On 21 July the first stage of France’s plan to pressurise its population into getting vaccinated will take effect, with vaccine passports required for entry to cultural venues such as theatres and cinemas. A few weeks later, that condition will be extended to a swathe of other activities, including long-distance travel, bars and restaurants. The unvaccinated can present proof of recovery from coronavirus or a recent negative PCR test as an alternative, though tests will soon cost €49. Venues which do not check their customers’ vaccination status will face hefty fines.
The administration rate of first doses has begun to taper off in many European countries – so is coercion the way to achieve vaccination? Without fully mandating compulsory vaccination, French president Emmanuel Macron has chosen to make life progressively more inconvenient – not to mention expensive – for those who have not completed a full course of immunisation. Other European countries are taking similar steps, though few have yet to go as far as France.
The initial signs are that the French strategy seems to be working, despite widespread concern about how the rules will be implemented and loud opposition from a heterogenous coalition of opponents of vaccine passports. Bookings for jabs on the Doctolib website, the main platform for scheduling a vaccine appointment, skyrocketed after Macron’s announcement last week. Bookings jumped tenfold the day after the televised address, to 1.2 million, from a previous rolling average of about 120,000 a day. Demand has since fallen, though it remains higher than before.
The burst of enthusiasm suggests that the people who have booked jabs are not hardcore anti-vaxxers, but rather the moderately hesitant, or those who simply had not got round to it yet. With Covid rates relatively low and the economy virtually fully open, many perhaps felt little urgency to get vaccinated.
Although the Covid-19 vaccines have received unprecedented public attention and scrutiny, mandatory vaccination is also nothing new, points out Samantha Vanderslott, a health sociologist at the University of Oxford. The UK required all babies born after 1853 to be vaccinated against smallpox. Some European countries demand that children receive certain jabs, such as those that protect against measles and tetanus. Yet such vaccines are usually given in childhood. Coercing the general adult population to be vaccinated has no precedent in the rich world, she says.
Coercive vaccination could be seen as an infringement of individual liberty, but lockdown, the only alternative to mass immunisation that can successfully stem mass death while the disease spreads widely, is arguably much more so. Being required to take a jab appears less of a limitation of personal liberty than the government once again mandating people stay in their homes and banning them from contact with loved ones. “Lockdown is much more coercive,” Hugo Drochon, a political theorist at the University of Nottingham, told me.
That argument appears to hold water among a majority of French people, 62 per cent of whom back the vaccine passport policy, according to one poll. “Mandatory vaccination will not result in a net loss of liberty [among the population] as it is a guarantee that freedom can be maintained for all,” Thomas Legrand, a French political journalist, wrote.
Moreover, in deciding how strongly to encourage vaccination, governments have to balance private freedoms with the welfare of society at large. “The choice to have a vaccine is partly seen as individual choice, but when it comes to infectious diseases and public health, it just can’t be,” Vanderslott told me.
This point of view appears especially relevant in light of the threat of the more transmissible Delta variant, which the European Centre for Disease Prevention and Control (ECDC), a public health agency, predicts will represent the overwhelming majority of infections in Europe within weeks. The ECDC’s modelling shows the incidence rate in the European Economic Area more than quadrupling to 420 cases per 100,000 by 1 August, up from 90 in mid July. Without mass vaccination, the only way to prevent that resurgence translating into many deaths would likely be more lockdowns.
“We can either have mass vaccination or a viral tsunami. There is no alternative,” Gabriel Attal, a spokesperson for Macron’s government, said in an interview.
Some European countries are already implementing policies similar to France’s. Portugal and Greece require vaccine passports for access to restaurants, while Italy is forcing health workers to be vaccinated or face losing their jobs. In the UK, Boris Johnson’s government has said that nightclubs and other mass events will be required to ask for proof of vaccination from September. The Prime Minister has also hinted at further use of vaccine passports, saying: “some of life’s most important pleasures and opportunities are likely to be increasingly dependent on vaccination”.
None has yet mandated vaccination for the general population, though Macron has not ruled it out, saying earlier this month that: “as the situation evolves, we may need to consider obligatory vaccination”. By contrast, German chancellor Angela Merkel has flatly said that her government will not force people to be vaccinated, arguing that a coercive approach could damage trust in public health authorities.
More likely than explicit compulsory vaccination is a gradual toughening of restrictions on the unvaccinated as the autumn approaches. PCR and rapid tests, which can be used for entry to some venues as an alternative to vaccination in most European countries, may become paid-for, providing a financial disincentive for holdouts. The president of the German Medical Association, Klaus Reinhardt, has called for free testing to be ended by the end of the summer, arguing that “the community [should not] pay for individuals who are unwilling to get vaccinated”.
However, if the EU’s third wave, which is beginning to pick up in countries such as France and Italy, once again threatens health systems, then governments may decide to take more drastic action – such as compulsory vaccination of the entire adult population. Like much of the past 18 months, that would be virtually without precedent.