One can definitely sympathise with the protestations against vaccines based on the freedom of choice and based also on the widespread media scares which were spread while the vaccine was being developed and experimented upon. The main issue is the fact it uses messenger RNA to go into the nucleus (although this is not new to medicine). Afterwards there was the scare of the side-effects although it is well known that no drug would have been investigated within that small amount of risk, which again, is an accepted fact of all medicine. The risk should be big enough to investigate. Given the current situation at the time, it was made big through undue reporting.
Having said that people have a right to make a choice but government also has the right and duty to implement laws and Public Health law can take precedence in certain situations. Public health is inherently utilitarian in nature. Given the development of the public voice it has become weaker indeed in trying to appease people’s rights and liberties. This is a good thing but only to a certain extent.
As a person who knows about the risks I still took the vaccine and even recommended that my wife and children take it, even though it was the Astra-Zeneca. Yes, notwithstanding what I write above, I am also human and doubts linger in my head as well. But as humans we cannot judge by our primary instincts only. We have to rationalise. We can tolerate some not taking the vaccine, perhaps out of fear. But if that number grows, then we are all putting each other in danger. I think that now that many people have taken the vaccine, we can say that it is safe and that the side effects are not as bad as was portrayed – or at least outweigh the risks of having had a large number of the population, including those who took the vaccine, die from Covid19. Of course, I would say otherwise if a tragedy had happened close to home; but then I would not be objective as dealing with one’s emotions is a big deal.
President Biden has also remarked that now in the United States they have a pandemic among those who did not take the vaccine. Many are now regretting they did not do so, following the advice of others, including political leaders. Many of the protestors would not have been present had it not been for people who had taken the vaccine. In Malta we were lucky with the uptake; in others the situation is bleaker.
It is interesting to note that one doctor on social media said that if people have a right not to take the vaccine then he has a right to refuse to see vaccinated people. Someone replied stating what kind of doctor was he then! What vows did he make? This would be true under many circumstances, but pandemics and major public health disasters do indeed merit safeguarding other patients in one’s clinic and the doctor himself not only can be a carrier, but allowing non-vaccinated people with symptoms of a cold to come to the clinic would also be irresponsible towards other patients. If one is vaccinated it does not mean that they may not get the variant (they will probably get it lighter), nor that they cannot transmit it to others. So the doctor here would be using the precautionary principle, which in disaster and pandemic circumstances is ethically viable.
Having said that, we had a situation around 20 or so years ago on the Bioethics Consultative Committee when I was the honorary secretary. It was during the HIV era and there still was no cure for the disease. Today it is considered a chronic condition with treatment, but not then. Surgeons had it bad. They wished to have people tested before operating. The issue was not in order for them to take precautions but for them to be able to refuse to operate. The Committee, which included several doctors, refused this based on the fact that doctors ought never to refuse patients because they may have a transmissible disease. But this was not a pandemic. In fact, surgeons who got HIV were obliged to stop operating. So, the fear was legitimate. However, it is not only the duty of doctors, but in refusing to operate they would be putting a greater burden on those who do their duty and continue to operate. Precautions against blood transmitted infections ought to be taken with everyone so as not to discriminate.
So, the accusation against that doctor was not fair. The issue really is whether employers ought to oblige their workers to take the vaccine. Until government decides about this with public health, it is a legitimate precaution. Some employers, I am told, are insisting that if workers are not vaccinated, they should do a swab test once a week. This is a good precaution to protect other workers. It is true that people have a right not to take the vaccine. But others also have a right to be protected. Had all these others not taken the vaccine we would all be in a worse situation and who knows how many would have died. I would agree therefore with the Archbishop who not only said that it was a moral duty to take the vaccine, but if my memory serves me well, he said it was immoral not to take it.
The fact is we are all in this together and no one should take advantage of herd immunity. Herd immunity is morally valid for us to protect the more vulnerable who cannot take the vaccine itself. I would go further in saying that those who are not giving the vaccine to their children would have only themselves to blame if something happens to a member of the family. There is no excuse that this is a new vaccine and that there have not been enough trials. I have already expressed myself in the actions of the WHO in the beginning of the pandemic. This does not mean we should lose faith in it. It is a large organisation made up of many accomplished, knowledgeable, professional and capable people. If they say the vaccine is safe; it is safe. If you want to work in health care or in the sanitary sector, public health imposes the Hepatitis B vaccine. If you don’t want it you cannot work there. It is not only for your good but also for your close contacts. It is the same with vaccination in such a pandemic, where, because we did not have enough vaccine, we gave time to the virus to mutate. Now is not the time for protests; now is the time for solidarity and to all take that minimal risk to prevent a great harm to ourselves and our contacts.
Politicians try to balance rights against obligations. But do not blame them to protect the rest of us if those rights cost you to lose other rights. Our public health system is working well and we should thank God for the people there. As GPs we did some grumbling but no one deserves the proverbial “first stone” to be thrown at her.
Pierre Mallia is Professor of Family Medicine and Patients’ Rights and teaches at the University of Malta. He chairs the Bioethics Research Programme of the Faculty of Medicine and Surgery. He also chairs the Bioethics Consultative Committee. This article is his personal opinion and does not represent the opinion of any committee or board he serves on.
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