Week 4: Health Policy Case Study: Mandatory Vaccination + Choosing policy instruments

Question 1

Mandatory as Vaccinations by force?

Answer 1

People may think vaccines are by force, this can be possible an d there are instances where force has been used to vaccinate people but in Canada this was not the case.

Question 2

Mandatory as Criminalizing non-vaccination?

Answer 2

Jail, fine or sanction if you do not get vaccinated, it is not forced but there are penalties if you do or do not get them.

Question 3

Mandatory as Conditioning access to services, jobs, school etc on vaccinations

Answer 3

Condition of doing certain things if you get vaccinated, this is the response mostly to covid

Question 4

Mandatory as Imposing costs

Answer 4

-Has been done to many vaccines including covid in some places of the world, allowing people to purchase the option to not comply
-If you harm others based on your choices you open the ability to be sued
-Maybe people who are unvaccinated have higher insurance, because there is a higher risk of them getting sick and hospitalized.
-purchase option

Question 5

Mandatory as Providing Incentives for Vaccination

Answer 5

-Some people but not a lot, believe providing incentives for vaccination is a form of a mandate
-Prize you win, tuition credit if you get vaccinated
-tips the scales, sees it as a form of mandate
-Vaccine passports, you don’t have to get vaccinated but if you wanna go to the movies (other fun things) this is the cost of entry

Question 6

Mandatory as in Persuasion?

Answer 6

-not many people view this as mandatory
-institutions and schools persuading how you feel about your health
-not commonly considered forms of mandates, first 4 more so are

Question 7

What are vaccinations mandates

Answer 7

-vaccination mandates are requirements that one be vaccinated as a condition of, e.g., working in a particular setting, traveling, going to a concert etc (no force or compulsory, don’t have to do it but are compelling reasons for why you’d want to do it)
-In this case vaccination is not compulsory but still call it mandatory

Question 8

Staff immunization

Answer 8

common in health care
-tuberculation test
-proof of vax
-blood test to test for hep
tetnis
whopping cough
influenza
mask fit tested

Question 9

Western Schullich policy in 2016

Answer 9

requires all students to be fully immunized

Question 10

Updated 2022 policy

Answer 10

requires immunization and visiting students ALSO require full immunization, must comply with COFM immunization and screening policy- council of ontario universities.

Question 11

This Schullic policy

Answer 11

-Emphasizes and puts into practice COFM policy
-Policy applies to every medical learners in any medical school in ontario
-Learners who fail to submit may be suspended
-Anybody performing medical procedures in Canada
-Require TB tests, show lab evidence for immunity to varicella (chickenpox), measles, mumps, rubella, hepatitis B (must complete a series of HBV immunizations in addition to testing for antibodies), Polio, tetanus, acellular pertussis (to protect against whooping cough), influenza (flu shot required, individual hospitals may not require flu shot),
-People who work with animal needs the rabies vaccine

Question 12

Ontario immunization of school pupils act

Answer 12

-If you attend school in ontario you have to be immunized for a series of different pathogens
-Meningococcal disease, pertussis (whooping cough), varicella, diphtheria, tetanus, polio, measles, mumps, rubella.
-Can object but you have to apply to an exemption, only need exemption when things are required, this suggests this is required and is a mandate
Can also be kicked out of school as child for not being vaccinated
-A medical officer of health may write a written order to require someone operating a school (principal or school border) and order a child to be excluded from that school.
-If the medical officer is in the opinion upon reasonable and probable grounds that there is an outbreak or immediate rise of an outbreak of a designated disease in the school at which the pupil attends.
-Doesn’t matter if they’re exempted if they put themselves at a health risk or others at a health risk.

Question 13

True or False: Almost every country had some form of a vaccine mandate during covid

Answer 13

true

Question 14

True or False: whether mandates make people get vaccinated, there is a sharp uptake in a lot of cases of people getting their first dose after mandates

Answer 14

true

Question 15

Average effect is a _% inc in the pace of vaccination, accounting for an extra __% of the eligible canadian person

Answer 15

66%, 2.9%

Question 16

Mandates objectives

Answer 16

-improve vaccine uptake
-improve pace of vaccine uptake
-Reduce incidence of infection? (population level? Setting specific?)
-Reduce transmission? (population level? Setting specific?)
-Reduce incidence of severe disease, hospitalization, death?
-Reduce absenteeism (from work, school)? (not wanting people missing school, teachers missing work)
-Achieve herd immunity? (achieved this for many different threshold, if we reach a percentage of 80 or 90 vaccination, those who can’t get vaccinated are safer)
-All/ some of the above? Other?

Question 17

Triggered riot in Montreal in 1885

Answer 17

After smallpox vaccines were required in Montreal
Vaccinator will go door to door and ask for proof, if they’re not and refuse to be vaccinated they would be fined.

Question 18

Order by M.O.H

Answer 18

A medical officer, in the health circumstances mentioned in subsection (2), by a written order may require a person who operates a school located in the health unit served by the medical officer of health to exclude from the school a pupil in the named order

-Ex measels outbreak in school, have not received statement from nurse or perscribed person showing that they have completed their immunization for that diseases or a statement of medical exemption, they can be excluded from school

Question 19

Even if it is granted that vaccination mandates are effective at achieving important societal goals, does that alone make them justified?

Answer 19

-Have to question trust
-Infringes on autonomy

Question 20

What is Coercion

Answer 20

-involves the use of force, threats, or intimidation to compel individuals to do something they would not otherwise do, mandatory vaccination compels people to get vaccinated by for instance, threatening them with benign fired they aren’t vaccinated, and is thus coercive, and hence, unethical”
People said it compels people to get vaccinated for covid by threatening them to get kicked out of school so it’s coercive

Question 21

True or False: coercion often applied to policies and a way to say a policy is not just

Answer 21

used as a way to say policy is not just

Question 22

True or False: The government power is never coercive, the sole people out there to criminalize things use police force and throw you in jail if you don’t do what they want you to.

Answer 22

False: ALWAYS COERCIVE

Question 23

True or False: Political power is always coercive power backed up by the government’s use of sanctions, for the government alone has the authority to use force in upholding its laws

Answer 23

true

Question 24

Bad coercive

Answer 24

both options are bad-robber saying your money or your life

Question 25

True or false: if one option isnt thought to make you worse off it isnt coercive

Answer 25

true

Question 26

Western sued example

Answer 26

sued for its vaccine mandates, saying their vax info and health status is private, and it violates charter rights. The judge disagreed, policy is not coercive, it’s not forcing them to disclose info, it forces individuals to choose, whether they want to attend western and provide that information or NOT.

Question 27

Discrimination ontario human rights code

Answer 27

“Every person has a right to equal treatment with respect to
services, goods and facilities, without discrimination because of
race, ancestry, place of origin, colour, ethnic origin, citizenship,
creed, sex, sexual orientation, gender identity, gender
expression, age, marital status, family status or disability.”

Question 28

T or F: Employment conditions commonly lead to the unequal treatment of people who belong to different groups constitutes discrimination

Answer 28

False: does not necessarily constitute discrimination (i.e.,
wrongfully imposed disadvantageous treatment) because the
distinction is not arbitrarily related to an immutable
characteristic of the person or is unrelated to job performance

Question 29

True or False: Vaccination status on its own is not considered discriminatory
because it is modifiable and can reflect a bona fide
requirement of occupational health and safety

Answer 29

true

Question 30

True or False: * “Requiring proof of vaccination to ensure fitness to safely perform
work, or protect people receiving services or living in congregate
housing, may be permissible under the Code if the requirement is
made in good faith and is reasonably necessary for reasons related
to health and safety.”

Answer 30

true

Question 31

True or False: While the Code prohibits discrimination based on creed, personal
preferences or singular beliefs do not amount to a creed for the
purposes of the Code.”

Answer 31

True

Question 32

Civil liberties

Answer 32

are not absolute and can be justifiably limited
-“My right to swing my fist ends where your nose begin
-This idea is also commonly enshrined in law and constitutions,
where a balance is effected between the rights of the individual
and the interests of society by permitting limits to be placed on
guaranteed civil liberties

Question 33

What sections are Fundamental rights and freedoms/liberties are protected in Canadas Charter of Rights and Freedomes

Answer 33

• Section 7: “Everyone has the right to life, liberty and security of the person and
  the right not to be deprived thereof except in accordance with the principles of
  fundamental justice.”
• Section 1 of the Charter effects a balance between the rights of the individual &
  the interests of society by permitting limits to be placed on those guaranteed
  rights and freedoms

Question 34

Policy instrument’s

Answer 34

-The set of techniques by which governmental authorities wield
their power in attempting to ensure support and effect or prevent
social change.”
-The means by which policy objectives are pursued.

Question 35

Policy instruments are also known as

Answer 35

‘Policy tools’
*‘Policy techniques’
*‘Policy means

Question 36

Why is the choice of policy instuments important?

Answer 36

Even when there is broad agreement over policy objectives, there
are often disagreements about the MEANS by which those objectives
should be pursued.

• “Instruments for government action set up RELATIONSHIPS between
  the state and its citizens.”
• ## “Discourse on public policy instruments is discourse on POWER.”

Question 37

Examples of Policy instruments

Answer 37

Laws (e.g., prohibition of human cloning)
* Taxation (e.g., when buying cigarettes)
* Subsidies (e.g., rate reduction for long-term care)
* Cash transfers (e.g., universal basic income)
* Education campaigns (e.g., Youtube ad)
* Vouchers (e.g., food stamps)
* Charges (e.g., emissions charges)
* Labelling (e.g., menu labelling in restaurants)
* Grants (e.g., business grants)

Question 38

The Stick

Answer 38

• Regulatory instruments that obligate people to act in accordance with what the government says
• Regulation: “Government intervention through a set of rules identifying permissible and impermissible activity on the part of
  individuals, firms, or government departments and agencies, along
  with accompanying sanctions and rewards.”
• Government of Canada, 2007
• Imposes the most constraint among policy instruments
• “A statute or regulation should be chosen only after the full range of
  possible instruments has been considered

Question 39

Stick policy instrument examples

Answer 39

• Legislation (i.e., laws)
• Regulations (defining the application and enforcement
  of legislation)

Question 40

The stick health policies

Answer 40

prohibition, prohibition with permissions

Question 41

Prohibition example

Answer 41

human cloning

Question 42

Prohibiton with permissions

Answer 42

Possession of cannabis,
except with an authorizing
medical document (e.g.,
Pennsylvania)

Question 43

The ‘carrot’

Answer 43

Economic instruments used as incentives or disincentives to
guide individuals in the direction of the objectives of policy

• “…the handing out or the taking away of material resources
  [where] the addressees are not obligated to take the measures
  involved.”
• People can avoid constraints imposed by these instruments

Question 44

The carrot policy instrument examples

Answer 44

Subsidies (conditional transfers of funds from governments to
individuals, etc.)
* Taxes
* Customs duties
* Grants
* Vouchers

Question 45

The carrot health policies

Answer 45

economic disincentive, economic incentive

Question 46

Economic disncentive ex

Answer 46

~$0.18 direct tax / cigarette

Question 47

Economic incentive

Answer 47

Nicotine replacement
therapy products
exempted from provincial
sales tax

Question 48

The Sermon

Answer 48

Information dissemination (a.k.a. moral suasion, exhortation)
* “…attempts at influencing people through the transfer of knowledge,
the communication of reasoned argument, and persuasion.”

• Includes the transmission of knowledge as well as judgments
  about which phenomena are good or bad, how citizens should
  behave, etc.
• No obligatory directives or provision of material resources
• Imposes the least constraint among policy instruments

Question 49

The sermon policy instrument examples

Answer 49

Advertisements (television, online, billboards, etc.)
* Product labelling
* Note: Information as a policy instrument versus information on
a policy instrument

Question 50

Health policies for the sermon

Answer 50

Negative (dont do), affirmative (do)

Question 51

Negative example

Answer 51

Pregnant women should avoid travelling to countries with recent Zika infection

Question 52

Affirmative example

Answer 52

the sooner you get the flu shot the sooner you’re protected

Question 53

Typology summary for the stick, the carrot, the sermon

Answer 53

the stick, regulation, threat of sanction, penalties, government decides, high

The carrot, economic means, costs associated with different behaviours, market + individuals, only to those choosing to engage with a product or service

The sermon, information, provision of information, moral suasion, individuals, non/negilible

Question 54

Nudge

Answer 54

any aspect of the choice architecture that alters
people’s behaviour in a predictable way without forbidding any
options or significantly changing their economic incentives (next episode)

Question 55

True or false: Policy instruments always come in packages to best achieve policy objectives

Answer 55

true

Question 56

Vertical packaging

Answer 56

one instrument is directed at the implementation of
another

Question 57

Horizontal packaging:

Answer 57

two or more instruments are directed at the same
ta

Question 58

Choosing the right instrument criteria (ELL) explain each

Answer 58

Effectiveness: the likelihood of the policy instrument
achieving the policy objective(s) – includes feasibility, cost,
timeline, etc.

Legality : the degree to which the policy instrument adheres to
relevant legal rules

Legitimacy: the degree of support/acceptance a government
has for its choices, based upon correspondence with public’s
views, values, feelings, objectives

Question 59

True or False: Choice of policy instruments is mediated by historical, political,
social, and legal contexts; policy-makers’ preferences;
governments’ ideological leaning; the nature of issues

Answer 59

true

Question 60

True or False: Each policy instrument has a policy context in which it occupies
a predominant position relative to other instruments (Lemaire,
2007)

Answer 60

true