The post-vaccination future

This week's column in the Stuff papers got me angry letters from the anti-vax people. 

I mostly look out to the US and Canada, and what things they're up to now that vaccination rates are high. There's a lot of support for vaccine passports in helping people avoid venues that have a lot of riskier people in them. 

Majorities of Canadians surveyed in late May, when only 54% of Canadians had had at least a first vaccination dose, and again in July, supported proof-of-vaccination requirements to board commercial airline flights; to travel internationally; to attend public events or large gatherings; to visit public places like restaurants, movie theatres and churches; and, to attend one’s own place of work.

Quebec will be requiring proof of vaccination for entry into high-risk places like gyms, concerts, and festivals in any fourth wave. And, last week, the University of British Columbia’s alumni association urged the university to require vaccination for students in the residence halls – a measure supported by 82% of students.

Across the US border, vaccination rates have plateaued at about 56% and the costs of low vaccination rates are more obvious.

America’s National Football League last week set a new policy. If a vaccinated player returns a positive test, without symptoms, he can return to play after two negative tests a day apart; unvaccinated players must quarantine for ten days.

If a game is cancelled due to a Covid outbreak among unvaccinated players, the team with unvaccinated players does not just forfeit the game. It also bears responsibility for any resulting financial losses.

The League’s policy does not mandate vaccination. It simply ensures that the costs of not being vaccinated fall where they should.

Once vaccination is readily available, I will be happy to pay a premium at venues that cater exclusively to the vaccinated, to use airlines making vaccination a condition of carriage, and so on. 

I would prefer to drink at a bar that allowed smoking but mandated vaccination, than to drink at a bar that forbade smoking but did not require vaccination. And similarly for restaurants, even though the smell of smoke while eating puts me off my food. The risks of second-hand smoke, at any levels to which I might be exposed occasionally at bars and restaurants, are far lower than the risks of fleeting exposure to Covid. 

Before Covid, and during the measles outbreak, I'd written a short bit on compulsion and vaccination. 

Were I suggesting policy targeting vaccination, rather than playing into other things, I'd be looking at:

• Compulsory vaccination as employment condition in the state-funded health sector, for both new and existing staff. They impose substantial direct risk. And how many antivaxxers will look at the recent reporting on low sector uptake and take it as reaffirming their beliefs? 
• Compulsory parental notification of vaccination status of employees at ECE centres, and consider making it a condition of receipt for 30-hours free. Like, the government made it compulsory that piles of workers in ECE have qualifications - even where there's no good justification for it - but we don't even know whether ECE workers are vaccinated? Come on. 
• Bring back the BPS targets around vaccination, penalise DHBs for vaccination rates less than 90%, reward them for rates above that. The DHB-level vaccination stats are hardly secret, but DHBs have no particular incentive to go and figure out what works or learn from each other. If DHBs faced financial incentives to ensure broad immunisation coverage, they might decide it's worthwhile to send somebody out to see just what Canterbury is getting right - or whatever DHB has population most comparable to theirs but higher immunisation rates. 
• There are piles of things you can imagine DHBs trying out. Catch-up vaccinations at school for those who missed them. Making sure that all schools get a visit from the nurse with the jabs. Sending a public health nurse along on Plunket visits. Sending public health nurses along to ECEs where vaccination rates are known to be low. How far can you get just by making it really really easy for folks to be vaccinated?
• Tell the Health Research Council that funding for research in public health, aimed at policy changes or behavioural interventions, should focus on the traditional remit of public health in vaccination and contagious disease rather than noncommunicable disease. I have OIA requests in now with MoH trying to get a handle on whether they've been putting any funding at all into vaccination work. We get piles of HRC grants for stuff like discouraging youth smoking and drinking and advocating for sugar taxes; it's hard to see anything like it for vaccination. It looks like they made a grant to Auckland Uni's immunisation centre. But there just hasn't been much research work there yet on encouraging vaccination uptake. They've done literature reviews, and they have an annual set of charts that come out of the Tier One vaccination stats, but nothing like the research push that HRC makes into noncontagious disease. I suspect that Janet Hoek, all on her own, gets more funding for anti-tobacco work than the government's provided for research into encouraging vaccination. But I'd like to know. 

It applies in the current case as well, particularly around BPS targets for DHBs to encourage them to find what works in encouraging vaccination. I note that in my old home province of Manitoba, they're sending out vaccination teams into the provincial parks to find people where they are at the weekend and jab them. Here it's all bookings. And that'll be great for those who are happy to get a booking. What happens after that?