Sir, – As the Covid pandemic emerged two years ago, it appeared that some people had never considered the possibility that they might ever incur a life-threatening infection. To many of us who work in the medical setting, this seemed bizarre. Infection was always among the commonest causes of death. “Lower respiratory infection” (or pneumonia) was the fourth most frequent cause of mortality globally, and the commonest communicable one, prior to the arrival of Covid. So it remains, per the World Health Organisation. The “novel”pathogen is, in a sense, just one more among about 200 known causes of such an outcome.
This is of relevance to the discussion around mandatory vaccination. Rather than asking how the recent pandemic can inform our preparations for future ones, many are suggesting we might leave matters as they are while the current situation apparently abates. For instance, Barry Walsh (Letters, January 25th) suggests that Nphet’s forthcoming paper on the ethical and legal considerations of mandatory vaccination are irreconcilable with their position recently that all remaining Covid restrictions should be lifted.
I would disagree, and suggest this is exactly the time to weigh up the matter. My logic is akin to the statement that “the time to fix the roof is when the sun is shining”.
The principle of mandatory versus completely optional vaccination cannot be based on the details or behaviour of one infection or disease. Principles exist, by definition, to be generalised. Concepts like notifiable diseases and mandatory quarantines overrule ideals such as medical confidentiality and liberty, as they prioritise the good of the many over that of the few.
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The recent pandemic has illustrated at least two realities that might have been suspected, but were not, until recently, certain. One is that modern science can produce vaccines very quickly. Highly effective vaccines were created, evaluated, the relevant studies published and the agents distributed in about 11 months. The previous record for such an endeavour was about four years. And second, it is hard to doubt that, unlike say when polio or smallpox vaccinations were introduced, there are people who will refuse such treatment for reasons that are hard to precisely articulate. The fact that the infection was about a thousand times more dangerous than the vaccine was insufficiently persuasive for some, which is an opinion, if not an especially reasonable one, upon which they were free to act. This can endanger friends, family and healthcare workers.
One thing that we can be certain of is that more pandemics will occur. The absence or presence of pre-existing immunity to the relevant pathogens, and how infectious, virulent or aggressive they may be, will vary. Treatments and preventative measures will probably emerge, and some will be sceptical of them, even if they are safe and effective.
It was useful during the Covid pandemic that the Government could simply designate it a “notifiable disease”, with all the implications of that step. We had no need to draft new laws for that purpose. A similar framework for mandatory vaccination might be considered in any review of the pandemic. If we are struck by a future outbreak of an especially dangerous or contagious infection, or one where the balance of risk warrants it, then that legislation could be invoked. Hoping it will never happen is entirely understandable, but it is not a strategy. – Yours, etc,
BRIAN O’BRIEN,
Kinsale,
Co Cork.