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Quebec Health Minister Christian Dubé speaks during a news conference on the COVID-19 pandemic, on Oct. 7, 2021, at the legislature in Quebec City.Jacques Boissinot/The Canadian Press

On Wednesday, Quebec Health Minister Christian Dubé announced he was dropping his long-standing plan to force health care workers to get vaccinated against COVID-19, or be fired. Also on Wednesday, Ontario Premier Doug Ford’s government declined to introduce a similar provincewide plan.

Both of these are bad outcomes. But they may not be bad decisions. In Quebec, Mr. Dubé described his policy reversal as the “least bad” decision. Under the circumstances, he’s probably right.

Back in the summer, Mr. Dubé issued an ultimatum to the province’s 330,000 health care workers: Get vaccinated by Oct. 15 (later extended to Nov. 15), or lose your job. It was a perfectly reasonable demand. You have to prove you’re vaccinated to visit a patient in hospital; shouldn’t you have to be vaccinated to work there? The question is an ethical and scientific no-brainer.

But when you tell someone “do this, or else,” you’d better be sure they aren’t going to choose “or else.” Before making The Godfather’s proverbial offer that can’t be refused, be sure it really can’t be refused. Otherwise, you end up with opponents emboldened and your moral authority in tatters.

Which is where the government of Quebec finds itself. On Wednesday, Mr. Dubé said that around 14,000 health care workers were without even a single shot, including approximately 5,000 front-line workers.

That’s only 3 per cent of those on the front line, but, if all were to be terminated, Quebec’s health minister says it would lead to a cascade of cancellations and shortages across the entire system.

Just 3 per cent of workers have so much leverage because Quebec health care was already short-staffed before COVID-19. For example, nurses in the province have long been forced to work mandatory overtime. Endless overtime leads to burnout, which leads to resignations, which leads to more staff shortages – and more mandatory overtime.

It’s a vicious circle (which Mr. Dubé has promised to break), so when several thousand employees effectively blackmailed their colleagues, and health care, he blinked.

But it’s not the same situation in all provinces or sectors. Take the vaccine mandate at Canada’s largest school board. On Nov. 2, the Toronto District School Board said that, of more than 42,000 workers, fewer than 800 had not attested to their vaccination status. What’s more, the TDSB says the vast majority of the holdouts are part-time or occasional staff, most of whom have not worked this year. Only 16 are permanent teachers – out of a permanent teaching staff of more than 16,000.

With 99.9 per cent of permanent teachers vaccinated, the TDSB has the leverage to make good on its ultimatum.

Or consider British Columbia. It has a vaccine mandate in health care, and it isn’t backing down. Health Minister Adrian Dix said on Monday that, of 127,500 health care workers, more than 3,300 are unvaccinated – and on unpaid leave.

However, it’s not as if those lost workers are not having an impact. For example, Mr. Dix said that Kelowna General Hospital had been forced to reduce the use of two operating rooms. The Interior Health region, with one-sixth of B.C.’s population, has one-third of the province’s unvaccinated health workers.

All of which points to why the Ford’s government decision to hold off on imposing a single, provincewide vaccine mandate on Ontario’s health care sector may not be such a bad choice. It may be a least-bad alternative – at least for Ontario, at least for now.

Yes, in an ideal world the best policy – one this page repeatedly urged – would be a single, simple, provincewide order to all health care employees to get vaccinated. But when and where that perfect outcome isn’t yet within reach, why not look to other approaches, at least in the short term?

For example, many Ontario hospitals have their own vaccine mandates, and are suspending unvaccinated staff. They know their employees, and they know whether issuing a vaccination order in their institution or region will deliver more benefits than costs. If they think they can make a mandate stick, Queen’s Park should be supporting them, rhetorically and financially.

And along with local mandates, financial penalties for the unvaccinated (in Quebec they cannot receive pandemic bonus payments), a vaccination requirement for new hires, and regular testing of the unvaccinated (in place in Quebec and Ontario) can all nudge the ball toward the goal. The goal is getting vaccination in health care to 100 per cent – immediately where possible, gradually if necessary.

In the long run, everyone working in health care in Canada should have to be vaccinated against COVID-19 as a condition of employment. Obviously. As the Ontario Hospital Association pointed out this week, the province’s Public Hospitals Act already orders institutions to require employees to prove vaccination or immunity against 17 different conditions, from tuberculosis to measles. COVID-19 should of course be added to the list.

But as Quebec’s struggles show, there are some places in Canada where that may best be accomplished in stages, rather than all at once.

When you hold all the cards, an ultimatum can be the winning strategy. Got a weaker hand? Open with subtlety, perseverance and patience.

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