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Is a compulsory COVID-19 vaccine possible?

Published: (Updated: ) in Australian News by .

John Wardle, a professor of public health from UTS, has told whether a vaccine mandate is possible and if not, what Australians could expect as an alternative.

The promise to provide free COVID-19 vaccines to all Australians has sparked intense discussion over how far the government will go to get people immunised.

Prime Minister Scott Morrison said he expected the vaccine would be "as mandatory as you could possibly make it" but later walked back the comments.

John Wardle, a professor of public health from UTS, has told whether a vaccine mandate is possible and if not, what Australians could expect as an alternative.

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Is a vaccine mandate possible?

Prof. Wardle said while a mandatory vaccination is technically possible, the logistics make it almost impossible to achieve.

"Any mechanism that would allow for mandatory vaccination would be incredibly complex, undoubtedly challenged and deeply unpopular," he said.

Generally, states have much greater power over public health laws than the Commonwealth does.

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Water fluoridation laws and mandatory mental health treatment – which are possibly the closest examples the country has to a mandatory vaccine – are all state-based.

"It would really require state legislation and it would require a nationally consistent approach with the states, which would add a whole other layer of difficulty as well," Prof. Wardle said.

"It's actually going to be a lot more complicated than Scott Morrison probably even thinks."

But as to whether our laws would allow for a mandatory vaccine, the short answer is yes.

"Implied within case law there is a definite right to autonomy and a right to refuse medical treatment but there is also capacity to override that, but it's quite difficult," Prof. Wardle said.

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Is there a precedent for a mandatory vaccine?

While Australia has precedents for mandating medical treatments, the coronavirus vaccine would be a nationwide first.

Water must be fluoridated, blood transfusions are compulsory, and Australia is the only country in the world that permits compulsory treatment for people with severe disabilities and mental illness.

Prof. Wardle says this makes Australia "more inclined" to introduce a harder line on vaccinations.

READ MORE: Top doctor flags 'no jab, no entry' policy

"With fluoride for example, it's mandatory to have your water fluoridated but there are options for people who don't want it," he said.

"For a lot of mental health treatment it's about reactive treatment rather than preventative treatment, which is a lot easier to make a case for so I'd say there's a technical possibility but a practical almost impossibility to do it."

Public health legislation replies on proportionality, meaning there has to be a compelling public health risk.

"In terms of blood transfusions, it's very obvious – you will die if you don't have it," Prof. Wardle explained.

But with COVID-19, the risks are slightly more obscure.

Australia has tried to mandate vaccinations in the past, but no attempts have been successful.

"The reason Australia has the system that it does is that the amount of people you have to get all pointing in the same direction is technically possible but very unlikely," Prof. Wardle said.

What would be the impact of a mandatory vaccine?

Prof. Wardle said a compulsory vaccination would have far-reaching impacts on public health.

"If you mandate this one thing, the public will start questioning other mandates the government tried to impose on them - like lockdowns, for example," he said.

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He said blanket legislation may even have the opposite of its desired effect, turning people away from wanting to get the jab.

"What a mandate says to people is we can't be bothered to explain why you should do this, you should just do it," Prof. Wardle said.

"The people who are 'vaccine hesitant', who sort of sit on the fence, are quite easy to drag over to support vaccinations but you need to bring the public with you on these decisions, you can't just force them to do it."

Do we need a mandatory vaccine?

Australia has historically been largely in support of vaccinations and Prof. Wardle said this factor has been underestimated.

"The anti-vaxxer community in Australia is actually not that influential or that large," he said.

"I think the thing that a lot of people forget is that Australia already has higher vaccination rates through voluntary mechanisms and incentives than many countries with mandatory vaccinations.

"It's a public health story that I don't think we celebrate enough.

"If the trial came through and it was safe and it was effective, Australia historically is a very strong support of vaccinations and to be frank I think the prime minister should give the public a lot more credit than he does."

But as Prof. Wardle points out, herd immunity requires the vast majority of people to use the vaccine and "it only takes 10 per cent of people to mess it up for everyone".

More limited mandates around immunising may be a possibility and Prof. Wardle said this is likely to be a more effective strategy. 

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"There are certain incentives that the government has control over – they might introduce incentives around movement for example, or travel or tax incentives like they've done with childhood vaccinations," he said.

"NSW Health has mandatory vaccinations for health care workers so that could be something that could be a possibility."

Should people be worried about how fast the vaccine is being created?

Vaccines typically take years to develop and test, and Prof. Wardle said while the vaccine will come eventually, it may not happen as soon as people think.

"The opposition isn't surprising. Just last week we were angry about Russians imposing their vaccine prematurely on their population," he said.

"For every really successful vaccination, you can also get a really bad vaccine like dengue (fever) which created a disaster due to premature implementation.

"We don't even know if this vaccine works and not just being safe, but it may not achieve herd immunity."

Source: 9News

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