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Are punitive measures on unvaccinated people against covid effective?

European countries are implementing anti-covid strategies in the unvaccinated population. Austria will make vaccination mandatory after extending its confinement targeting the unvaccinated to the entire population. In Germany, the unimmunized have restricted access to restaurants and hotels, and must show a negative test on public transport. Slovakia has also imposed restrictions on those who have chosen not to be vaccinated. Sweden will introduce a covid passport at events of more than 100 people. What is the effect of these policies?

19/11/2021 - 14:09 CET
Punitive measures

A sign informs about mobility restrictions due to covid-19 in Scharnitz, Austria. EFE/EPA/PHILIPP GUELLAND

Does it make epidemiological sense?

For epidemiologist Pedro Gullón, the success of these measures in containing the infection depends on the age distribution and the activities being prevented. "If you are vaccinating by age groups, you have few vaccinated people and you decide to prohibit unvaccinated people from entering, for example, nightlife venues, you are de facto closing these places".

He considers that in that case "you can cut off transmission if it is occurring there." On the other hand, if the distribution of those vaccinated and the activities they carry out is more heterogeneous, the effect would be less. That is why he believes that these measures would work better if they serve to "subtly" shut down certain activities at times of high transmission.

Would it make sense in countries with as many vaccinated people as Spain?

With almost 90% of the target population vaccinated in Spain, would it be necessary to apply this type of measure when the next wave arrives? Gullón believes that "restricting activities to 10 % of the population when 90 % of the population is doing them has little impact".

He clarifies that the impact is not non-existent: "We have seen that vaccines do reduce transmission and in relative terms the unvaccinated infect and become more infected, so you would be preventing part of the transmission and even some supercontagious event". However, he reminds us that "that 90% can still be contagious, even if it is less".

Will it convince the unvaccinated?

"We know that punitive measures cause trust in institutions to decrease, which is not good data," says sociologist at the Complutense University of Madrid (UCM) Celia Diaz.

"Given that a large part of the non-vaccinated have opposed it so far, I sense that it will radicalize them even more," fears sociologist Igor Sádaba of the Complutense University of Madrid. "It is expected to generate resistance and greater activism."

Given that a large part of the non-vaccinated have opposed it so far, I sense that it will radicalize them even more

Igor Sádaba, UCM sociologist

He adds that these movements are an "amalgam" that includes naturalist, extreme right-wing, conspiracy groups and also people who are reticent about the new drugs. "This will make their reaction uneven, but the more active and political sector will be a little more radicalized." In any case, he does not fear that this will be the case in Spain, where they are "very minority positions that have not achieved massive mobilizations" as in France, Austria, Belgium, the United States, Poland, New Zealand and Holland.

Gullón thinks that in countries with few vaccinated people these measures can stimulate vaccination "if the non-vaccinated sectors are not very reticent". He does not believe that this is the case in Spain, where there is a 10% of people who "are difficult to reach" and "have already been offered the vaccine repeatedly". In that case, he also fears that these situations "reinforce their own subjectivities".

Will it create a social divide?

Diaz thinks that these measures could "accelerate conflicts between vaccinated and unvaccinated", but also that we must try to ensure that vaccinated people can "benefit" from the fact that they have been vaccinated. "Otherwise, conflicts may be greater if they blame the reluctant for their restrictions."

Aarhus University (Denmark) researcher Michael Bang agrees that "a long period of restrictions for the vaccinated majority will decrease their confidence." On the contrary, he explains that "fatigue facilitates radicalization" and that selective restrictions will reinforce distrust among the unvaccinated.

It is important not to fall into the criminalization of those who do not vaccinate because it can lead to many risk situations

Celia Díaz, UCM sociologist

"It is important not to fall into the criminalization of those who do not vaccinate because it can lead to many risk situations," comments Díaz.

Sádaba explains that these dynamics will depend on the percentage that each group represents in the population and on the attitude of those vaccinated. "If they begin to discriminate and distance themselves from the unvaccinated and generate stigmas and segregation, new stratifications or medical social classes could be generated if regulations are implemented that act in a differential way."

In that case "there will not only be social isolation, but also criminal persecution". However, he warns that this will be more noticeable in countries with lower vaccination rates and that it will depend on the epidemiological situation. It will also depend on the political context, as some countries have even proposed making covid-19 vaccination mandatory.

"At the moment, in the vaccinated population we have not seen this [discriminatory] attitude and the most belligerent movement is the anti-vaccine one," he reassures, although he warns that there is no conclusive data and there is room for speculation due to the uncertainty.

Bang does fear that "the social conflict will increase in the coming months between the vaccinated and the antivaccine" and he considers it unlikely that the dynamics of "moralization", which he has studied in the context of the pandemic, will work among these already established groups.

How to convince the unvaccinated?

Díaz and Sádaba say that it is necessary to try to understand the causes of vaccine reluctance. The sociologist gives as an example the case of Romania, where only 36% of the population is vaccinated: "There seems to be a deep-rooted distrust of institutions in general and health institutions in particular, and many sectors believe that vaccines are bad for health".

For Díaz, the strategy involves developing outreach campaigns with the evidence we already have. "The available vaccines have proven to be more effective than expected and there is enough data on side effects to eliminate fears about their novelty. We should also remember how harmful confinements and school closures are, which we can avoid thanks to vaccines."

Diaz adds that if infection rates lead to the imposition of punitive measures, "it should be done from clear ethical principles, highlighting and reinforcing solidarity". For example, "we should highlight the protection factor for loved ones and the vulnerable and point out the success stories that already exist".

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