As we enter a fourth wave of COVID-19, there’s increasing frustration about the role of unvaccinated people in driving the pandemic. Governments are responding with vaccine mandates and passports, which are presented as the obvious (and only) solution to promoting vaccination and protecting public health. But this is also provoking concerns from across the political spectrum, from anti-vaxxers to labour advocates. Will these mandates end the pandemic, what are the potential pitfalls, and what other mandates are available? More generally, how should we promote vaccination and what kind of mandates will help end the pandemic?
According to the Canadian Labour Congress, “Any decision to impose mandatory vaccination policies must be based on scientific evidence and be made by public health officials, not employers or unions.” It’s true that public health should be based on scientific evidence, but it’s not true that public health officials are neutral arbiters between workers and employers, or that we should put politics aside when we consider public health.
The entire history of public health is political, where officials have often relied on the state to police workers and alleviate the responsibility of employers, and sections of the left have often uncritically supported these policies. But in a society where health outcomes reflect social and economic inequalities, and where the uneven application of policies reinforces these inequalities, we need to centre equity and workers rights in any public health discussion.
The current debate over vaccine mandates and passports is just the latest debate about the latest wave. So it’s worth reviewing the previous waves and the debates they provoked, and draw from those lessons to help inform the current discussion.
First wave: mandate border closures or status for all?
The dominant response to the first wave was it was caused by those who cross borders. The novel coronavirus was first discovered in China, it wasn’t here, so we should just close our borders to stop it from spreading—or so the argument went. But this didn’t work. China’s military quarantine delayed the spread of COVID within China by 3-5 days and internationally by only 2-3 weeks. Trump’s travel ban, first on China and then all of Europe, did nothing to protect public health. And Canada’s travel ban didn’t stop community transmission. As The Lancet medical journal predicted in February 2020,
“Some countries argue that they would rather be safe than sorry. But evidence belies the claim that illegal travel restrictions make countries safer. In the short term, travel restrictions prevent supplies from getting into affected areas, slow down the international public health response, stigmatise entire populations, and disproportionately harm the most vulnerable among us.”
Travel bans were also applied unevenly: while Ontario Finance Minister Rod Phillips could freely vacation, there was spike in xenophobia, conspiracy theories and anti-Chinese racism, and border restrictions that targeted migrant workers. At the same time, other options were ignored. Migrant workers themselves outlined a whole series of effective public health policies, including:
- permanent status on arrival
- health and safety, including workplace inspections and multilingual public health information
- suspend work at COVID-19 farms
- ensure income for all
- make quarantine work for workers
- decent housing
- increase in wages, access to workers compensation and PPE
- public health not policing
These worker-led mandates would have reduced the spread of COVID-19 and helped protect public health. They were also echoed by Canada’s Chief Public Health Officer Theresa Tam: “We need to ensure good pay and conditions for every worker along the food production chain, while also addressing the specific needs of temporary foreign workers.” But governments and employers refused to implement these public health mandates.
Second/third wave: police lockdowns or mandate employer-paid paid sick days?
Because workers rights were not strengthened during the first wave, we had another two waves driven by precarious work. But the dominant response was that it was caused by individual failures to socially distance. So the dominant solution was to impose lockdowns. The lockdowns were very effective for those who were able to safely socially distance and work from home, in wealthy and predominantly white neighbourhoods. But they did nothing for essential workers who were at greatest risk of COVID because of precarious work, and who are disproportionately low-income and racialized.
The lockdown mandates on workers did nothing to stop the worst outbreaks across the country—from farms to long-term care, and from meat processing plants to Amazon factories. But they did trigger anti-lockdown protests, which combined the conspiracy theories of the first wave with the economic anxieties of the larger second and third waves. Some of these lockdown concerns were not without merit—as forcing “stay at home orders” worsened domestic abuse, increased social isolation and accompanied a rise in the opioid epidemic. The policing of lockdowns did nothing to alleviate these problems, and instead was applied in the same way that all policing is applied—disproportionately targeting low-income, Black, Indigenous and racialized communities—which contributed to a resurgence of the Black Lives Matter movement to challenge the pandemic of anti-Black racism that fueled COVID-19 and police violence.
What would have been effective in protecting essential workers and helping people “stay home when sick”, would have been mandates on employers to provide paid sick days for all, mandates on prisons to decarcerate, and mandates on cities to provide affordable housing. This could also have divided the anti-lockdown movement, separating the legitimate economic anxieties from the reactionary conspiracies. But provincial governments refused to mandate employer-paid sick days, police evicted encampments, and prisons continued to incarcerate.
Refusing to mandate paid sick days undermined early vaccination efforts. In February a poll by SEIU healthcare found 81% of healthcare workers want to get vaccinated, but 64% were worried about losing pay in order to get vaccinated and recover from side effects; and 68% would be more likely to get the vaccine if they had PSD.
As physician and researcher Noah Ivers explained, “We have spent months thinking about how to build vaccine confidence. This survey shows us a simple approach: governments can show how convinced they are that the vaccines are safe by saying that any missed work for side effects will covered, by guaranteeing sick pay for those who might have side effects.”
While Ontario Premier Doug Ford got the vaccine and was able to safely isolate with pay after a COVID exposure, he was unwilling to mandate paid sick days for frontline workers. As a consequence, early vaccine rollout showed that it was least accessible in those communities that were at greatest risk: low-income and racialized communities, who are over-policed and under-vaccinated.
The last straw was Ford proposing to further increase police powers to enforce lockdowns, sparking outrage that he would rather police racialized communities than mandate paid sick days or support vaccine equity. The decent work movement created a crisis for Ford, who backtracked and tearfully promised the “best paid sick days in North America.” These few paid sick days (replicated in BC, Manitoba, Ontario and Nova Scotia) have been important in promoting vaccination across the country for those at greatest risk of workplace exposure. And community-led health initiatives have been crucial to promoting vaccine equity and to overcome vaccine hesitancy—which is a legitimate reaction to the long history of medical racism and pharmaceutical profiteering.
So the second and third waves showed that the best way to promote vaccination and protect public health is not by strengthening state powers but by increasing workers rights and expanding community healthcare. These lessons should have been generalized, by mandating employer-paid sick days and expanding community healthcare. Paid sick days are not counterposed to vaccination, they are complementary and both necessary.
While vaccinations are highly effective at reducing COVID mortality, they are not a panacea. There are still breakthrough infectious (though usually much milder thanks to the vaccine) and still the need for paid sick days—for workers to get tested for COVID or to take their children to get tested, to stay home awaiting the results, and to continue to isolate if positive. But just as temporary paid sick days are set to expire, governments are shifting the focus away from mandates on employers and towards mandates and passports for workers.
Fourth wave: mandate vaccine passports or vaccine equity?
Now that there are safe and effective vaccines, the fourth wave is being blamed on those who are not vaccinated, who are all portrayed as reactionary anti-vaxxers. So the dominant solution is to police this stubborn minority through mandates and passports, and by encouraging employers to terminate unvaccinated employees. But why the sense of crisis, and why the need for coercion? Three quarters of the population across Canada has already received one dose and two-thirds have received two doses—all without coercion—and gaps in vaccination have been best addressed through paid sick days and community-led initiatives.
Resorting to government or employer mandates go against these approaches and could actually fuel the anti-vaccine movement, which can now appeal to legitimate concerns about state and employer powers. In response, some are calling to police to crack down on anti-vax protesters, as though the police are the guardians of public health. This creates a dangerous and false dichotomy between civil liberties and public health. As the Pivot Legal society warned about vaccine cards in BC, “sweeping policies that restrict access, however well-intentioned, can have the effect of forcing people into isolation, cutting off their lines of resources, and making their lives even more dangerous during a pandemic.” As with the impact of the earlier lockdowns, they cited concerns about undocumented migrants who don’t have a health card; people experiencing homelessness who don’t have identification; people who use drugs, who have been forcibly isolated during an epidemic of opioid deaths; people who can’t be vaccinated for health reasons; and two-spirit, trans and non-binary people whose government ID perpetuate inaccurate names and genders.
As the CLC has rightly pointed out, the best way to encourage vaccination in the workplace is to centre equity and workers’ rights. Empowering employers does not promote public health and instead entrenches inequities:
“Some workers face challenges in getting time away from work and caregiving obligations. There are also systemic barriers facing low-income workers and those from racialized and equity-seeking groups. Some are hesitant and need education, information and support. Governments and employers have a responsibility to make vaccination as easy and straightforward as possible, including providing workplace and community vaccination clinics, paid vaccination leave and paid sick leave to deal with side effects resulting from vaccinations… Vaccinations must not be an excuse to drop these protections or to download their health and safety responsibilities onto workers’ shoulders.
Unions reject threats of discipline or termination as an approach to increasing vaccination rates. Unions will defend workers’ interests and insist employers respect the terms and conditions of the collective agreement and human rights codes. There are feasible and practical ways to respond to workers who are hesitant or opposed to vaccination. Regular testing, PPE, remote work, leave without pay and proven health and safety protocols are often feasible alternatives to discipline and termination.”
The application of vaccine passports and mandates will also be applied in a highly uneven way. At the global level, the same states pushing mandates for vaccination at home are effectively enforcing mandates against vaccination abroad—by supporting pharmaceutical patents and price gouging. This global vaccine apartheid undermines any vaccine mandate at home by fueling new resistant strains that will undermine current vaccines. As the Director General of the World Health Organization explained, “the longer it takes to vaccinate those most at risk everywhere, the more opportunity we give the virus to mutate and evade vaccines…unless we suppress the virus everywhere, we could end up back at square one.”
At the local level, passports and mandates will also be applied unevenly. Police unions have come out against mandates, but police officers will not be fired for refusing to get vaccinated and there will be no passports restricting their movement. But low-income racialized workers will be subjected to termination/surveillance. These workers are already subjected to unjust termination, and now employers can claim the mantle of public health in carrying out more terminations—which will target the same communities that are disproportionately denied paid sick days and vaccine equity.
As Deena Ladd, executive director of the Workers Action Centre explained, “One of our core demands that we’re fighting for is just cause protection. Right now, under our labour laws, you can be fired for no reason and the employer doesn’t have to give a reason. Who does that fundamentally impact? If you’re looking at workers who are fired for no reason, who are most impacted by low-wages and by precarious work, it’s racialized workers. So the fight for just cause protection is about supporting Black workers, workers who face systemic discrimination.”
The PPC surged in the polls, in part by appealing to concerns about vaccine mandates and passports. But they have done so in order to fuel a racist, anti-migrant, anti-vaccine agenda. They support the racist border controls that failed during the first wave, pay lip service to the economic anxieties of the second and third waves, and have no interest in paid sick days or vaccine equity. We need to reject the PPC and ensure that concerns about vaccine mandates and passports center migrant justice, vaccine equity and workers rights.
Passes or mandates are out of the question, but they should be worker-led. Like smoking bans, the first of which were won by flight attendant unions framing the issue as one of workplace safety, workers could demand customers provide proof of vaccination as part of maintaining a healthy workplace.
Similarly, SEIU Healthcare has fought for paid sick days as well as worker-led vaccine mandates: “Members of SEIU Healthcare have asked their union to fight for safe workplaces. In a recent survey, a vast majority of our union members showed support for mandatory vaccinations as a matter of workplace safety. They told us that vaccinations mean knowing you’re protected and knowing that the person you’re working shoulder to shoulder with is protecting you.” But this is much different than giving employers even more reasons for unjust termination.
We also have to remember that there are plenty of other effective mandates that governments have refused to implement. It’s been almost a year since Dr. Theresa Tam recommended dozens of evidence-based areas for action to address the pandemic through a health equity approach—including protections for temporary foreign workers, paid sick leave, employment security, income and social supports, fair hours and scheduling, accessible childcare, affordable housing, minimum LTC staffing levels, support for survivors of domestic violence, transitions from incarceration to community, accessible transportation, substance use programs and decriminalization of drugs, mental health supports, access to PPE, and safer food systems. Where are the mandates for these?
Public health is about political priorities: do we prioritize border control or migrant justice, police powers or paid sick days, vaccine passports or vaccine equity. We’re four waves into a pandemic fueled by social and economic inequality, but the search for scapegoats continues—from those who cross borders, to those who don’t socially distance, to those who are not vaccinated. This has led to a series of top-down coercive policies—from border closures, to lockdowns, to vaccine passports—that are applied unevenly, have limited effectiveness and further entrench inequalities. But we’ve also seen movements raising effective alternatives—including mandating status for all, mandating employer-paid sick days, and mandating global vaccine equity. These movement-led demands are gaining traction—with a new report showing 86% of people in BC support 10 employer-paid sick days. By centering equity and decent work, we can keep focusing on these mandates, and demand that any others are subordinate to these priorities.
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