Would national vaccine mandates work in Canada? Experts aren't sure

With European states turning to mandatory national vaccination regimes to deal with record COVID-19 infections, experts in Canada say that while science and the law may back the Liberal government if it chose to follow suit, it might not be the panacea the public is hoping for.

There are significant challenges to imposing a national mandatory vaccination program for all Canadians, the first of which is the age-old jurisdictional battle between the federal government and the provinces.

Under the Constitution, the provinces are responsible for delivering health care, and a vaccine mandate would fall under that remit. If the federal government wanted to take over that responsibility, it would have to either use the Emergencies Act or pass legislation giving it the authority to act.

"To do that, all hell would break loose from the provinces," Michael Behiels, a constitutional law expert at the University of Ottawa, told CBC News. "It's theoretically possible, but this would go to court immediately, and they would have to prove that the crisis is in fact a national crisis."

Behiels said a federal government taking this route would likely win any challenge in court, providing it could prove that the rate of infections, the death rate and ongoing mutations were creating a threat only a national response could mitigate.

Even in victory, he said, the move would likely create a backlash among provincial governments that see the step as unnecessary at this stage of the pandemic.

"Up until this moment in Canada, there has not really been a need to consider it," Dr. Allison McGeer, an infectious disease specialist at Toronto's Mount Sinai Hospital, told CBC News.

"We're not back to normal, but we're getting there — and there's no guarantee that we'll be right back to normal even if everybody is vaccinated because there are breakthrough infections," said McGeer, who is also a professor at the Dalla Lana School of Public Health at the University of Toronto. 

Context is everything

Behiels said a national vaccine mandate could not only create bad blood between the unvaccinated and the federal government but also between the provinces and Ottawa that could undermine the vaccination effort.

If the situation were different, he said, with a much higher death rate or a more aggressive infection rate, making that move might be easy and the provinces might even ask for the intervention if the situation got bad enough. But experts are not sure Canada has reached that point just yet.

European countries such as Austria and Greece appear to believe they have, and they're moving in the direction of national vaccine mandates because they are seeing infection rates three times higher than at any other time during the pandemic, and vaccination programs have stalled.

In January, Greeks over the age of 60 who are not yet vaccinated will be subject to a monthly fine of 100 euros ($140 Cdn). Slovakia is looking at taking the opposite route and offering 600 euros ($844) to encourage people to get their shots.

Austria, with one of the lower vaccination rates in the European Union, is looking at plans that, if implemented, would fine unvaccinated Austrians more than 7,000 euros ($9,880). There are already signs that enforcing that mandate will be a challenge; late last month some 40,000 protesters turned up in Vienna to challenge the new rules.

Only 67 per cent of the EU's population has been fully vaccinated against COVID-19, according to Our World in Data, while in Canada, 76 per cent of the population is fully vaccinated. Greece sits at 64 per cent, while Austria's population is only 66 per cent fully vaccinated.

Germany isn't much better at 68 per cent, and countries such as Hungary have some of the lowest vaccination rates in Europe at just 61 per cent.

Both Germany and Hungary are experiencing record infection rates, and both are turning to strict national policies to try to turn the tide. For now, Germany is only talking about mandatory vaccination. Hungary, however, is allowing companies to impose the policy on employees and compel any unvaccinated staff to take unpaid leave until they get immunized.

In Canada, by comparison, all passengers travelling on planes and trains must be fully vaccinated, as must the staff working in those sectors. All federal employees must also be fully vaccinated.

Reasons for hesitancy

McGeer and other infectious disease physicians, such as Dr. Isaac Bogoch of the University of Toronto and Dr. Gerald Evans, chair of the division of infectious diseases at Queen's University in Kingston, Ont., all agree that the goal some European states are pursuing — a fully vaccinated population — is a worthy one.

But they also agree that imposing mandatory vaccination regimes across the population might cause an uproar, stress the goodwill between Canadians and their government and, in the end, not deliver the desired results.

"Say it works and you actually get huge numbers of people now being vaccinated because of the imposition of fines or restrictions. The fact of the matter is that it would help, it would have an impact," Evans said.

"If we had 95 to almost 100 per cent of the population vaccinated, this virus would have one devil of a time trying to maintain itself in the environment."

Bogoch agreed with the sentiment that more vaccinations are necessary, but he remains unsure that a mandatory vaccine regime would have the desired effect.

"There are multiple reasons why people remain unvaccinated, and understanding those reasons and tailoring your response to those reasons is usually a more effective approach so you don't further alienate people in an already polarized world," he said.

Bogoch says there are typically four types of unvaccinated Canadians. The first two are people who intend to get vaccinated but have not gotten around to it yet and people who work multiple jobs or are single parents and have not had the time or opportunity to get vaccinated. Bogoch says these groups likely wouldn't be put off by a vaccine mandate.

But the other two — people with lingering concerns and anxieties and people who have been influenced by misinformation campaigns — might be pushed further away from vaccination by a mandate, he says.  

One size does not fit all

Within those groups, experts say, there are subgroups turned off of vaccination for different reasons.

"People who are white, rich, highly educated and born in Canada have much more faith in the public health system and have much more willingness to believe their government, so we get higher vaccination rates," McGeer said.

"Racialized communities who already are at strikingly higher risk of being infected with COVID are the very people who have more trouble in deciding to get vaccinated and with good reason."

She added, "Vaccine mandates are systemically inequitable, and you can work to mitigate it, but you can't fix it."

Bogoch says the best way to increase vaccination rates is to understand why each group won't get vaccinated and then try to meet them on their ground: If they can't get to a vaccination clinic because they are too busy, use mobile clinics, he says. If they still have lingering questions, sit them down with health professionals and try to answer their questions. If they have been influenced by misinformation, try to combat those false narratives. But don't, Bogoch says, try to motivate everyone with the same approach.

"There is not a one-size fits all solution to this problem," he said.