Anti-vaccine positions have been gaining visibility in the face of the impulse that states are giving to vaccination as a strategy and public policy to stop the advance of the pandemic generated by COVID-19. To this end, some countries and states within federated countries are taking more drastic measures to boost vaccination and contain those who do not wish to be vaccinated, so that they do not endanger other citizens.
In this sense, the Peruvian Executive published Supreme Decree (DS) 168-2021-PCM, which in its articles 14.5 to 14.8 indicates the obligation to present the Covid-19 vaccination card to carry out certain economic and transportation activities, as well as to have access to enclosed public places, which was criticized and described as an unconstitutional measure by Congressman Alejandro Muñante, alternate spokesman of the Renovación Popular party.
In Ana Neyra's opinion, Professor of Law at Universidad del Pacífico (UP), the aforementioned articles of the above-mentioned SD could not be considered unconstitutional, except for some specific exceptions.
"The purpose behind these measures is the right to public health, which has a constitutional basis in article 7 of the Constitution, so it has legitimacy. Although some people argue against it, I believe that the measure allows achieving the purpose without excessively affecting other rights, because it is not about forcing vaccination, but about generating incentives for people to get vaccinated, by making interprovincial transportation and access to enclosed places conditional on full vaccination. It is important to identify this purpose, especially since vaccination does not prevent the transmission of the disease. I think that the effect on free transit or the free development of personality, although restricted, are not so restricted as to justify the non-fulfillment of the right to public health," Neyra pointed out.
However, with regard to the restrictions related to labor, specifically article 14.7, which indicates that as of December 15, any company with more than ten workers may only operate in person if all its workers accredit their full vaccination dose, could be the most debatable, since unlike the interprovincial travel or the entry to public spaces, in this case a relevant right such as the right to work is at stake.
"In that sense, I believe that limiting the right to work could be the most questioned. Nevertheless, it is also true that it could be justified, but again, only as an incentive because transmission can occur between vaccinated and non-vaccinated. And in order to achieve the level of vaccination that will allow a return to normality. In any case, although they have a strong impact, I would think that, ultimately, they are justified by a public health issue," she said.
On the one hand, just as there are those who question vaccination and its obligatory nature for certain activities in public spaces or economic activities, on the other hand, the question arises as to whether the decision not to be vaccinated is ethically correct. For Alonso Villarán, professor of Ethics at UP, this issue can be analyzed from several perspectives, so he proposes to analyze it from the perspective of virtue ethics.
Villarán explains that, according to Aristotle, virtues are ways of being that allow us to live rationally and thus achieve our supreme good: flourishing or happiness. According to the philosopher, these virtues regulate the way we act and feel. There are several, but there are four cardinal ones: moderation, courage, justice and prudence. In addition, they are located in the middle of two vices: one by excess and the other by deficiency. For example, bravery regulates fear and is in the midst of cowardice (excessive fear) and recklessness (very little fear).
"The pandemic has put our virtues to the test: courage, for example. As in a theatre in which we are also actors, we have seen courageous, cowardly and reckless characters. Courageous, for example, have been all the "essential" workers, such as those in the Health sector. Risking their lives, they did not leave their post. Cowardly, on the other hand, were the politicians who rushed to get vaccinated on the sly when it was not yet their turn. Finally, reckless were those who refused to wear masks and, today, those who refuse to be vaccinated when the effectiveness of the vaccine has been proven. Let us seek, then, the golden mean of virtue. And not only in terms of COVID-19 and courage," he reflected.
Health and safety
Currently, the pandemic generated by COVID–19 has intensified in countries of Central and Eastern Europe, mainly due to stagnation and low vaccination rate. In this context, governments such as Germany, Belgium and Austria have tightened their policies to avoid contagion through border closures, general and targeted quarantines, as well as the promotion of vaccination campaigns through the requirement of a proof card for access to some public services and work activities. A further aggravating factor is the recent discovery of the Omicron variant, which has led to the restriction of flights from southern Africa, where vaccination rates do not reach 20% of the population, according to the BBC.
"The increase in COVID-19 cases may be due to two reasons: new variants or an increase in viral load, this associated with a decrease in biosecurity measures. Let us remember that, although the vaccination rate in Europe has optimal levels, the opening of borders, control of capacity and use of personal protective equipment have been much laxer measures than those taken in Peru," said Paula Ponce de León, physician and professor at Pacifico Business School.
In this sense, she reiterated that the vaccine does not eliminate the contagion or transmission of the virus. So far, only the reduction of symptoms and severity has been demonstrated, so the request for a vaccination card is presented as a health control measure since it reduces the risk of transmission of the disease and the risk of contagion in enclosed places; and allows for economic and labor reactivation.
"In Peru, the sanitary control measures that will be in force as of December 15, seek to promote economic reactivation, allow the return to work and increase the number of people in enclosed places. This measure will provide greater security, but does not replace hand washing, social distancing and the use of face masks", emphasized Ponce de León.
Regarding the efficacy of vaccines, she explained that the evidence in the world determines that 90% of seriously hospitalized patients are non-vaccinated or have incomplete vaccinations.
"It is important to consider that, in Peru, we had 773 new cases on November 22 and if we consider that the average of the last 7 days is 1,392, we could estimate a decrease. Although the figures may be encouraging, it is important to consider that the decrease in new cases is not related to the increase in the transmission rate, so it is of utmost importance to continue with all safety measures," she said.
However, the emergence of the new Omicron variant could lead to a major setback in the global struggle to overcome the pandemic.
The evidence in favor of public policies
According to Alexandra Ames, head of the Public Policy Observatory of the UP School of Public Management, in the conference "
Evidencia como fundamento de mejores políticas públicas" ("Evidence as a foundation for better public policies"), organized within the framework of the Evidence Week 2021 by the School of Public Management and the UP Research Center, there is a part of the vaccination process - as public policy - that is not under the control of public servants and where the user's response, the citizen's decision making about the health services provided, is involved, the citizen's decision making on the health services provided, which when not taken into account, often leads to an undesired outcome of the public policy: a level of vaccination that reaches herd immunity.
In this sense, she pointed out that the evidence generated by academia, in reference to the study “Hay vacunas, pero ¿me vacunaría? Propuestas para superar la reticencia a vacunarse contra el COVID-19 en el Perú” ("There are vaccines, but would I get vaccinated? Proposals to overcome the reluctance to get vaccinated against COVID-19 in Peru"), can be used as an additional piece to push a domino effect in the vaccination process in order to adequately design strategies with the users in mind, such as providing information to generate confidence in the process and, especially, to counteract the myths and fakenews created around vaccination, particularly around the Sinopharm vaccine.
"When the public servant uses this information produced by the academy, this virtuous circle is generated, which allows the expected effectiveness to be generated, but at the same time reinforces or begins to generate this knowledge management that is beginning to be institutionalized in the organizations. When decisions are already being made based on evidence, not on intuition, this culture begins to be generated based on data, information and the perspective of the user who receives this service, and this state capacity that we all talk about and say is needed is generated, which in turn translates into greater generation of trust and reinforcement of this social pact that we all want to see strengthened," she emphasized.