We’re counting on a COVID-19 vaccine. What if people refuse it?

The latest Ontario data, revealed Monday, shows that social distancing has pushed back the surge — for now, for as long as we keep it up.

But we won’t truly be in the clear until a vaccine saves the day a year or two from now. Or maybe not.

What happens if that medical miracle finally arrives and people refuse the shot? The risk of public resistance to a vaccine seems far-fetched — and far off.

But a decision point is coming sooner than many imagine — this fall, in fact. It requires us to rethink now how we deal with thoughtlessness in dangerous times.

The challenge will come not only from the anti-vaxxers but the apathetic, from those who insist on their individual right to be wrong versus our collective right to life. It already has.

Today we have a safe, life-saving vaccine to protect ourselves and spare the elderly — not from the novel coronavirus, but seasonal influenza. And yet many people — including some health-care workers — refuse it every autumn, exposing the most vulnerable among us to pneumonia and death.

What’s the relevance of the annual flu shot to a COVID-19 vaccine yet to be discovered? They are different viruses both in terms of transmission and treatment, but each has the potential to strain immune systems and health-care systems.

Remember hallway medicine? One of the main causes of overcrowding in many hospitals was an unexpected surge in patients showing up with seasonal influenza in overstretched emergency rooms.


Clearly this pandemic is far more unpredictable and terrifying than flu season, given the rapid spread by asymptomatic carriers and the lack of societal immunity. But the devastating toll on the elderly from COVID-19 reminds us how vulnerable they are to influenza for similar reasons — they have compromised immune systems and are confined to nursing homes or hospitals in close proximity to fellow patients and providers who may be infected.

There are other connections to consider between seasonal influenza and COVID-19, between a perennial and a pandemic:

First, the possible confusion of symptoms — does one have the flu bug or something more serious — can cause panic for patients and distractions for diagnosticians.

Second, the confluence of sick patients clogging emergency rooms — requiring treatment for a preventable influenza — takes resources away from those unavoidably infected with COVID-19 (think of supermarket cashiers or front-line workers unable to shield themselves) in intensive care units.

Do we dare tempt fate this fall, with all the potential for confusion and confluence?


Every year, Ontario’s government promotes and pays for free doses of influenza to protect us. Not just as individuals, but to bolster herd immunity for the overall population, so that those who cannot be vaccinated (people with medical conditions, the very young, the very old, the pregnant) have minimal exposure to the virus.

Yet every year, many people still don’t get vaccinated — either because they believe they know better than our public health authorities (they think it’s risky or ineffective); or because they underestimate the seriousness of influenza for themselves or those they infect, and can’t be bothered getting the shot.

It’s true that the flu vaccine is never a sure thing, merely a science-based prediction of what the next season’s strain of influenza will look like. But it has proven remarkably effective in reducing risk and saving lives — many of the same lives we are desperately trying to save now in nursing homes.

We don’t require 100 per cent vaccination rates to achieve the herd immunity that protects society at large, whether from influenza or measles. But if we don’t aim for the highest possible percentage, we risk falling short as resistance keeps growing — from religious exemptions to apathy and anti-vaxxer sentiment.

The most galling opposition comes from some diehards who work in hospital settings. By refusing the shot that reduces their exposure to influenza — exercising their individual choice — they risk imposing it on ailing patients who never chose to be in a hospital setting.

Hospitals that required employees to get the shot or face consequences — from losing their front-line jobs to wearing medical masks — have faced union battles and lost in court. It’s time for health-care professionals and their unions to back down on this one, because they signed up to put their patients first.

Just as we are considering blood (serology) tests to determine immunity from COVID-19, and possible “pass” systems to allow for expedited airline travel, so too we must think hard about proof of vaccination as a litmus test (in the same way we must show ID before boarding). During a cholera epidemic, some countries require travellers to show they have been inoculated.

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We already require children to show proof of vaccination or risk expulsion from school, and have only recently realized the consequences of failed enforcement. We should at least consider making the flu vaccine a civic duty (apart from medical exemptions), using the carrot and stick to promote compliance.

This isn’t Big Brother surveillance. Public health protection is not an intrusion, it’s a matter of life and death in a country where more than 8,000 people die of influenza annually.

Now is the time to reconsider our complacency and laxity — ahead of flu season, and in advance of any COVID-19 vaccination. The freedom to refuse a shot ends with society’s right to stay safe.

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