COVID-19 Differentiated Measures for Unvaccinated Individuals: The Need for Clear Goals and Strong Justifications

Abstract

Numerous countries and jurisdictions have implemented differential COVID-19 public health restrictions based on individual vaccination status to mitigate the public health risks posed by unvaccinated individuals. Although it is scientifically and ethically justifiable to introduce such vaccination-based differentiated measures as a risk-based approach to resume high-risk activities in an ongoing pandemic, their justification is weakened by lack of clarity on their intended goals and the specific risks or potential harms they intend to mitigate. Furthermore, the criteria for the removal of differentiated measures may not be clear, which raises the possibility of shifting goalposts without clear justification and with potential for unfairly discriminatory consequences. This paper seeks to clarify the ethical justification of COVID-19 vaccination-based differentiated measures based on a public health risk-based approach, with focus on their deployment in domestic settings. We argue that such measures should be consistent with the principal goal of COVID-19 vaccination programmes, which is to reduce the incidence of severely ill patients and associated healthcare burdens so as to protect a health system. We provide some considerations for the removal of vaccination-based differentiated measures based on this goal.

Note:
Funding Information: JS received funding in the form of grants from Wellcome Trust (WT104848/Z/14/Z and WT203132/Z/16/Z) and the UK Arts and Humanities Research Council (AH/V013947/1). JS, through his involvement with the Murdoch Children’s Research Institute, received funding from the Victorian State Government through the Operational Infrastructure Support (OIS) Program.

Conflict of Interests: TCV, OS, AHZL and CCT declare they have no competing interests. JS is a Partner Investigator on an Australian Research Council grant LP190100841 which involves industry partnership from Illumina. He does not personally receive any funds from Illumina. JS is a Bioethics Committee consultant for Bayer.

Keywords: COVID-19, pandemic, public health restrictions, ethics, vaccination