Nathan Grills: Covid mandates are no longer ethical and are exacerbating the hospital crisis

Vaccine mandates are currently ineffective and potentially counter-productive as we seek to respond to this health system crisis.

Covid-19 vaccine mandates, be they ethically right or wrong, helped get people vaccinated and save lives. But it’s time for them to end for the good of our community, business and the health system.

The original aim of Covid vaccines, like influenza vaccines, was to stop severe disease. They did this very effectively and averted thousands of deaths in Australia. Vaccinations also protected our health system by keeping people out of hospital.

And keeping up to date with further doses results in a two to fourfold decrease in your odds of getting severe Covid (compared with not being up to date). I’m booked in for my fourth dose. It’s the single best thing you can do to protect yourself from Covid.

In addition to vaccines decreasing severity, studies in 2020 and 2021 showed mRNA vaccines also reduced spread. Therefore, the argument was made, especially in a zero-Covid space, that mandating vaccination would protect our vulnerable and minimise outbreaks (and the inevitable lockdowns).

Widespread vaccine mandates have become disproportionate and (more) ethically questionable. Picture: Joseph Prezioso

In bioethics, limiting personal freedoms is more justified where exercising that personal freedom harms others. Such justifications were behind the introduction of vaccine mandates.

However, vaccine mandates really worked not by protecting others from the unvaccinated, but by “encouraging” or forcing high numbers of people to get vaccinated quickly or risk being alienated from society and work. Mandates produced some of the highest Covid vaccination rates in the world and we consequently fared relatively well through the devastating Delta wave.

Enter Omicron. While vaccination still reduces the chance of infection from Delta, protection against getting infected from omicron quickly wanes after vaccination. As anticipated, vaccination and natural infection helped to select a variant that was able to “escape” vaccine immunity to infect the vaccinated at similar rates to the unvaccinated.

But effectiveness against severe disease is maintained (if you’ve been boosted). We hoped this may happen as there’s no advantage for a virus to kill its host. It dies too.

Therefore, with the advent of Omicron, and the subsequent realisation that vaccines didn’t markedly reduce transmission, the public health justification for mandates became tenuous. And in my view widespread mandates became disproportionate and (more) ethically questionable.

The argument for vaccines mandates was stronger when they stopped unvaccinated people from infecting others, especially the vulnerable in hospital. They don’t anymore. Ethically, therefore, the decision to get vaccinated should fall within the realm of exercising personal agency. That is, it’s your prerogative to make a poor choice that endangers your life. That’s why we haven’t banned smoking.

Of course, maintaining vaccine mandates might protect intensive care units and free up hospital beds. More vaccination means less severe disease, fewer hospital admissions and fewer ICU admissions.

But if that is the main benefit, then why make mandates only for those who work in selected jobs like education, health and disability?

By all means, we should continue to mandate staff to wear N95 masks and PPE when working in high-risk settings and when working with Covid patients or the immunocompromised. But the risk to the patient is similar from a vaccinated or unvaccinated healthcare worker.

It therefore makes little sense to maintain blanket mandates in all health settings, except in the

highest risk settings such as oncology wards. Perhaps the opposite.

Maintaining mandates has minimal direct public health benefit, and potentially further stresses our struggling health system. Picture: Richard Walker

I work in an emergency department. Three quarters of the patients I have seen over the past three months I’ve treated on ambulance trolleys (ramping) and in the waiting room. Not in the ED. This is caused by the hospital being “bed blocked”. Yet often we have empty beds, but they are closed due to inadequate staffing.

The causes and solutions are complex, but clearly we need more healthcare staff.

In this setting, it’s counter-productive to sack or furlough health staff because they aren’t vaccinated.

Maintaining such mandates has minimal direct public health benefit, and potentially further stresses our struggling health system.

Maybe strict and prolonged vaccine mandates are one reason why Victoria is specifically struggling.

We medics can all name multiple nurses, allied healthcare staff and even doctors who aren’t

working due to mandates.

Victorian nurse Holly Hale is out of a job after she stipulated she did not want to get her third dose of Covid-19 vaccination. Picture: David Crosling

I was speaking with a GP friend who can’t get enough staff to run his practice. They have lost nine nurses and receptionists due to vaccine mandates. I can personally name 15 people who left Victoria as their vaccination status made working in health nearly impossible.

Allowing those unvaccinated staff to work has little risk but carries some benefit. This is perhaps even more true for businesses which unreasonably retain vaccine mandates.

And for health employers, there is no additional liability that unvaccinated staff might catch Covid-19 from a patient, and be at higher risk due to being unvaccinated. In fact, the Australian Technical Advisory Group on Immunisation (ATAGI) have delayed prioritising fourth booster doses for healthcare workers partly because healthcare settings probably represent a lower risk than other workplaces. Healthcare staff mostly wear N95s masks and or PPE which is highly effective at preventing transmission. I am more likely to get Covid-19 from shopping than going to work in the ED.

Finally, if we want people to respect necessary public health directions like masks in high-risk

settings, self-isolating when symptomatic and even working from home, then we need to remove unnecessary and ineffective restrictions.

Vaccine mandates are currently ineffective and potentially counter-productive as we seek to respond to this health system crisis.

Prof Nathan Grills is a public health physician at the University of Melbourne.

Originally published as Nathan Grills: Covid mandates are no longer ethical and are exacerbating the hospital crisis