Imposing a mandatory national immunization program for all Canadians presents significant challenges, the first of which is the age-old jurisdictional struggle between the federal government and the provinces. Under the Constitution, the provinces are responsible for the delivery of health care, and a mandate for immunization would fall under that mandate. If the federal government wanted to assume this responsibility, it would have to either use the Emergency Measures Act or pass legislation giving it the power to act.
“To do that, hell would break loose from the provinces,” Michael Behiels, a constitutional law expert at the University of Ottawa, told CBC News. “It is theoretically possible, but it would immediately go to court, and they would have to prove that the crisis is in fact a national crisis. “
Behiels said a federal government taking this route would likely win any challenge in court, provided it can prove that the rate of infections, death rates and ongoing mutations create a threat that only a national response. could mitigate.
Even if won, he said, the move would likely create a backlash among provincial governments who view this step as unnecessary at this point in the pandemic.
“Up until that point in Canada, it didn’t really have to be taken into account,” Dr. Allison McGeer, an infectious disease specialist at Mount Sinai Hospital in Toronto, told CBC News.
“We haven’t returned to normal, but we are getting there – and there is no guarantee that we will return to normal even if everyone is vaccinated because there are breakthrough infections,” said McGeer, who is also a professor at University of Toronto Dalla Lana School of Public Health.
Context is everything
Behiels said a national immunization mandate could not only create animosity between the unvaccinated and the federal government, but also between the provinces and Ottawa, which could undermine the immunization effort.
If the situation were different, he said, with a much higher death rate or a more aggressive infection rate, that decision could be easy and provinces could even seek intervention if the situation worsened. enough. But experts aren’t sure Canada has come to this point yet.
European countries such as Austria and Greece seem to believe so, and they are moving towards national vaccination mandates as they see infection rates three times higher than at any time during the pandemic, and vaccination programs have stalled.
In January, Greeks over 60 who have not yet been vaccinated will face a monthly fine of 100 euros (CA $ 140). Slovakia is considering going the other way and is offering 600 euros ($ 844) to encourage people to get vaccinated.
Austria, with one of the lowest vaccination rates in the European Union, is considering plans which, if implemented, would result in a fine of more than 7,000 euros ($ 9,880) for Austrians not vaccinated. There are already signs that fulfilling this mandate will be a challenge; At the end of last month, some 40,000 demonstrators showed up in Vienna to challenge the new rules.
According to Our World in Data, only 67% of the EU population has been fully vaccinated against COVID-19, while in Canada 76% of the population is fully vaccinated. Greece stands at 64 percent, while Austria’s population is only 66 percent fully vaccinated.
Germany isn’t much better at 68%, and countries like Hungary have some of the lowest vaccination rates in Europe at just 61%.
Germany and Hungary are experiencing record infection rates, and both are looking to tough national policies in an attempt to turn the tide. For now, Germany is only talking about compulsory vaccination. Hungary, however, allows companies to impose this policy on employees and require any unvaccinated staff to take unpaid leave until vaccinated.
In Canada, by comparison, all passengers traveling on planes, trains and ferries must be fully immunized, as should staff working in these areas. All federal employees must also be fully immunized.
The reasons for the reluctance
McGeer and other infectious disease physicians, such as Dr. Isaac Bogoch of the University of Toronto and Dr. Gerald Evans, chair of the division of infectious diseases at Queens University in Kingston, Ont., All agree that the The goal pursued by some European states – a fully vaccinated population – is worth it.
But they also agree that imposing mandatory vaccination regimes on the entire population could cause an uproar, underscore the goodwill between Canadians and their government and ultimately not achieve the desired results.
“Say it works and a lot of people are now being vaccinated due to fines or restrictions being imposed. The point is, it would help, it would have an impact, ”Evans said.
“If we were to vaccinate 95 to almost 100% of the population, this virus would have a long time trying to maintain itself in the environment. “
Bogoch agreed with the feeling that more vaccinations are needed, but he is still not sure that a mandatory vaccination regimen would have the desired effect.
“There are many reasons why people are not vaccinated, and understanding those reasons and tailoring your response to those reasons is generally a more effective approach so as not to further alienate people in an already polarized world,” he said. -he declares.
Bogoch says there are generally four types of unvaccinated Canadians. The first two are people who intend to be vaccinated but have not yet done so and people who have multiple jobs or are single parents and have not had the time or opportunity to get vaccinated. get vaccinated. Bogoch says these groups probably wouldn’t be put off by a vaccination warrant.
But the other two – people with lingering worries and anxieties and people who have been swayed by disinformation campaigns – might be further removed from warrant vaccination, he says.
One size does not fit all
Within these groups, according to experts, there are subgroups that turned off vaccination for different reasons.
“White, wealthy, highly educated, Canadian-born people have a lot more confidence in the public health system and are a lot more willing to believe their government, so we’re getting higher immunization rates,” McGeer said.
“The racialized communities that are already at a surprisingly higher risk of being infected with COVID are the very ones who have the hardest time deciding to get vaccinated, and with good reason. “
She added: “Immunization mandates are systematically inequitable, and you can work to mitigate it, but you cannot fix it. “
Bogoch says the best way to increase immunization rates is to understand why each group won’t get immunized, and then try to meet them in their field: if they can’t make it to an immunization clinic because that they’re too busy, use mobile clinics, he says. If they still have unanswered questions, sit them down with medical professionals and try to answer their questions. If they have been swayed by misinformation, try to combat these false narratives. But don’t try, says Bogoch, to motivate everyone with the same approach.
“There is no one-size-fits-all solution to this problem,” he said.