Thankfully, Québec Premier François Legault has abandoned his controversial plan to tax those who refuse COVID-19 vaccination. Instead, Legault now says that he wants to “extend a hand to the unvaccinated.”
A recent Ipsos poll found that 58 per cent of Quebecers agreed with the concept that those who refuse COVID-19 vaccination should have to pay a health tax unless they have a medical exemption. Recent experience, however, has shown that the proposed tax to “encourage” vaccination has increased “division” among Quebecers. The proposal emboldened hard-core anti-vaxxers and increased mistrust of government among the vaccine hesitant.
Premier Legault originally described the tax as a “health contribution” and promised that details would be forthcoming prior to debate in the National Assembly. As is often the case, however, “the devil is in the details” and it now seems there was no way for the government to address the logistical challenges without fanning the flames of discontent.
What conditions would have qualified for a medical exemption? When would the tax have come into effect? Who would have had to pay the tax? What amount would they have had to pay? And, how would the tax actually have constituted any meaningful kind of “health contribution?”
Would natural immunity from a previous COVID-19 infection, or trypanophobia (extreme fear of needles) have been a sufficient medical reason to refuse vaccination? Or, would medical exemptions have been limited to those currently in place for proof of vaccination, which are allergy to all COVID-19 vaccines available in Québec and myocarditis or pericarditis following COVID-19 vaccination.
Would the proposed tax have come into effect for the 2021 or the 2022 tax year? If the tax had applied to the 2021 tax year, it would have been an unfair retroactive penalty. If the tax had only come into effect for the 2022 tax year, it very likely would not have had a timely impact on vaccination rates as the financial penalty would have been delayed until April 2023. Also, would the tax have applied annually thereafter as COVID-19 became endemic and new variants emerged?
And who would have had to pay the tax? Premier Legault originally suggested it would only have applied to adults and only to those who filed their taxes in Québec. This would have meant, for example, that it would not have applied to children between the ages of 5 and 18; it would not have applied to thousands of university students who study at Québec universities; it also may not have applied to many poor elderly persons who do not file taxes. These limitations would have effectively narrowed the target population, thereby limiting the impact of the proposed tax.
How much would those who were taxed have had to pay? Would the amount owed have been different as between the partially vaccinated (those with one dose) and the unvaccinated? Eighty-four per cent of eligible Quebecers (5+ years of age) are fully vaccinated (two doses of a COVID-19 vaccine) and 91 per cent have at least one dose. The goal of the proposed tax was to move these percentages higher. Originally Premier Legault said the tax would be significant, “more than $50 or $100.” Later, there were references to a minimum tax of $100 to $200 and a maximum tax of $800 to $1,000. The suggestion of a flat fee raised important concerns about equity. A flat fee would have had a disproportionate impact on lower-income earners who file taxes because it would have taken a higher percentage of their earnings. Further, whatever the amount, high income earners would have been better able to simply pay the tax and remain unvaccinated.
What kind of “health contribution” would the tax have really amounted to? Even if the tax was significant, it likely would not have made a meaningful “health contribution” to the cost of treating long COVID or the cost of COVID-19 related hospitalization. It is estimated that the average cost for a COVID-19 patient in the ICU in Canada is $50,000 (by comparison, the average cost for a heart attack patient in the ICU is $8,400). Moreover, it is worth noting that we don’t otherwise demand a “health contribution” from those who make poor lifestyle and health choices even as these choices endanger health and strain the health-care system.
In various Canadian provinces, there are fines for breaking public health orders like restrictions on gatherings, mask mandates and requirements to self-isolate. Outside of public health, there are also fines for a range of behaviours that impact others such as speeding and reckless driving. As well, there are offenses against public order ranging from disturbing the safe operation of an airplane to riots. Until Premier Legault proposed to tax the unvaccinated, however, no government in Canada had proposed fining or taxing individuals for refusing to consent to a vaccine recommended by Canada’s National Advisory Committee on Immunization. Doing so would have set a bad precedent insofar as competent persons have the right to make decisions about their own health care – including the right to make decisions with which others disagree.
Implementing and enforcing the proposed tax would not only have been administratively difficult, it would also have been very costly. The money saved by cancelling this initiative could now be well spent distributing free N-95 masks. Another cost-effective strategy for ending the pandemic would be to gift vaccines to people in other countries who are ready and willing to consent to COVID-19 vaccination.
All in all, by backing down from the threat of a tax on the unvaccinated, Premier Legault has narrowly avoided yet another policy debacle in the wasteland of COVID public-health policy in Canada.