How should society treat people who can receive a coronavirus vaccine, but refuse to do so? Since 8 December the Singaporean government has been making Covid patients who have chosen not to be vaccinated pay the full cost of their own treatment – an approach that some have approved of in the United Kingdom.
I think in many ways the vaccines are a poor starting point. While the various vaccines have received regulatory approval and been declared safe, and carry a much, much lower risk than actually getting Covid-19, they are very new. I think that people who refuse to have a shot have very badly misjudged the risk they are taking – but they aren’t wrong that there is more of a risk with a coronavirus vaccine than with a much older vaccine, which would have a lot more substantial evidence on its long-term effects.
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People who refuse to be vaccinated because they have imbibed one or more conspiracy theories do not have a poor understanding of risk, they believe something that isn’t true. However, neither “believing something that isn’t true” nor “having a poor understanding of risk” are offences that ought to carry a death sentence: which, for many people, being asked to pay for their own medical treatment essentially would be.
Given the Covid vaccines’ novelty, a better starting point – on the grounds that you should always test an argument against its strongest possible opponent – is a vaccine that has been in use for a long time, and where we can make confident predictions about the long-term benefits of getting that vaccine: the tuberculosis jab, for example, which is offered for free to babies and children in most major cities in the UK, or the MMR (mumps, measles and rubella) inoculation, which is offered to everyone in the country.
We can say with essentially close to 100 per cent certainty that these are safe, reliable vaccines whose side-effect risks are trivial compared to the risks of catching TB or mumps, measles or rubella. If you refuse these vaccines for yourself or for your children, your understanding of risk is much worse than that of someone who declines a coronavirus vaccine, and your exposure to conspiracy theories is probably even greater. But these still aren’t transgressions that should result in a death sentence.
The reality is that most of us will end up needing medical care due to bad decision-making: whether it is a fondness for salted butter, unprotected sex or failing to look both ways before crossing the road. And those shouldn’t be mistakes that the rich take a lighter punishment for than the poor.
That’s surely the most dangerous part of the argument that people who don’t get a coronavirus vaccine should pay for their own treatment: we are ultimately saying that bad decisions should carry a higher cost for the poor than for the wealthy. There are many ways and many walks of life in which that is already true, but we should be aiming to reduce those, not add to them.[see also: How the battle against Covid became a forever war]