Opinion

My vaccine status? It’s private

“So, did you get your vaccine?”

With more than 70 per cent of Canadians having received at least one dose of the COVID-19 vaccine, a decline in the number of hospitalizations and fewer deaths, life is starting to feel more “normal” than it has in a while.

The eagerness and interest most Canadians have shown in vaccination has made it such that it is common to hear people ask one another, “Did you get your vaccine?” or “Which vaccine did you get?”, anticipating a response worthy of celebration. In fact, while standing in the elevator the other day, a stranger turned to me and asked, “Did you get your second dose?”

The intention of asking others about their vaccine status may be good. The question may stem from a desire to ensure that others have the needed information; they may be concerned about others’ health and wellbeing; and/or they may simply want to celebrate how far we have come as a society whenever possible.

Upon further reflection, however, I worry that while the intention may be good, the impact may be the opposite. Because of this, I suggest that we ought to reconsider posing these questions as part of our general public life or find a way for people not to respond without experiencing negative consequences.

When we ask others to respond to questions related to their vaccine status in public, then we are ultimately asking them to disclose personal health information (“PHI”). As per Canada’s Personal Health Information Protection Act (“PHIPA”), the definition of PHI includes any identifying information about a person that relates to physical or mental health. PHI, as its name makes abundantly clear, is personal, meaning that it does not need to be disclosed to others, barring legal constraints. This means that a person typically does not need to answer a question regarding vaccine status; expecting a person to answer fails to recognize the information as PHI. So, when asked in the elevator, “Did you get your second dose?” I could have said, “I’d rather not disclose this information. It’s my PHI.”

The decision not to disclose PHI, however, may lead to a host of inaccurate assumptions about one’s health, health status and personal values. Each of these assumptions can lead to harmful consequences.

For instance, suppose a person decides not to disclose their vaccine status. In this scenario, the question-asker may immediately jump to the conclusion that this person is not vaccinated. The thought process may be something like, “If this person received a COVID-19 vaccine, then they would have disclosed their vaccine status. They decided not to disclose their vaccine status. Therefore, they did not get their vaccine.”

However, the logic of this argument is flawed. Sure, it may be the case that the person did not get a vaccine. However, perhaps this person simply values maintaining the right to privacy/the right not to disclose PHI to others. Privacy is a value that many may want to maintain.

The above conclusion (i.e., “is not vaccinated”) may be false, though it comes with a host of other assumptions about a person’s ideology and values. In our polarized society, assuming or learning that a person is not inoculated seems to influence the idea that the person is unconcerned about others’ health or that the person is ideologically opposed to vaccines. However, it may be the case that an unvaccinated person has a health condition preventing vaccination. The decision not to receive a vaccine because of another health condition is based on further PHI (i.e., the health condition), which one also does not need to disclose.

Alternatively, perhaps this person identifies as part of a community that previously experienced abuse at the hands of the health-care system and is hesitant about the vaccine or had experienced unjust discrimination or harm. In short, the justification to disclose or not disclose information about one’s vaccine status and to receive or not receive a vaccine is deeply personal.

Ultimately, there are conflicting perspectives at play about needing to disclose/not disclose one’s vaccine status in the public domain and having a right to ask. One is the perspective that people should not need to disclose their vaccine status since it is PHI. However, we know that not disclosing can lead to negative consequences. The other is the argument that people should disclose their vaccine status since the decision to/not to be inoculated may influence others’ health.

As it turns out, we may be able to honour both perspectives by: (1) not asking others to disclose their vaccination statuses; and (2) adhering to public health measures that help to reduce transmission. By continuing to follow evidence-based guidelines (e.g., not hosting large gatherings indoors), people should not need to disclose their vaccine status because it will be unlikely to influence others. We can respect PHI and stay safe.

It may be the case that there are good reasons for people in certain professions (e.g., health care) to disclose information to their employer if doing so may protect those with whom they work. The points noted above specifically relate to disclosing information to the general public (including patients or colleagues).

Ultimately, the potential consequences associated with asking people to disclose their vaccine status are real. And since we do not necessarily need to have this personal information to keep ourselves safe, we ought to reconsider asking about it during our regular public interactions. Why not just follow public health protocols and provide people with an opportunity to make informed decisions about the vaccine and to keep their PHI private? This approach would likely allow each of us to live more comfortably and safely together.

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9 Comments
  • Linda Murphy says:

    An interesting article which highlights the ‘vilification’ that often results from those who have opposing views (on both sides of the issue). I have had extended exchanges on this topic (and related ones) with a few people in my network.
    For those who are immuno-compromised or suffer from auto-immune diseases (greater than 10%), it is more than a philosophical discussion as it remains uncertain that we will be able to generate COVID antibodies from vaccines. This means that we need to remain extra cautious in our prevention measures. Vaccination status of those with whom we interact is not insignificant in making these decisions.

  • Ruby says:

    A point of clarification: You reference the Personal Health Information Protection Act (PHIPA), which is the provincial legislation in Ontario. There are only four provinces (including Ontario) that have legislation that is specific to Personal Health Information.
    There is no federal legislation specific to PHI, although PHI it is included as personal information in both the Privacy Act and the Personal Information Protection and Electronic Documents Act (PIPEDA).

  • DBASS says:

    I agree! First, the article is well-written. Second, whether someone “chooses” to or “chooses” not to be vaccinated, it is a personal choice. Here is a partial quote, from an alternative source: “In our time, place and condition there is a trend to create a new class of “untouchables”, a form of disgust based discrimination, based on the irrational fear of disease.”

    • Kim says:

      Excellent response, it captures and puts into words something I’ve noticed over the past year. The IMMEDIATE labelling of someone as an ‘anti-vaxxer’ is shocking. And, as noted, it’s done with little or no information on what is truly behind one’s choices. I’d love to read the entire article you cited.

  • Adelaide Bruchert says:

    Thank you for shining the spotlight on a very real problem. My children and I have all experienced discriminating comments and the target of false and damaging rumors about our values related to vaccinations. We have kept our thoughts and vaccination status private, and yet individuals continue to make false accusations. Even if we were anti-vaxx (which we most certainly are not), it is none of anyone’s business. We should not be required to explain why we are unvaccinated, and if we did, it would likely be met with a lack of understanding and judgement anyway. As an educated science teacher specializing in Biology, I am also not ill-informed. I am however very shocked that the status quo finds it acceptable to bully the unvaccinated (even with encouragement from public media and health care professionals), and to base discriminatory policies and restrictions on the unvaccinated as a means of coersion. My family all contacted Covid-19 in October, and have recently tested positive for antibodies, 9 months later. I am waiting to be part of a study looking at the long-term immunity derived from the wild strain of the virus, without having received the vaccine. I am absolutely appalled that the vaccine passport has come to fruition.

  • Mark Taylor says:

    The right to privacy about PHI does not include the right to endanger others. Masks, social distancing, etc are important, but are not foolproof (importantly, neither are vaccines). I do not accept that another person’s right to privacy gives them the right to threaten my health, particularly when they can take an action that has close to a zero chance of harming them. Anyone who does not wish to be vaccinated has the obligation to respect the rights of others, and stay home. Anyone who has a medical reason not to get vaccinated is probably at higher risk of serious infection, and should probably stay home to protect themselves. The Globe and Mail editorial from July 15 makes some valid points,

  • Carol Biberstein says:

    This is the first really meaningful comment I’ve heard on this website on the topic of vaccines. It’s your own personal choice and there is no need to broadcast it. And no need to ask others about it. The vaccine passports that are supposedly coming are the ultimate stupidity.

Author

Andria Bianchi

Contributor

Andria Bianchi, PhD, is a Toronto-based bioethicist and an assistant professor (status-only) at the Dalla Lana School of Public Health, University of Toronto.

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