Week 4: Health Policy Case Study: Mandatory Vaccination + Choosing policy instruments Flashcards
Mandatory as Vaccinations by force?
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.
Mandatory as Criminalizing non-vaccination?
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.
Mandatory as Conditioning access to services, jobs, school etc on vaccinations
Condition of doing certain things if you get vaccinated, this is the response mostly to covid
Mandatory as Imposing costs
-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
Mandatory as Providing Incentives for Vaccination
-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
Mandatory as in Persuasion?
-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
What are vaccinations mandates
-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
Staff immunization
common in health care
-tuberculation test
-proof of vax
-blood test to test for hep
tetnis
whopping cough
influenza
mask fit tested
Western Schullich policy in 2016
requires all students to be fully immunized
Updated 2022 policy
requires immunization and visiting students ALSO require full immunization, must comply with COFM immunization and screening policy- council of ontario universities.
This Schullic policy
-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
Ontario immunization of school pupils act
-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.
True or False: Almost every country had some form of a vaccine mandate during covid
true
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
true
Average effect is a _% inc in the pace of vaccination, accounting for an extra __% of the eligible canadian person
66%, 2.9%
Mandates objectives
-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?
Triggered riot in Montreal in 1885
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.
Order by M.O.H
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
Even if it is granted that vaccination mandates are effective at achieving important societal goals, does that alone make them justified?
-Have to question trust
-Infringes on autonomy
What is Coercion
-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
True or False: coercion often applied to policies and a way to say a policy is not just
used as a way to say policy is not just
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.
False: ALWAYS COERCIVE
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
true
Bad coercive
both options are bad-robber saying your money or your life
True or false: if one option isnt thought to make you worse off it isnt coercive
true
Western sued example
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.
Discrimination ontario human rights code
“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.”
T or F: Employment conditions commonly lead to the unequal treatment of people who belong to different groups constitutes discrimination
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
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
true
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.”
true
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.”
True
Civil liberties
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
What sections are Fundamental rights and freedoms/liberties are protected in Canadas Charter of Rights and Freedomes
- 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
Policy instrument’s
-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.
Policy instruments are also known as
‘Policy tools’
*‘Policy techniques’
*‘Policy means
Why is the choice of policy instuments important?
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.”
Examples of Policy instruments
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)
The Stick
- 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
Stick policy instrument examples
- Legislation (i.e., laws)
- Regulations (defining the application and enforcement
of legislation)
The stick health policies
prohibition, prohibition with permissions
Prohibition example
human cloning
Prohibiton with permissions
Possession of cannabis,
except with an authorizing
medical document (e.g.,
Pennsylvania)
The ‘carrot’
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
The carrot policy instrument examples
Subsidies (conditional transfers of funds from governments to
individuals, etc.)
* Taxes
* Customs duties
* Grants
* Vouchers
The carrot health policies
economic disincentive, economic incentive
Economic disncentive ex
~$0.18 direct tax / cigarette
Economic incentive
Nicotine replacement
therapy products
exempted from provincial
sales tax
The Sermon
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
The sermon policy instrument examples
Advertisements (television, online, billboards, etc.)
* Product labelling
* Note: Information as a policy instrument versus information on
a policy instrument
Health policies for the sermon
Negative (dont do), affirmative (do)
Negative example
Pregnant women should avoid travelling to countries with recent Zika infection
Affirmative example
the sooner you get the flu shot the sooner you’re protected
Typology summary for the stick, the carrot, the sermon
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
Nudge
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)
True or false: Policy instruments always come in packages to best achieve policy objectives
true
Vertical packaging
one instrument is directed at the implementation of
another
Horizontal packaging:
two or more instruments are directed at the same
ta
Choosing the right instrument criteria (ELL) explain each
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
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
true
True or False: Each policy instrument has a policy context in which it occupies
a predominant position relative to other instruments (Lemaire,
2007)
true
