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People take part in a demonstration against the Quebec government’s measures to curb the spread of COVID-19 in Montreal on Jan. 8.Graham Hughes/The Canadian Press

Quebec will impose a tax on those who aren’t vaccinated against COVID-19 to offset their disproportionate cost to the health care system and encourage more people to get their shots.

Premier François Legault pointed to the makeup of intensive-care hospitalizations in Quebec as the driver for the levy. Unvaccinated Quebeckers make up just 10 per cent of the province’s adult population but comprise about half of those admitted to ICU with the disease, he said.

“It’s a question of equity,” he said. “Right now, these people put a very important burden on our health care network. I think it’s normal that the majority of the population are asking that there be a consequence.”

The pandemic’s painful fifth wave has overwhelmed Quebec hospitals and the government’s imposing of strict restrictions. On Monday night, the province’s Public Health Director Horacio Arruda resigned, citing an erosion of public support in his explanations for lockdown measures.

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The tax will be for a “significant” amount, Mr. Legault said, while offering few additional details about a policy that would be a Canadian first. The levy will not be applied at hospitals in exchange for health services, but will be more like the premium Quebec residents pay for public prescription drug insurance, which is collected through income tax returns, he said.

The government is still studying legal issues around the tax, but those with valid medical reasons will be exempted, Mr. Legault said at a news conference on Tuesday.

On social media, his chief of staff, Martin Koskinen, tweeted a defence of charging the unvaccinated. “In order to avoid paying a health fee or a COVID fine, there is a simple solution: a free and accessible vaccine,” he wrote. “We have rights, but also responsibilities. The democratic debate on this question will be fascinating.”

The new tax overshadowed the departure of Dr. Arruda, Quebec’s long-time Director of Public Health, who resigned on Monday after a tumultuous 22 months helping lead the province’s pandemic response. In the early days of the crisis, Dr. Arruda was a popular and colourful personality, whose gesticulations, vivid clothing and talk of Portuguese custard tarts helped reassure Quebeckers at a frightening time.

But as the death toll mounted and the months ground on, the public soured on his style and came to doubt some of his advice. The punishing fifth wave of the virus, which has seen Quebec impose a curfew for the second time, saw growing calls for his departure. In a resignation letter, Dr. Arruda acknowledged that doubts about his scientific credibility had eroded support for restrictions.

In introducing his interim public health chief – Dr. Luc Boileau, a veteran of the province’s public-health bureaucracy – Mr. Legault laid out his case for imposing the tax measure in Quebec’s fight against COVID-19. He said that the province still plans to expand the use of vaccine passports to include places such as shopping malls and hairdressers, but that the vaccinated majority deserves even stricter measures.

“I think it’s a question of fairness for the 90 per cent of the population who made some sacrifices,” he said. “I think we owe them this kind of measure.”

Asked his position on the tax, Dr. Boileau said the policy was formulated before he took the new job and that it was too early for him to offer an opinion.

Some researchers were sharply critical of making the unvaccinated pay, arguing that it could hurt disadvantaged people and be hard to enforce. Pierre-Carl Michaud, a health economics specialist at Montreal’s HEC business school, wondered about those who can’t afford the fee.

“I just have this fear that if the penalty is set at a very high level, obviously it’s going to change people’s behaviour but we’re going to get this problem with people who can’t pay. And, in my opinion, there’s probably a lot of people in that situation,” he said. “Suppose they put the penalty at $5,000 or even $1,000. And you get someone on social assistance, non-vaccinated, what do you do with those folks? Do you go to their home and confiscate food from the fridge?”

Quebec Premier François Legault said Tuesday that adults who refuse to be vaccinated against COVID-19 will have to pay a 'significant' financial penalty.

The Canadian Press

Quebec is not the only jurisdiction to impose financial penalties on people who refuse to get vaccinated and don’t have a valid medical exemption. In December, Austria said people who flout the country’s vaccine mandate could be charged up to approximately $5,171 every three months starting this year. In Greece, the government this month mandated vaccines for everyone 60 and older, with people who refuse facing a $144 monthly fine.

While Mr. Legault released few details on Tuesday, it appears his policy won’t conflict with the Canada Health Act, said Katherine Fierlbeck, the chair of Dalhousie University’s political science department who researches health care policy and governance.

“It would only violate the [Canada Health Act] if required at point of service provision, and if failure to pay led to refusal of service,” Prof. Fierlbeck said in an e-mail. She said the surcharge for people who refuse COVID-19 vaccinations proposed by Quebec is similar to the health premium model that provinces such as Ontario apply in addition to provincial taxes. Under that model Prof. Fierlbeck said the penalty for not paying is the penalty for not paying taxes.

“Services are not denied, so no violation,” she said.

Prof. Fierlbeck said the policy from Quebec isn’t as severe as a mandate but does ratchet up the pressure on people who have so far refused a vaccine. She said it will present questions of fairness depending on whether it’s applied on a sliding scale based on income and whether it’s equally applied to people no matter their risk of contracting COVID-19 and getting severe outcomes from it.

In a brief statement late Tuesday, a spokesperson for federal Health Minister Jean-Yves Duclos said the government is reviewing the announcement from Quebec and focused on what it can do nationally to increase vaccination coverage.

“Provinces and territories will continue to make decisions on their own public-health measures that are within their jurisdiction,” spokesperson Marie-France Proulx said.

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