Analysis: One of the most challenging ethical issues concerns returning to normality in a manner that protects public health without jeopardising the personal freedoms of anti-vaxxers or setting an unethical precedence for future pandemics.

Despite three lockdowns, Ireland is in a better position than many European countries in terms of the percentage of vaccinated people and prospects of economic recovery. Nevertheless, COVID-19 and its complexities seem infinite, and the road to normality rather long. Particularly, dealing with those who refuse COVID-19 vaccination (anti-vaxxers) leaves us facing tough ethical quandaries.

While the number of anti-vaxxers in Ireland is unknown, patterns observed in the UK and the US might offer some lessons. The Opinions and Lifestyle Survey shows that out of 17,201 respondents, 6% are vaccine-hesitant - some of whom have already been offered the vaccine and rejected it.

Among the studied sample, some cohorts had a rate of vaccine hesitancy higher than the national average, including Black or Black British adults (22%), adults in the most deprived areas of England (12%), parents living with a dependent child aged 0 to 4 (11%), and the 16-29 age group (10% of males and 14% of females).

In the US, the situation varies by state, but a recent Quinnipiac University Poll showed that among 1,237 participants, 27% already have or would refuse vaccination.

While 45% of Republicans indicated vaccine refusal, only 7% of Democrats were among anti-vaxxers. Others report that white evangelicals are among anti-vaxxers, relying on religious arguments such as "it would be God's will if I am here".

Perhaps one of the most challenging ethical issues of vaccine refusal concerns returning to normality in a manner that protects public health without jeopardising the personal freedoms of anti-vaxxers or setting an unethical precedence for future pandemics.

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From Radio 1's Drivetime, Ciaran O'Connor, Disinformation Analyst at Institute for Strategic Development, speaks to Sarah about anti-lockdown protests and disinformation.

Addressing this challenge has become slightly more complex after the European Court of Human Rights' recent ruling about a case from the Czech Republic, allowing signatory states to legally mandate childhood vaccination.

The court rejected the argument that the EU's guarantee of freedom of thought, conscience and religion extends to vaccine refusal.

Furthermore, although the court agreed that compulsory vaccination is "an involuntary medical intervention, [that] represents an interference with physical integrity and thus concerns the right to respect for private life, protected by Article 8 of the [European] Convention [for Human Rights]"; it asserted that since vaccination "protects both those who receive it and also those who cannot be vaccinated for medical reasons", the societal benefits outweigh respect for private life.

The ruling implies that public authorities could tie vaccination to the receipt of specific social services/privileges without infringing human rights.

Such implications are laced with ethical issues around privacy, consent, and personal freedom and might contribute to new socio-political divisions.

Recent developments in countries where more people are vaccinated add further credit to the opinion that tough ethical challenges await Irish society.

In Israel, anti-vaxxers have been denied some of the freedoms granted to those who have been vaccinated (e.g., using public spaces including gyms, museums, bars, restaurants). This is facilitated via Green Passports. Consequently, anti-lockdown protests of 2020 are transformed into Anti-Covid vaccine and anti-Green-Passport protests in 2021.

While some cite religious or personal reasons for refusing a vaccine, others use rights-based and liberal arguments (e.g., my body, my choice) to explain their decision. In the US where 45% disdain vaccine passports, Ohio lawmakers have recently introduced a bill (Vaccine Choice & Anti-Discrimination Act) to prevent anti-vaxxers facing "discrimination, being denied services or forced to follow a requirement that they wear masks or other penalties".

This could allow Ohioans to refuse a COVID-19 vaccine – or any other vaccine – because of religious reasons, medical reasons or natural immunity. While citing religious and medical reasons together could be interpreted as a deliberate category mistake (to satisfy conservative communities), the House Bill 248 could set an awkward legal precedent.

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On Radio 1's Today with Claire Byrne, Helena Smith, Greek Correspondent, The Guardian, Sam McConkey, RCSI University of Medicine and Health Sciences discuss EU Vaccine Passports.

The road ahead

With COVID-19 vaccination expected to gain speed in Ireland, relevant procedures for refusal should be communicated to healthcare providers and the public. More importantly, however, future restrictions that may be imposed on anti-vaxxers should be communicated as early as possible to assist these groups in careful deliberations about their choices and prevent further marginalisation.

As the experiences of other countries show, since refusal patterns differ by community, local and contextualised research, communication and public engagement could benefit policy development. Moving forward, two equally important steps seem necessary:

1) Healthcare authorities should conduct regular surveys and initiate a public debate about vaccine refusal. Currently, no accurate and public data is available about vaccine refusal, the rationale for hesitation or its prevalence in different cohorts. This information would be immensely helpful in developing tailored communication with anti-vaxxers and addressing their concerns.

2) Guidelines should be made available on what anti-vaxxers should expect and how they will be identified (e.g., via a Green Passport or other mechanisms?). Currently, the closest publicly available example is the HSE's refusal form for primary childhood immunisation.

According to this form, personal information of those refusing primary childhood vaccines will be "included in an Immunisation Database". If a similar database is generated for anti-vaxxers, guidelines should be developed on various issues, including public authorities’ access to such database and the rights and responsibilities of involved parties (e.g., anti-vaxxers and their children, GPs, insurance providers, employers, etc.).

From an ethical perspective, dealing with anti-vaxxers would present serious challenges for Irish society. Should anti-vaxxers be respected for their choice; given that the larger the size of this group, the harder it is to protect those who are allergic to vaccine, thus, the longer the pandemic is going to last, and more people will suffer?


The views expressed here are those of the author and do not represent or reflect the views of RTÉ