [reach] that further bit is difficult."

Dr.Gerald Evans, infectious-disease specialist, Queen's University, Kingston

Drive-thru clinic,Kingston.  CP/Lars Hagberg

According to a newly published study from Public Health Ontario, unvaccinated people account for 90.9 percent of all COVID-19 hospitalizations in the province, and 90.2 percent of all deaths due to the coronavirus. Fully vaccinated people in SARS-CoV-2 breakouts account for a mere 2.7 percent of hospitalizations and 3.3 percent of deaths, according to the report's data. The study represents the most detailed investigation yet of the effectiveness of the     COVID-19 vaccines, both at preventing infections and in limiting severe outcomes.

Data was examined from December 14, 2020 when the first vaccinations were rolled out in the province -- until November 14, including early stages of booster doses for the most vulnerable people in the province. Unvaccinated individuals, measured in the 30 days before the release of the study, were 4.8 times more likely to contract COVID than were fully vaccinated people, according to the study results.

Making up 91.7 percent of all COVID-19 cases in the province, those who remain unvaccinated obviously receive the brunt of the casualties of COVID infections. Infections that hit fully vaccinated individuals -- known as "breakthrough cases" account for only 3.8 percent of infections, with fewer than 0.2 percent of infections occurring in people having received a third dose of vaccine. 

 

Among people aged 60 and over, data are particularly alarming; in that age group those unvaccinated are over 16 times likelier to end up in hospital, as opposed to someone who is fully vaccinated. Seniors for the most part who have received a third dose -- which encompasses those over age 70, the immunocompromised and their caregivers at this juncture -- account for less than 0.2 percent of hospitalizations and under 0.1 percent of deaths.

 

"Yes, you could get infected if you're fully vaccinated, particularly if you're hanging out with someone who is infected and unvaccinated -- and that's what we're beginning to see because there is more soci8alizing going on since we're all desperate for it. But we know that the ultimate outcome is not going to be as bad", advised Dr.Evans. Of 11,154,162 Ontarians fully vaccinated by mid-November, 17.596 had undergone a breakthrough infection. 

 

Current vaccination rate in the province stands at about 78 percent of the entire population. Children aged five to 11 represent roughly 30 percent, with eligibility to receive pediatric doses of the Pfizer-BioNTech vaccine just ratified. Under age four children are not eligible for inoculation, accounting for about 15 percent of the unvaccinated.

 

Experience in Israel and some parts of the United States provide reliable evidence of the utility in expanding the third, booster dose of vaccine to the over-50 group: "Over age 50, you start to see a benefit to third doses", Dr.Evans explained.