Vaccine passports will hurt the poor and threaten medical ethics

It primarily comes down to resources and cost.

Right now in Ontario 80% of covid cases are coming from non fully vaccinated individuals(1).

It costs $23k to treat a covid patient and $50k if they reach the ICU(2). Chances of not landing in the ICU are 99.9% if you're fully vaccinated(3).

Many health resources are going to treat covid instead of things like elective surgeries. Allowing non-essential businesses to fully open without a vaccine passport will only lead to more cases and more resources being wasted.

The thought of getting injured right now is scary because I could wait years for something like a herniated disc surgery (which is very debilitating). I'd much prefer we take steps to take as much strain off the health system as we can.

1 - https://toronto.ctvnews.ca/ontario-logs-600-new-covid-19-cas...

2 - https://www.cbc.ca/news/health/cihi-covid19-canada-hospital-...

3 - https://www.cnn.com/2021/07/31/health/fully-vaccinated-peopl...

This article asserts none of its top level claims, it merely brings up a series of questions they feel are important for the discussion. There are below the fold assertions that are outright false, such as "Vaccine certificates render the individual in an impossible place of having to choose vaccination or loss of employment and exclusion from society." Vaccines are free. Vaccination is hundreds of times safer than infection, and infection has a much higher societal cost. If you can't afford the vaccine, you definitely can't afford the illness. Given this structure, this article looks suspiciously like JAQing off.

Assuming that the article is in good conscience, I'm just going to give a quick answer on each of the points.

1. What is the intent and what are the end points? Vaccine certificates impose a significant burden on the population.

Yes, vaccine certificates would impose a burden. However, unchecked covid19 imposes a huge societal burden as well. Given current knowledge, covid19 has a much higher cost than a vaccine certificate. A 1-2 year expiration on a vaccine certificate law would be one way these concerns could be balanced.

2. Can we stop transmission with vaccine certificates?

False dichotomy. We don't need to completely stop covid19. We just need to lower the societal cost. Vaccines are very good at doing that, and this article doesn't really have a strong argument as to why vaccine certificates wouldn't at push vaccination numbers higher.

3. What are the logistical considerations of such a program?

Similar any similar nation wide legal system. Also, I can't help feel that this article uses "Think of the homeless!" the way that some people like to use "Think of the children!" The homeless aren't the only members of society (in fact, they're a smaller population than the children) and their concerns must be balanced against everyone else's. Given the extreme cost of dealing with covid19, both financially and in terms of medical resource utilization (both resources that the homeless use as well), it's reasonable to believe that a higher vaccination rate will improve resources available for the homeless.

4. What are the unintended consequences?

Something. There's always an unintended consequence. Yet life goes on, and legislative bodies still pass laws. This point isn't an argument against a vaccine certificate, it's merely an argument that such a law should be well crafted. Something I agree with 110%. Given the extreme cost of covid19, it's also fair to say that even a flawed implementation could still be very useful.

5. Why are people vaccine-hesitant?

A valid question, but much like point 4, not particularly an argument against vaccine certificates. One thing that I have to iterate again is that if you think the vaccine is expensive, think how much worse the illness can be.

6. Are vaccine certificates ethical?

Vaccination records have been considered ethical for some time, this article makes no argument as to why covid19 vaccines are special.

> 5. Why are people vaccine-hesitant? While it is easy to dismiss the unvaccinated as conspiracy theorists and selfish, this is overly simplistic and frankly inaccurate. The unvaccinated are disproportionately of lower socio-economic status, ethnic minorities and children. Many minority groups have legitimate reasons to distrust the medical establishment, based on a long and sordid history of racism and classism. Some are unable to get vaccinated because they cannot afford time off work for vaccination and post-vaccine side effects. It is imperative that we understand the unintended potential health equity impacts of vaccine certificates on specific population groups, and that we target our efforts to vaccinate these populations in a way that is respectful, accessible and meaningful.

This right here is what the priority should be.

Policy-makers, with private doctor(s!), chauffeurs and staff won't empathize and understand the burden of vaccination for the lowest 10% percentile. But that's the long tail is, and were we'll see outbreaks in the following months if we keep ignoring it.

> mandate paid recovery days

A big problem for this sort of intervention, and one of the reasons why covid is as socioeconomically predestined as it is, is that many of the sort of people a mandatory paid recovery day would benefit from are paid under-the-table or in other informal work arrangements. If your way of putting food on the table involves standing outside Home Depot until a crew needs you, a benefit administered through the above-board employment system is useless and you're going to be turning up for work (and infecting your co-workers) regardless.

I generally agree with the thrust of your comment, but it's easy to underestimate the additional barriers faced by the poor. I won't get into the whole litany of disadvantages here, but I think you get the idea. The whole thing honestly smells a little like the "well, why don't they just get an ID?" shit in voter-identificaton debates, just from the other side.

While I don't subscribe to the idea that "disparity implies racism", this is most certainly a case where, if you accept that view, vaccine mandates must be interpreted as racist precisely because Black and Hispanics are disproportionately unvaccinated. And the points made in (5) stand regardless of whether you accept the disparity view.

But this is hardly the main point. (6) is more relevant (and the second part of (5) is worth also adding separately).

> 6. Are vaccine certificates ethical? One of the most sacred principles in medical ethics is autonomy, meaning that an individual has the right to decide what happens to their body. [...] Even the most well-informed individual cannot provide informed consent if their “choice” is coerced. Vaccine certificates render the individual in an impossible place of having to choose vaccination or loss of employment and exclusion from society. This impossible “choice” forces the hand of those in this predicament and ultimately results in consent under duress. [...] Loss of trust in the medical establishment can lead to poor health outcomes, as patients may avoid care and be less receptive to medical management. Given that we have exceeded numerous vaccine targets and offered protection to those at greatest risk, we should make every effort at this time to maintain patient autonomy and guide with openness rather than exclusion.

> Public health interventions need to take into account not only the immediate threat before us, but also the downstream negative effects that may occur as a result of our actions. The introduction of vaccine certificates threatens individual autonomy and societal norms, and runs the risk of further isolating marginalized groups without clear metrics to assess efficacy. The sacrifices that have been made throughout this pandemic are astonishing

Medical ethics is being thrown out the door and those pushing for vaccine coercion seem completely unable or unwilling to accept that that's what they're in favor of. And practically speaking, coercion, given the sickening and duplicitous politicization of the vaccine, is only going to result in skepticism toward the vaccine, which it has.