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People gather to protest COVID-19 vaccine mandates and masking measures during a rally in Kingston, Ont., on Nov. 14, 2021.Lars Hagberg/The Canadian Press

The push for mandatory vaccinations is growing. Several European countries are moving in that direction, and the Quebec government plans to impose what sounds like an unvax tax.

We can debate whether imposing a financial penalty goes too far. But the unvaccinated need to know that they will pay an ever higher price for imperilling our health care system by refusing to protect themselves from COVID-19.

The Omicron variant is straining hospitals across the country. In Ontario, almost half the people in intensive care who have COVID-19 are unvaccinated, even though they account for only 9 per cent of the people 12 and older in the province.

“The science on this issue is clear (and unsurprising),” said Dr. Adalsteinn Brown, dean of the Dalla Lana School of Public Health at the University of Toronto and co-chair of the Ontario COVID-19 Science Advisory Table, in an e-mail exchange. “The risks of hospitalization and ICU use are so vastly lower with vaccination.”

But “whether citizens should be legally required to get a vaccine isn’t a scientific question,” he added.

Federal Health Minister Jean-Yves Duclos has asked premiers to consider making vaccinations mandatory. Premier Blaine Hicks is considering the possibility for New Brunswick, while Quebec Premier François Legault told reporters Tuesday, “We’re looking for a health contribution for adults who refuse to be vaccinated for non-medical reasons.”

Mandatory vaccination is not a yes/no question, but rather a question of degree. No one is proposing the unvaccinated be strapped to a table and forcibly injected. The real question is how far governments should go in restricting the freedom of people who refuse the vaccine.

“There are ramifications,” for refusal, said Colleen Flood, University Research Chair in Health Law and Policy at the University of Ottawa, in an interview, ”and so really it’s a question of how tough those ramifications are.”

Prof. Flood points out that there are still some people who simply haven’t gotten around to getting vaccinated. Maybe they live in rural communities or work shifts or have other duties that make it difficult for them to get a shot. Others may be fearful of the medical system, which has historically mistreated disadvantaged groups.

“And then you have the hardcore anti-vaxxers, the conspiracy theorists and so forth. And I really don’t think for a lot of them that anything will change their mind,” she said.

Pushing restrictions beyond a certain point – prohibiting the unvaccinated from entering grocery stores or taking public transit, even making vaccine refusal an offence – could be challenged in court. Timothy Caulfield, research director of the University of Alberta’s Health Law Institute, says such a challenge may or may not fail.

“I don’t think it’s a slam dunk that it would be struck down,” he told me. While the Charter of Rights and Freedoms protects citizens from coercive acts by government, “these rights are not without limitation. And if it can be shown the mandates are effective, and necessary, and that appropriate accommodations are in place, they might survive a Charter challenge,” he said.

Another uncertainty is the political impact. Although hardcore vaccine deniers are only a small minority of the population, they are passionate, and coercion could drive them into the arms of extremists.

Although, as Prof. Caulfield points out, imposing further restrictions could serve as an excuse for some vaccine deniers who were thinking of changing their minds.

“What a mandate can do is allow people to hold two conflicting views,” he said. “‘I don’t want to get this vaccine, but I guess I have to.’ So they don’t lose face.”

When the Quebec government announced it would require proof of vaccination for people to enter liquor and marijuana stores, vaccinations increased. There are other less-than-essential services, such as beauty salons and barber shops, clothing stores, even entire shopping malls, that could be placed off-limits.

Prof. Flood would like to see governments push harder to get children vaccinated and bring in legislation that would enable businesses to require proof of vaccination from employees and customers.

Italy, Greece and Austria are imposing fines on citizens who refuse vaccination, and Quebec appears set to do something similar. Not all provinces will want to go that route. But they should consider tighter restrictions to cajole or coerce people to receive the vaccine.

Refuse the needle if you must. But you may not enjoy the life you lead.

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