What happens if people don't want to take the COVID-19 vaccine?

The recently approved Pfizer COVID-19 vaccine is expected to start rolling out across Canada in the coming weeks, following the lead of the UK. And though a large percentage of Canadians anxiously awaits a chance to get inoculated, there will be many who feel hesitant, especially during the first round of roll outs.

While most public health systems in Canada take an encouraging and educational approach to vaccination, there are currently no mandatory requirements to get the shot. Still, in order to develop herd immunity to the virus, health experts say 70 per cent of the population will need to be vaccinated. That is factoring in the percentage of people who don’t respond to the vaccine. The first round of vaccines that are coming to Canada have a 95 per cent effectiveness rate.

A lot can be learned as other countries around the world begin their immunization efforts, says Noni MacDonald, a processor in the Department of Pediatrics at Dalhousie University.

“We all learn as countries roll out vaccines and numbers accumulate,” she says. “We’ll see safety as well as effectiveness in real world settings and give time for more study results to come out.”

It’s still not clear when restrictions will be lifted and life will return to normal, though that’s likely a while away. Since the vaccine was only first approved two months ago, more will be known over time about how long immunization lasts. Similar to the flu shot, the COVID-19 vaccine will likely need to be taken on a yearly basis.

“We’re not going to eradicate this virus,” says Tania Bubela, a professor and dean with the faculty of Health Sciences at Simon Fraser University. “It’ll be part of the seasonal viruses that cycle through the human population.”

She adds that any pandemic will wear itself out over time as people develop immunity.

“The reason (COVID-19 is) so severe is because no one’s immune so it’s going to sweep through unless you take public health precautions,” she says. “You want to make sure that enough people in the population are immune to the coronavirus strain that’s circulating at any time.”

Consequences of not getting vaccinated

Once COVID-19 vaccination is widespread, those who choose not to take it could face consequences when it comes to travel. Several countries, like Brazil and Kenya, require visitors to be vaccinated for Yellow Fever, for example. It’s possible similar restrictions could apply with COVID-19, says MacDonald.

“It might well happen that countries want to limit the potential risk of COVID-infected people coming in by requiring evidence of COVID vaccination,” she says.

On Tuesday, Ontario’s Deputy Premier and Minister of Health Christine Elliott said that the province would be issuing proof-of-vaccination cards.

“That will be very important for people to have, for travel purposes and perhaps work purposes or going to theatres or cinemas or any other places where people will be in close physical contact when we get through the worst of the pandemic,” Elliott said during a press conference.

Since the delivery of vaccines will be managed on a provincial basis, the consequences of not getting vaccinated will vary depending on the jurisdiction.

The rollout will likely be a complicated process, with two shots needed for some of the vaccines, and potential issues with global supply chains.

“Some patience will be required,” Bubela says. “It will continue to be a difficult winter through spring, with care needed to comply with basic public health measures. However, there is definitely light at the end of the tunnel.”

While the vaccine will help people feel protected, the health precautions adopted during the pandemic such as hand washing, social distancing and wearing a mask will likely stick around indefinitely.

“The main person at risk is the person not getting the vaccine,” says Bubela. “The best thing to do to protect yourself from those who aren’t getting vaccinated is to get vaccinated and to follow the public health measures.”

Healthcare workers not obligated to get the vaccine

Bubela says most likely that health care workers and those in long-term care will be first in line, which will benefit healthcare services more broadly. Some regions are planning on also focusing on remote communities due to the pressure on healthcare services.

“I would expect that some essential sectors would be next in line, although, the prioritization may be some combination of essential workers and age categories,” she says. “Essential workers could include first responders, those working in institutions, the education sector, work-camps, transit, agricultural work, meat-packing plants, grocery stores and deliveries. The list is long.”

When it comes to frontline workers, most unions representing doctors and nurses say they’ll encourage their members to get the shot, just as they do with other vaccines.

“Like every other Canadian, health care workers will not be mandated to get the vaccine,” says Linda Silas, the president of the Canadian Federation of Nurses Unions. “But every healthcare organization, including nurses unions across Canada, will be promoting the vaccine.”

Bubela stresses that the public rollout of vaccinating Canadians will be complex process. Our knowledge of the vaccine and its impact will continue to shift, which means our understanding will improve and recommendations will change over time.

“What we want the population to know is that that is normal,” she says. “Changing messaging in line with the best new evidence is a normal process as we know more. It’s not a show of weakness. It’s not that the public health agencies don’t know what they’re doing, it’s just that they’re learning as they go.”