Kerry Bowman is a bioethicist at the University of Toronto. In various media appearances, he has voiced skepticism about whether requiring the use of vaccine certificates is ethical. We interviewed him about his stance on this issue, and what follows is a transcript of this interview, edited for length and clarity.
Why are you skeptical that vaccine certificates are ethical?
Pretty close to the top of the list is the curtailment of freedom of movement. In a mature democratic society, people have freedom of movement. And equity: Is it fair for people with vulnerabilities, people with challenges, whether they be physical or cognitive disabilities or due to racial injustices? Does it create potential problems in terms of equity? And I would think it actually does in some cases.
One of the greatest concerns I have is that the kind of solidarity that we had earlier in the pandemic, the notion that we’re all in this together – which was never fully true, but at least it was encouraging to hear – that’s really fallen away. I often ask this fundamental question: Does a measure or policy bring people together or divide people? And I think this clearly divides people. Now, I’m pro-vaccine, but I work with some unvaccinated people who have very senior positions, both within the hospital system and the university system. To characterize the unvaccinated as extreme right-wing radicals or selfish, thoughtless people is really unfair. We are absolutely demonizing the unvaccinated. Our politicians and many people in leadership roles are very comfortable with being incredibly aggressively negative towards unvaccinated people and creating an us-and-them mentality within society. This is dangerous stuff. We are human beings, and we are primates, and this feeds into the weaker aspects of human nature.
There’s almost a presupposition that the division of vaccinated and non-vaccinated people is a complete firewall. And it’s not. We do know that vaccinated people are far less likely to become critically ill, and there’s some growing indication they have less chance for transmission. But it does not mean that if there are vaccinated people on one side and unvaccinated people on the other, that there’s absolutely no virus on the vaccinated side. And we kind of are creating policies as if it does.
So, is it a violation of people’s rights? I would say it is. Is it justifiable? I sincerely don’t know. I’m not sure we’re ever going to know because it’s bundled with a lot of other public health initiatives, and we’re never going to be able to completely tease out the overall epidemiological effect of vaccine certificates.
What do you think the most compelling arguments in favor of the vaccine certificates are? Where do you feel the most torn?
Safety: you have a right to as safe an environment as can possibly be constructed for you if you go out for lunch or if you’re a patient in a hospital. The vaccine passport likely contributes to safety, but how much it contributes, we don’t know. The risk-benefit analysis in ethics is very, very challenging in this pandemic, because the data is not solid. Having other vaccinated people around you will elevate your safety. Does it elevate it enough to justify it despite all the ethical problems it brings? I don’t know.
In July, Ontario’s COVID-19 Science Advisory Table stated that not implementing a vaccine certificate in high-transmission settings could lead to “greater social isolation and continued precautionary measures for people with disabilities, who are among the most susceptible to COVID-19.” What do you say to those who argue that, without vaccine certificates in high-transmission venues, people who are especially vulnerable to COVID-19 because of a disability or health problem will either have to remain isolated or face a greater risk of becoming gravely ill due to someone else’s choice to not get vaccinated?
You know, when it comes to people with disabilities, it cuts both ways: I’ve worked with people with developmental delays. The routines of daily living are a challenge for them. Adding this would mean they’d interact less with society because there’s another barrier that they find hard to manoeuvre. You know, society is becoming increasingly focused on systemic problems and systemic barriers. They’re real and vaccine passports probably exacerbate them.
We are human beings, and we are primates, and this feeds into the weaker aspects of human nature.
But it is a legitimate concern that the more vulnerable people will be put in a greater amount of harm’s way if vaccine passports are not used. But again, we come back to the fact that vaccine passports suggest that we’re presupposing that we’ve got a firewall between the vaccinated and non-vaccinated. And we don’t. We have a significant improvement. But we don’t know how much and we’re not creating a disease-free environment for them.
It is estimated that someone infected with the Delta variant will on average infect at least five other people, and research indicates the variant could well be more virulent than the original strain.
The threat this variant poses to our health-care system is therefore greater than the original strain, especially given how strained our health-care system is now. Since the unvaccinated are more likely to catch the virus and get hospitalized, some argue it is necessary to bar them from high-risk settings to not overwhelm our health-care system. How do you respond?
Delta has changed everything. There’s no question. But we are theoretically well into the fourth wave. Remember those projections in late August for Ontario? They did not materialize at all. Our medical leadership could be a lot more humble about trying to at least explain to the public why the modeling was as far off as it was. They’re doing the best they can, and I respect those guys enormously, but the bottom line is we’re not sure.
My concern would be the fourth wave is not as severe as we thought it might be, and we have to be nimble enough to change systems if need be. Our hospital systems are strained from the exhaustion of this pandemic, but our critical care units are not at capacity at this point.
What do you make of the argument that vaccine certificates, while a curtailment of people’s freedom, are justifiable because they keep people safe by making them either get vaccinated or stay out of harm’s way?
The free and informed consent of the individual has really been the foundation of health-care ethics in Canada, and it has really given way to a larger utilitarian, population-based calculus of determining what is best for the largest number of people. This is a radical shift. It’s a shift that sometimes happens in wartime. Some would say it’s a logical shift because of the crisis. But a crisis is a time where you really need your ethics, and if your ethical platform is so unstable that you can just replace it depending on the circumstances, was it really a solid ethical platform in the first place?
Someone not getting vaccinated creates a risk for other people. But how great a risk is that person to the broader community? We don’t know, to some extent. And vaccines themselves are not without risk, even if most people would agree that the risks from COVID-19 are far worse.
The comments section is closed.
The pandemic has been a real blow to people’s health, living conditions, and movement. People have lost loved ones to Covid-19, and there are people fighting for their life in hospitals with Covid-19. I think the general public doesn’t have a problem with a vaccine passport, but that it might be a sign of the abuse of power of the political people at the helm of government. It’s at the back of many citizens’ mind and it gets scary when things don’t add up, like not making vaccination mandatory for healthcare workers in hospitals.
I fear that the wrong type of arguments are being used here: binary yes/no arguments do not apply well. Here we should be talking about probabilities: of getting disease, of transmitting, and of getting severe disease. Further, we need to recognize uncertainty going forward. We know that predictions are wrong: but they are better than no information at all, so it is right to make the best possible, even while knowing they will be wrong in some aspects. While I have no training in ethics, I cannot see that moderately curtailing freedom of movement is a hill to die on.
The points made about vaccine passports restricting freedoms are salient. However, we restrict people from driving with blood alcohol above an arbitrary limit. The total no of people hurt by drivers drinking , Because of alcohol ( My emphasis) is likely much smaller than the number of persons infected by unvaccinated individuals . The absolute probability of causing an accident with a blood alcohol just above the legal limit is extremely small . Yet we agree as a society and as individuals to impose harsh penalties for driving with alcohol in the blood ( note I do say “ drunk driving”) .
In a different example , seat belt laws protect the individual and the health care system ( from excess load) but have little effect on others nearby.
Despite the absence of black or white withe respect to vaccine and risk of transmission , are vaccine passports not a clear case of the maxim: first do no harm? Also , are marginalized persons not in even greater need of being protected from infected persons in their environment?