By Jess Davies (BSc Economics)
[This essay was written for the Government, Welfare and Policy third-year undergraduate module. Students were tasked with writing a blog-style essay on a topic linked to a group poster project. Topics were chosen by students and reflect their own interests. The essay gave them experience of writing content in an engaging style for a non-expert audience. What you see below is one of this year’s top-marked blog-style essays. Christa Brunnschweiler]
Over the past year, the Covid-19 pandemic has affected nearly every nation in the world. There have been over 2.8 million deaths worldwide (covid19.who.int) as of the 6th of April 2021, and over 125,000 of those deaths have occurred in the UK. Pharmaceutical companies across the world raced to develop Covid-19 vaccinations, and with huge levels of government funding there are now 3 vaccinations approved for use in the UK, all of which massively reduce the levels of infection, illness, and mortality.
So far, the NHS has administered over 53 million doses of the vaccine (coronavirus.data.gov.uk), making us a world leader in the vaccine rollout. Now that the country is beginning to reopen and emerge from its third lockdown, policymakers are facing questions over the use of vaccine passports, or ‘Covid-certification’. This has proved controversial, as many have deemed the idea an infringement on human rights or discriminatory. It could also be considered an indirect way of mandating vaccination. However, vaccine passports are not a new concept – the idea fist emerged in 1897 with the invention of the plague vaccine. People were concerned about mass gatherings at religious sites in British India during the plague, and some people would be refused access without proof of vaccination (www.npr.org).
It is important to define Covid-certification in the context that I will be using the term. Currently, there are suggestions that a person could gain this certification if they have either had the vaccine, had a negative Covid test recently, or have had Covid in the last 6 months so they have antibodies. So, is there a case for using Covid-certification in the UK?
First, we must analyse the benefits of vaccination. Vaccines provide people with immunity from viruses and can also help to reduce disease transmission. This means that vaccines are considered a merit good – one which provides positive effects to third parties, and people will underestimate the benefits of taking it. Without intervention, they are likely to be under-consumed in the free market. Covid-certification could be a form of intervention to encourage more people to take the vaccine and eliminate this market failure. It is also important to note that it would be unethical to enforce such a policy unless the vaccine is available free at the point of consumption and accessible to everyone.
There is evidence that government intervention can increase uptake of a vaccination. The first example of this is from Italy, where the government mandated the MMR (measles, mumps, and rubella) vaccine after seeing upticks in all these diseases in the past 2 decades. It is likely this occurred due to high rates of vaccine hesitancy stemming from the false claim that some childhood vaccinations were causing autism. The law on mandatory vaccination in Italy did cause a significant increase in uptake (Gori et al., 2020). Another successful example is mandatory polio vaccination in Belgium, which has been the law since 1967, where uptake is over 99% (Walkinshaw, 2011). The punishment for non-compliance is a fine in both scenarios. Additionally, every US state requires certain vaccinations for children to enter the school system. This intervention was at first extremely effective, however in recent decades the anti-vaxxer movement has built momentum, impacting rates of uptake.
One of the main arguments in favour of the use of Covid-certification is that it will help the UK to open the economy. If people can prove they have been vaccinated, it would provide some assurance that they are less likely to spread Covid-19, making it safe to visit pubs, restaurants, clubs and even festivals. Without this we could see mass gatherings of unvaccinated people. Additionally, the UK has now experienced three mandatory lockdowns, which have all been accompanied by huge social and private costs, such as loss of employment, education, and social interaction. The costs of vaccination are tiny in comparison, since we know how safe the vaccine is.
The use of Covid-certification would help to mitigate the problem of adverse selection. Due to asymmetric information, individuals know more about their Covid-status than the pub owners, festival organisers and other officials, therefore it would be easy for them to lie about whether they have had the vaccine, and we cannot rely on people to tell the truth. Introducing this policy gets rid of this problem because it allows the government to control which people can get into events and reduces this market failure.
Additionally, requiring Covid-certification to gain freedoms is a massive incentive for people to get the vaccine. Therefore, we may see a higher uptake of the vaccine among groups who are typically less likely to get the vaccine. The positive externalities of this are that Covid cases and deaths will continue to fall and there will be a higher level of herd immunity within the community. Also, the government may feel that some individuals may not get the vaccine off their own accord, so could use paternalistic policies to nudge people into getting it. Paternalism is any action which limits an individual’s liberty or autonomy, usually to increase their own welfare or protect them from harm (plato.stanford.edu). From an ethical point of view, using such a policy may be justified on the grounds that it will prevent harm to others (Savulescu, 2020). Some good examples of paternalistic policies are taxes on cigarettes which make people reduce their consumption of them or requiring by law that people wear a seatbelt in a car. Despite the private benefits of receiving a vaccination, some people will depend on others to get herd immunity – this is ‘free-riding’; therefore, it is still important to incentivise people to get the vaccine.
However, no policy is without its downsides. An argument against the use of Covid-certification is that if people could gain certain freedoms by gaining immunity from infection, they may try to intentionally get infected with Covid. The technical term for this is moral hazard, which in this circumstance means that individuals could influence their ability to obtain a vaccine passport. The negative effect of this would be that cases of Covid could rise, and could be spread to high-risk or unvaccinated people, leading to more fatalities. The risk of this problem occurring would mostly lie with young people, who are at the bottom of the list to receive a vaccine and who, for the most part, have been relatively unscathed by an infection of the virus, so could be tempted to become infected intentionally.
Additionally, the private benefit of receiving the vaccine to young people is low, which leads them to ‘under-consume’ the vaccine, which is a merit good. Prospect theory – the idea that people value losses more than they do gains (Kahneman & Tversky, 1979) – also comes into play, as people are likely to place more value on the cost of getting vaccinated than they would the benefits. Additionally, individuals have different risk preferences, causing varying levels of uptake of the vaccine, for example more old and vulnerable people are likely to be very risk-averse regarding Covid-19 which means they could be more likely to take the vaccine.
Another argument against the use of Covid-certification if it were to include people who are ‘immune’ due to previous infection, is that individuals’ immune responses to the virus can vary (Doshi, 2020). This means that people could have varying levels of protection. Additionally, at this point in time we don’t know whether this immunity will be short-lived or if it provides protection for a long period of time. Therefore, it would be difficult to determine who could have a Covid-certification based on the timing of their previous infection. There are also differences between the level of immunity within the population of regions of the country, for example it is reported that in cities like London around 18% of people had immunity from infection in December 2020 (Doshi, 2020). Among the general population the numbers are much lower. This means that there are ethical considerations to be made because different parts of the country may experience more economic benefit than others if the number of people who are Covid-certified varies.
There are also problems with the enforcement of the policy. For example, if somebody turns up to a venue without Covid-certification, it will be the venues responsibility to turn people away. This may be difficult for staff, and they also might not wish to do so because they are losing customers.
There is a strong case for the use of Covid-certification within the UK as a temporary measure, until the pandemic is over. It is a useful tool to try to combat vaccine hesitancy and open the economy safely. However, this could be any period of time due to uncertainty around the speed of vaccinations globally and the emergence of mutated variants of the disease. The measure should include the option of having a negative Covid test, because many groups haven’t yet been offered a vaccination yet, making it unfair to only include vaccinated people. Alongside this policy, we should continue encouraging vaccination through myth-busting campaigns by the NHS and trustworthy public figures.
Bibliography
Doshi, P., 2020. Covid-19: Do many people have pre-existing immunity?. BMJ, p.m3563.
Gori, D., Costantino, C., Odone, A., Ricci, B., Ialonardi, M., Signorelli, C., Vitale, F. and Fantini, M., 2020. The Impact of Mandatory Vaccination Law in Italy on MMR Coverage Rates in Two of the Largest Italian Regions (Emilia-Romagna and Sicily): An Effective Strategy to Contrast Vaccine Hesitancy. Vaccines, 8(1), p.57.
Kahneman, D. and Tversky, A., 1979. Prospect Theory: An Analysis of Decision under Risk. Econometrica, 47(2), p.263.
Savulescu, J., 2020. Good reasons to vaccinate: mandatory or payment for risk?. Journal of Medical Ethics, 47(2), pp.78-85.
Walkinshaw, E., 2011. Mandatory vaccinations: The international landscape. Canadian Medical Association Journal, 183(16), pp.E1167-E1168.
https://coronavirus.data.gov.uk/details/vaccinations
https://plato.stanford.edu/entries/paternalism/