Countries Have Tried Mandates, Isolation, and Herd Immunity to Curb Covid – Barron’s

About the authors: Arthur L. Caplan is the Drs. William F. and Virginia Connolly Mitty professor of bioethics and the founding head of New York University School of Medicines Division of Medical Ethics. Nicholas Agar is distinguished visiting professor at Carnegie Mellon University in Australia. Oliver Feeney is a researcher with the Institute of Ethics and History of Medicine, University of Tbingen and Centre of Bioethical Research and Analysis, National University of Ireland (Galway). Vojin Raki, full professor, is founding director of the Center for the Study of Bioethics and head of the Steering Committee of the Continental Divisions of the International Chair in Bioethics, World Medical Association Cooperating Center.

The pandemic isnt done with us yet. The emergence of the Omicron variant of the virus that causes Covid-19 has put new urgency behind national vaccination campaigns. But a look around the world at different vaccination strategies finds both hesitancy and no easy answers.

Were scholars from different parts of the globe. We surveyed national responses to the pandemic in nations we knew and which had adequate vaccine supplies. We were looking for lessons that can be learned about various efforts to rein in the pandemic using vaccination. What are the moral norms that have fueled different outcomes? Should we follow a particular set in moving forward?

Start in Australia and New Zealand. In spite of differences of political style between conservative Australian Prime Minister Scott Morrison and progressive New Zealand leader Jacinda Ardern, both societies settled on similar approaches to the pandemic. Both aimed to get as many people vaccinated as soon as possible. But the Australian and New Zealand vaccination programs were slow to start. Australias rollout in February 2021 promptly ran into trouble because it relied on the domestically produced AstraZeneca vaccine. Stories of a rare blood-clotting condition significantly slowed uptake, requiring an awkward pivot toward mRNA vaccines. New Zealand dodged this issue by making the Pfizer BioNTech vaccine available to all from the launch of its vaccination program.

The slow start of Australasian vaccination programs can be partially attributed to over a year of internationally celebrated success at eliminating the virus by community-oriented and personal-sacrificing stay-at-home orders and social distancing. For much of the pandemic death from Covid-19 was something Australasians watched on TV. But despite temporary success the approach failed. Outbreaks of the Delta variant led to a significant acceleration of vaccination in both nations with expectations of very high rates of compliance. Ardern hopes to achieve a vaccination rate of 90% of New Zealanders. There are similar aspirations in Australia. In both nations there are concerns about lagging rates of vaccination in some populations, for example, among indigenous Australians and among Mori and Pasifika in New Zealand.

Sweden by contrast did not fight the Covid-19 pandemic with lockdowns. The idea of naturally acquiring herd immunity proved not only controversial, but a manifest failure. Nonetheless, some continue to tout the herd immunity approach, such as the small but vocal members of the Great Barrington group in the U.S.

In spite of initial vaccine hesitancy, now more than 80% of Swedes are vaccinated with one dose and well over 50% with two. Swedish epidemiologists have assessed thatbetween 52% and 82% of vaccinated Swedes is sufficient to attain herd immunity. In that light, it appears that Sweden has finally achieved the immunity it desirednot in a natural way but supplemented with mass vaccination.

Serbia differs from the three mentioned countries in two ways. First, vaccine hesitancy in Serbia is more widespread. Second, Serbia has been subjected to populist autocratic rule in various periods during the past decades. The consequences are that, in spite of a rapid major success in vaccine acquisition, years of anti-Western official media campaigns have taken their toll. These campaigns, which have included anti-medicine messages, culminated in believers in alternative medicine obtaining dominant attention in state-controlled media at the beginning of the pandemic. State-run campaigns used the pandemic for political purposes, and Covid-19 deaths and infection rates were falsified. Serbia is now among the countries with the highest infection rates per capita in the world. Several days this fall Serbia was even world No. 1. Half of the population is still vaccine-hesitant. Serbia has reached a vaccination rate of around 50% with at least one dose, with stockpiles of unused vaccines produced mostly in China, the U.S., the U.K., and Russia.

In the Republic of Ireland, by November 2021 over 90% over the age of 12 had received at least one dose. However, this number fell by about half for Central and Eastern European immigrant communities. The overwhelming majority of politicians have advocated vaccinations. Nonetheless, vaccines are not mandatory and it is unlikely that any such policy will be adopted. The Republic of Ireland has one of the lowest rates of Covid-19 vaccine hesitancy in Europe.

Nearby in Northern Ireland, which has experienced years of intercommunal conflict and division, things are different. In September, the seven-day average death rate per 100,000 people from Covid-19 was 10 times higher than the Republic of Ireland rate. One local doctor memorably attributed those differences to the presence of an anti-authoritarian, an anti-government thing, which runs through society, particularly on the [Irish] nationalist side. Thats in addition to other factors associated with lower uptake rates of vaccinations, such as social deprivation. Overall, in Northern Ireland, the levels of vaccination uptake by persons aged 12 (and above) is 85% vaccinated with a single dose.

Northern Ireland has a dual identity in politics and culture. One can also compare it with the U.K. as a whole, where the 7-day average death rate per 100,000 was half the rate in Northern Ireland. Of the four nations of the United Kingdom, as of November 2021, Northern Ireland has the lowest rates of vaccine uptake.

In the U.S., efforts have focused on state and local initiatives to increase vaccination. The federal government has authority to impose vaccination requirements for federal workers, the military, and those wishing to enter the U.S. Mandates have been used for these groups and while challenged they have been upheld insofar as they permit masking and testing as alternatives. Vaccination rates are nearly 100% in these populations. States have tried persuasion and financial incentives to boost vaccination rates. As of late-November 59.3% of the entire U.S. population was fully vaccinated. The New England states all reported rates over 70%. The poorest rates of vaccination under 45% were in Alabama, Wyoming, Idaho, and West Virginia, with many other states reporting under 55%. Opposition to government-imposed mandates at the state level has been strong, with some states attempting to prohibit mandates of any kind. Some private entities, including hospitals, airlines, banks, food delivery companies, groceries, casinos, athletic teams, and small businesses, have moved to mandates as a condition of employment with impressive success. The federal government is seeking to impose mandates on businesses in the name of worker safety, which has triggered a broad legal battle over federal authority.

In the U.S. government mandates are met with far more resistance than those imposed by private businesses. Ideological divisions tend to correlate with higher voluntary compliance in more left-leaning blue states than in conservative red states, where there seems to be more sympathy for mandates that permit religious exemptions.

What can we learn from this varied picture? Public health in general and vaccination in particular are as much about politics, values, and public trust as they are about science and facts. Isolation and natural infection both failed as policies. Distrust in authorities and government, particularly in societies that are divided or polarized, has led to innovation, including fines and compensation. But no nation has achieved easy or huge success. Worries about vaccine safety, sometimes rooted in reports of adverse events, at others in social-media misconceptions, undercut vaccine rates everywhere. In every nation there are subpopulations that either have particular distrust for the government mandates or simply lack ready access to healthcare.

Mandates may be the answer to achieving higher rates of vaccination. But if they are not rooted in convincing arguments about moral obligation and community protection, they can evoke loud opposition, further diminishing social trust.

Guest commentaries like this one are written by authors outside the Barrons and MarketWatch newsroom. They reflect the perspective and opinions of the authors. Submit commentary proposals and other feedback toideas@barrons.com.

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Countries Have Tried Mandates, Isolation, and Herd Immunity to Curb Covid - Barron's