By Kevin Bardosh
November 24, 2022
Just as the Freedom Convoy started in 2022, I released a pre-print calling for the end to mandatory COVID-19 vaccine policies. Our paper, “The Unintended Consequences of COVID-19 Vaccine Policy,” outlined 12 possible negative consequences of the new global rollout of mandates, passports and segregated restrictions, and summarized research insights for why they would likely cause more harm than good (Bardosh, de Figueiredo, and Gur-Arie et al. 2022).
Early evidence on COVID told us a few key things: that bad clinical outcomes were strongly based on age (Spiegelhalter 2020) and health status; that vaccines did not durably stop transmission (Singanayagam, Hakki, Dunning, et al. 2021) since they waned after a few months (Eyre, Taylor, Purver, et al. 2022); that safety signals in young people, including myocarditis (Couzin-Frankel 2022), complicated universal recommendations; that the virus was likely to quickly mutate; and that prior infection (Kojima and Klausner 2021) provided strong protection against reinfection.
This was all known before September 2021, when mandatory Canadian policies began. According to government data (Canada 2022), 70 percent of Canadians over 18 had already received two-doses by this time, rising to nearly 90 percent for those over 60. Without a clear threshold for vaccine-induced herd immunity, there was no clear end goal for the government’s vaccine policy: 85 percent? 99 percent? No one knew.
Many health authorities in other nations (e.g., Nordic countries and the UK) did not implement state mandates. They also used a precautionary approach to carefully weigh costs and benefits for young people, including with boosters (Bardosh, Krug, Jamrozik, et al. 2022). This approach was less divisive and followed traditional public health ethics (Jamrozik 2022).
Like many Western political leaders, Trudeau and others in Canada (including BC Provincial Health Officer, Bonnie Henry) had originally dismissed the idea of making COVID-19 vaccine compulsory; in a May 2021 interview, Trudeau stated that, “We’re not a country that makes vaccination mandatory” (Hopper 2022).
But decision-makers in North America were faced with an emotive public, driven to maximize mitigation measures and ignore their wider societal consequences. Earlier slogans helped set the stage: “everyone is at equal risk,” “no one is safe until everyone is safe,” and “no death from COVID is acceptable.” By September 2021, and despite the available evidence, media and public framings re-enforced the idea that vaccination was the magic bullet that would “end the pandemic.” It was wishful thinking.
This is not to say that mandates did not increase vaccine coverage. Threaten someone’s career, ability to pay their mortgage, or enrol in school, or deny them access to a normal social life, and many will comply. How many COVID hospitalizations and deaths this averted is unclear. Modelling studies have important limitations (Doidge, de Figueiredo, Lemmens, and Bardosh 2022). A recent study (Karaivanov, Kim, Lu, and Shigeoka 2022) estimated that vaccination rates increased by 5 percent in Canada due to mandates while a second (Anato, Ma, Hamilton, et al. 2022) estimated only 1 percent. Evidence from other countries (Mills and Rüttenauer 2022) found that mandates increased coverage most in countries with low uptake and among people under 30 (a low-risk group).
There are many reasons why Canada pursued mandatory vaccination. One has to do with the cultural significance of vaccination in contemporary North American society. In her 2019 book, Anti/Vax: Reframing the Vaccination Controversy, medical humanities scholar Bernice Hausman notes a contemporary paradox: as coverage and acceptance of vaccination increased from the 1970s onwards and cases of vaccine-preventable diseases decreased, journalistic framings and pro-vaccine advocacy has become more alarmist and moralizing. This cultural change has been accompanied by stricter school vaccination mandates (Greyson, Carpiano, and Bettinger 2022), including the removal of religious, medical, or philosophical exemptions (Conis and Hoenicke 2022).
Hausman and many others (Fairhead and Leach 2007; Goldenberg 2021) have made a vital argument: those promoting vaccination have come to believe they are fighting a war – a war against science deniers, disinformation spreaders, and hostile foreign states. Rather than persuade the public, they take an increasingly militaristic perspective in their battle against the enemy. They also simplify the multiple ways people view, access, and take (or refuse to take) vaccines.
This cultural trend is represented in the updated Merriam Webster dictionary: “anti-vaxxer” is not only someone completely opposed to all vaccination but also someone who opposes some vaccines as well as mandatory vaccination policy itself (Merriam-Webster Undated).
According to this definition, Canadians who refuse tetanus and diphtheria boosters every 10 years are “anti-vaxxers,” despite it not being recommended by the World Health Organization (Slifka, Park, Gao, and Slifka 2021). The same could be said for half of the European Union (ECDC Undated) and the UK, who do not recommend chickenpox vaccination for healthy children, partially due to concerns that mass vaccination may increase the severity of chickenpox and shingles in adults (NHS Undated). Professor Paul Offit, the co-developer of the rotavirus vaccine, an FDA vaccine advisor, and one of the most prominent public scientists arguing for vaccine safety in the United States, may also be considered an “anti-vaxxer.” Dr. Offit is the author of the 2011 book Deadly Choices: How the Anti-Vaccine Movement Threatens Us All, which adopts the anti-science battle frame. Yet he has been one of the most vocal mainstream scientists against universal COVID-19 boosters for young adults (Offit 2022), advising his son (in his 20s) not to get a booster (Gutman-Wei 2022).
Vaccine refusal and skepticism is not going away. It cannot be “eliminated.” We urgently need a more nuanced public discussion based on liberal and democratic values. The arguments put forward by the first anti-vaccination movement, which emerged with mandatory smallpox vaccination in 1853 in Britain (Durbach 2005), are the same we face today: concerns about individual liberty, fears that risks exceed benefits, resistance to the perceived arrogance and over-reach of biomedical and state authorities, and discrimination towards lower income social groups. They also led, as they have today, to political confrontation, as with the Montreal Vaccine Riot of 1885 (Berman 2021).
One blind spot of the Canadian medical establishment relates to the socio-demographics of vaccine refusal. A recent study published in the Canadian Medical Association Journal (CMAJ) (Smylie, McConkey, Rachlis, et al. 2022) found that Indigenous people in Toronto had a lower (60 percent) COVID-19 vaccination rate than the general population (80 percent). Surprisingly, the paper does not mention one obvious conclusion: mandatory policies disproportionately affected Indigenous people in Toronto.
Canada’s preeminent medical journal claims to support “equity and inclusion” but also strongly supported COVID vaccine mandates. Yet CMAJ has ignored research showing Canadian COVID mandates have had a disproportionate impact on certain social groups. A recent meta-analysis (Cénat, Noorishad, Farahi, et al. 2022) found that hesitancy was higher among non-White Canadians, and influenced by gender, education, and age. Put plainly: Canadians were told to trust medical authorities and pharmaceutical companies, such as Pfizer (United States, Department of Justice 2009) that many simply did not trust (Cayley 2021) due to past social, economic, cultural, and medical experience.
Studies on media representations in Canada of pandemic lockdowns, mask mandates, social distancing rules, and vaccine policies have found that journalists generally tended to reinforce strong moralizing narratives (Labbé, Pelletier, Bettinger, et al. 2022) and in some cases created moral panic (Capurro, Jardine, Tustin, and Driedger 2022). Canadians were divided into “the virtuous” rule followers (selfless, smart) and the COVIDiot (immoral, self-centered, stupid). Those who deviated, questioned, or opposed specific rules became a threat to public health, social cohesion, and moral order.
Perhaps partly as a result of this strong moralistic stance, Canadians endured some of the most restrictive pandemic measures among all high-income countries (Razak, Shin, Naylor, and Slutsky 2022) including those on internal movements, public events, public gatherings, workplace closures, travel, school closures and, of course, vaccine mandates. Vaccination was required for employment, for school, for access to restaurants, bars, and entertainment. Without a certificate, you were denied the ability to fly or take a train. We barred unvaccinated visitors from entering the country. The vaccinated were told to disinvite their unvaccinated family members from 2021 Christmas gatherings. Even some churches made vaccination a prerequisite to worship.
The Toronto Star featured angry quotes about the unvaccinated on its front page on August 26, 2021, including the bold sentence: “I have no empathy left for the wilfully unvaccinated. Let them die.” Justin Trudeau added to the divisive rhetoric: “They don’t believe in science or progress and are very often misogynistic and racist…This leads us, as a leader and as a country, to make a choice: Do we tolerate these people?” (Naylor 2021).
Canadians largely supported the new mandates and passports. Opinion polls circulated in the media in late 2021 showing 57 percent would not invite an unvaccinated person into their home (Dawson 2021) and 80 percent supported passports in their province (Leger 2021). I have yet to see a rigorous evaluation of the media representations during this time or how the government shaped public opinion. Alarming claims that the Canadian military used information warfare tactics to monitor (and perhaps influence?) public opinion during the pandemic (Brewster and Burke 2021) need to be more thoroughly investigated.
It is through this context that the Freedom Convoy should be understood: a sizeable minority of the Canadian public had had enough of the erosion of democratic norms, the moralization of public discourse, and the stigmatization of over 4 million of their fellow citizens. As with many spontaneous protest movements, the crowd defies an easy description. But it had one focus: stop the social normalization that vaccination certification is a prerequisite for basic Canadian freedoms and civil liberties.
Yet the Canadian political response denied democratic grievance. Instead of meeting with the protesters, Trudeau (fond of promoting democratic norms abroad) dismissed them as a “small fringe minority” with “unacceptable views” (Global News 2022). The first government to follow a “feminist” foreign policy had become decidedly paternalistic at home. The journalistic framing was quick and ruthless. The truckers were anti-vaxxers, Trump-supporters, white supremacists, and Nazi-sympathizers. They stole from the homeless and desecrated war memorials. A far-right group, with foreign money, was going to violently overthrow the Trudeau government and re-enact the January 6, 2021, storming of the US Capitol.
This fantasy misrepresentation should be a dire warning of the dangers of medical mandates. These protesters were not terrorists. Those who advocated for the draconian vaccine mandate policies should now be alarmed, if for no other reason than to marvel at the sheer scale of their inability to understand their fellow unvaccinated Canadians and those who stood beside them in protest. Surveys show that Canadians are more divided now than before the pandemic (Silver and Connaughton 2022) and that social trust has decreased, especially among lower socio-economic groups (Wu, Bierman, and Schieman 2022). I doubt that millions of Canadians will ever forget what it was like to become pariahs in their own country, and how quickly it happened.
The conditions for the Emergencies Act were always tenuous (Alford 2022) and, in my opinion, the bigger crisis was an emergency in government management and accountability. While an environmental group violently attacked a gas line in BC (Coastal GasLink 2022), there were no acts of overt violence by protesters in Ottawa. Yes, there was annoyance, endless honking, unpleasantness, and disruption of the busiest international border crossing in North America. But that disruption was never going to precipitate a violent winter coup.
The New York Times (2022) begrudgingly acknowledged that the protest was not a “threat to democracy” but rather a “test of democracy.” The circumstances around the Emergencies Act, the Trudeau government’s behaviour at the time, and the ongoing parliamentary investigation suggest that his government failed the test. The unprecedented move to freeze the bank accounts of protesters sets an alarming future precedent, as does the mandatory use of the ArriveCan app for entry to Canada, the development of which was grotesquely over budget (Lévesque 2022). How many Canadians were fined or denied entry for refusing to use it?
Most provinces lifted mandates and passports in February and March 2022 (Sun Media 2022), no doubt influenced by the protesters, but the Trudeau government continued many policies until October. And some still remain. A recent court case (Malone 2022) upheld the denial of an organ transplant for an unvaccinated Albertan. Litigation for terminated unvaccinated workers continues and has cost the public purse significant tax money (Fox 2022). Some universities, most notably Western (Chagla 2022), have mandated boosters for their students, despite studies suggesting that clinical risks outweigh benefits in young adults (Bardosh, Krug, Jamrozik, et al. 2022).
Public health generally neglects to study the adverse consequences of its interventions in society (Lorenc and Oliver 2014). But pandemic policies demand more scrutiny: How many Canadians lost their jobs because of vaccine mandates? How many could not return to school? How many now regret getting vaccinated under threat? It is entirely possible that the long-term reductions in income and the psychological distress that unvaccinated Canadians experienced are greater than the benefits from mandates. But will anyone study this? In August 2021, Trudeau had promised the provinces $1 billion dollars to roll out vaccine passport systems (Tasker 2021). Where did it go? Do we care?
Our national approach to mandatory COVID-19 vaccine policy needlessly fomented social polarization, eroded democratic principles, harmed scientific integrity, and damaged public trust in our vital social institutions. We changed accepted ethical norms to fit erroneous assumptions about transmission, risk, and the nature of the virus. A moralizing narrative denied our fellow citizens their bodily autonomy and human rights organizations did little to hold the government to account. We accepted executive power abuses (Gidengil, Stolle, and Bergeron-Boutin 2022) because they promised safety and security. Yet no university in Canada held a public debate about this; an online event about our paper (March 2022) was the first sponsored by a Canadian university (Lemmens 2022).
As Canada emerges from a pandemic fog of war, we need an independent scientific and policy evaluation of the mistakes made during the pandemic, including with vaccine policy. This should incorporate a broad cost-benefit assessment, legal and ethical evaluation, and consider the unintended negative consequences for Canadian society (Bardosh, de Figueiredo, Gur-Arie, et al. 2022). My concern is that we will fail to learn the right lessons for the next health emergency. Our country needs to confront the hard truths about the pandemic lest we learn the wrong lessons and, by blind wilfulness, slip further into an illiberal abyss.
About the author
Kevin Bardosh, PhD, is a medical anthropologist affiliated with the School of Public Health, University of Washington in the US and Edinburgh Medical School in the UK. A Canadian, he has worked in more than 20 countries around the world on infectious disease research and control programs, including in the response to Zika and Ebola. Correspondence: firstname.lastname@example.org; Twitter: @KevinBardosh.
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