Tackling the anti-vax sentiment: how do we balance freedom and public health safety?
By Mariane Saroufim
Last November, just as there was a glimmer of hope of having a somewhat normal holiday season, Québec detected its first Omicron case. With a fifth wave starting early December, there was tightening of public health measures starting December 20th. Suffice to say, 2022 was not the new beginning millions of Québécois had optimistically hoped for. Although this optimism of returning to normalcy may not have been realistic in a world where vaccine inequity remained prevalent and gives way to novel variants, people were emotionally drained and wanted to hope. Public health measures, though necessary, led to intense anger, resentment, and frustration among some of the public, especially among those who were not informed or misinformed about the necessity of public health measures to minimize the impact of COVID-19.
Those emotions culminated to a peak when the anti-vax movement called the Freedom Convoy formed convoys, blockades, and rallies at Parliament Hill from January 22 to February 21. These protestors in Canada (especially in Québec and Ottawa) were first against vaccine mandates and vaccine passports for crossing the United States border. As the convoy reached Ontario, the movement evolved into a protest about COVID-19 mandates in general and the Trudeau government, encouraged by American and Canadian conservative political forces. It was also alarming to notice the palpable racist themes that the protest portrayed. Overall, the Freedom Convoy portrayed the level of polarization around public health caused by divisive political messaging on public health, lack of information and misinformation, and highlighted the work that we have ahead of us to build bridges through science communication. While effective science communication is one part of the solution, addressing political parties that profit from public polarization is also something that needs our attention.
Among protesters, there are those who were vaccine hesitant, anti-vaxxers, the anti-vaccine mandate community and those who opposed public health measures. Protests were also opportune moments for far-right extremists, anti-government activists, and conspiracy theorists to shine. While they might not make up a big proportion of the population, vaccine hesitancy is an important factor in vaccine-preventable disease outbreaks and deaths. Vaccine hesitancy is also one of the top ten threats to global health in 2019. To understand the polarization between anti-vaxxers and the pro-vaccination movement, we must look at the difference in freedom perspectives.
Fear of vaccines is not recent, and dates as far as smallpox vaccines. Fear of the unknown morphs into refusal and then anti-vaccination propaganda. While some beliefs against vaccination are difficult to rationalize (e.g., microchips in the vaccine, big pharma and government conspiracy) there are many degrees for vaccine hesitancy. Many anti-vaxxers are against vaccines in general, but others may have concerns about safety, lack of trust in development processes and doubts about efficacy. These doubts are common when faced with any novel vaccine or medicines. However, during this pandemic, doubts were amplified and received extensive attention in media and social media. Another side of vaccine hesitancy is the factors that influence acceptance or refusal of vaccines, including ethnicity, working status, personal belief, religion, politics, gender, education, age, income, COVID-19 infection, concern about COVID-19 infection and working in healthcare. But based on observations during this pandemic, the “Don’t tell me what to do” mentality has contributed significantly to creating opposition to vaccines and public health measures.
A lot of the manifestations seen in the past months stem from the idea that constitutional and civil rights to liberty and freedom have been violated. For example, the truckers wanted freedom from being forced to vaccinate to be able to keep their jobs. Political theorist and philosopher Isaiah Berlin would call it negative freedom, the freedom from constraint to be able to do what you want without interference by others or external obstacles. Vaccine deniers fight against vaccination in an attempt to protect their individual liberty they feel is trampled on by vaccine mandates, mask mandates and other public health measures. However, from a purely constitutional point of view, section 123 of the Public Health Act of Quebec clearly specifies that when a state of health emergency is in effect, the government, on the recommendation of the national director of public health, may order the compulsory vaccination of all or part of the population. That same act is why 137 healthcare workers who challenged the decree requiring them to be vaccinated to keep their jobs saw their request denied.
While it’s hard to start a discourse with people when their arguments are much more ideological and belief-based, the issue at stake here is not the freedom of people to not be vaccinated but the harm they cause by not being vaccinated. The anti-vaxxers might see vaccines as harmful –because of misinformation or conspiracies - but it is the lack of vaccination that has proved to be more harmful. The push back against vaccines has in fact made the lives of the population more difficult since unvaccinated individuals in Ontario are catching COVID-19 7 times faster than vaccinated people, are 25 times more likely to be hospitalized and 60 times more likely to be in the ICU due to the infection, which in turn requires governments to turn to strict public health measures.
While being infected and recovering from COVID-19 provides a degree of protection, the length and degree of this protection is uncertain. Thus, ensuring protection by vaccination remains crucial especially for higher risk groups as new highly transmissible variants continue to emerge. Additionally, the rise in hospitalization among unvaccinated people means taking medical resources and personnel away from someone that needs it for COVID-19 or non-COVID-19 disease, which leads to an increase of non-COVID-19 deaths, a more congested health system and delays in attaining herd immunity. When you consider all these factors, it becomes clear that what we should be focusing on is not the attack on personal liberty that anti-vaxxers feel but the collective freedom that vaccinations can provide and the right of individuals to health. The utilitarian philosopher and political economist John Stuart Mill articulated it well: “The only purpose for which power can be rightfully exercised over any member of a civilized community against his will, is to prevent harm to others”. Similarly articulated by the famous phrase “Your freedom ends where mine begins”, it evokes Berlin’s second and opposing concept of freedom, positive freedom, the freedom to act upon one’s free will in a collective society. Since the actions of anti-vaxxers to not vaccinate puts the health of a collective group at stake, the individual liberty and freedom to not vaccinate should not be prioritised over the collective right to health. Wearing a mask and getting vaccinated is a positive conscious choice that a member of society can do. Claiming that following health guidance is a violation of one’s liberty is to reject the liberty and right of the collective to health by misinterpreting the risks of coronavirus transmission.
On the other hand, even though public health measures are necessary, it is still crucial to make sure they are reasonable, non-discriminatory, and based on the law, to consider the impact of those measures on populations at risk, and to continue positive discourse with both opposing sides. Organizing peaceful meetings with opposing groups, actively listening to their arguments and needs, finding common grounds, temporary solutions, being transparent and open-minded and meeting them in the middle are strategies that governments and public health officials should implement so as to not have more disgruntled citizens and manifestations that could be avoided. To combat vaccine hesitancy during this pandemic and future outbreaks, it might be useful for us to consider our collective health and not see it as a threat to individual liberty, but as a pathway to regaining that freedom.
Although the argument for the prioritizing of public health to reach herd immunity through vaccination is strong, it is equally important not to dismiss or insult those who disagree. As highlighted above, the ideological differences on these topics require a meaningful effort to find compromise. Herd immunity can only be achieved with a common sense of purpose and public health measures only work with collaborative efforts from everyone. In situations such as pandemics, moral panic can set in and it’s easy to accuse, point fingers at anti-vaxxers and marginalize groups that do not embody the same beliefs as the majority group. These differences are further heightened due to media coverage and through social media. When infection control behaviors became normalized, those who were non-compliant were stigmatized and called derogatory terms like “covidiots” and were quickly portrayed as threats to public health in Canadian media. Alienating a group does not help the common goal of public health safety. We must distance ourselves from unhealthy polarizing tactics and try, as much as we can, to build bridges based on science and the value of collective freedom. Methods of communication in public health need to be clear, empathetic, and impartial to facilitate compliance, promote behaviors that prevent infection and reduce stigmatization of opposed groups. We cannot keep spreading false information or keep being polarized.
There is no black or white in a pandemic, especially as the science keep evolving. We need to be better, united in a world community and discuss responses to COVID-19 to achieve our common goal of ensuring public health safety while respecting the opposed opinions, recognizing privilege positions and realising rights. Proposing incentive solutions or appeasement proposals like clinics for non-vaccinated can be a start. Just like Isaiah Berlin states, the two concepts of liberty – positive and negative – need to coexist even if there is a collision. After all, it’s not health for some, it’s health for all.
About the Author:
Mariane Saroufim is a recent Bachelor of Science graduate in Physiology from McGill University and an incoming student at the Masters of Science in Public Health program at McGill University. She is also an editorial board member of the McGill Global Health Perspectives. She tweets at @MarianeSaroufim.