COVID-19 Vaccinations Have Become Quasi-Mandatory

21/11/2021

By Darius Lee, I on Singapore, A blog on Singapore current affairs 新加坡时事博客

On 20 November 2021, one day short of the end of the "Stabilisation Phase", the Singapore Government has announced a new slew of measures as Singapore moves to a "Transition Phase".

Among the measures are the extension of Vaccination-Differentiated Safe Management Measures (VDS), for the stated reason "to protect the unvaccinated from getting infected and becoming severely ill".

While the increase of number of household visitors (from 2 to 5 per day) will apply to the vaccinated and unvaccinated alike, the unvaccinated will not be able to dine in at food and beverage establishments. This is on top of the earlier ban of unvaccinated individuals from shopping malls, attractions, as well as hawker centres and coffee shops.

VDS measures have also been extended to more settings and activities, including in all Libraries under the National Library Board (NLB), and selected activities in community clubs/centres under People's Association (PA).

Additionally, there is the removal of the "VDS concession" for "voluntarily unvaccinated individuals". The Ministry of Health (MOH) press release states:

12. We will further strengthen efforts to protect unvaccinated individuals from getting infected, as they are subject to greater risks of severe illness. Under current rules, unvaccinated individuals can get a PET and show a negative test result to enter a VDS setting. We will remove this concession for unvaccinated individuals to perform PET in lieu of being fully vaccinated. Hence, only fully vaccinated, recovered, or medically ineligible individuals, or children aged 12 years and below (subject to venue/event-specific caps) will be allowed to enter settings where VDS is implemented . We will effect this on 1 January 2022, to allow time for more individuals to complete their primary series vaccination regime.
[Emphasis in original]

This appears to be the first time that pre-event testing (PET) as an alternative to vaccination for dining in has been described as a "concession". In a Facebook post on 11 August, Health Minister Ong Ye Kung had said in a Q&A:

1. If I cannot take the vaccine, how can I join my family for meals at restaurants?
Take a PET (pre-event test) at an MOH approved test provider <go.gov.sg/swabproviders>. It costs about $20, valid for 24 hours. But that merely shows you are not likely to have the virus. It does not protect you from being infected. So please be careful. 

On the other hand, the VDS measures do not apply to medically ineligible patients/residents and visitors, on the basis of a "concession" granted by the Government.

With the latest slew of measures, an eligible but unvaccinated person (or "voluntarily unvaccinated" person) is effectively subject to numerous restrictions, all for the ostensible reason of "protecting" him or her "from getting infected and becoming severely ill". Conversely, those who are medically ineligible for COVID-19 vaccinations are given a wide exemption. As such, COVID-19 vaccinations have become quasi-mandatory, even though there is no fine or jail term attached.

Protection or Pressure?

The Government has maintained that the purpose of the VDS measures is to "protect the unvaccinated", although this position has shifted over time. Dominic Chan has discerned four distinct reasons given by the Government in different statements over the course of time.
In a statement in Parliament on 14 September 2021, Health Minister Ong Ye Kung said:

We are now one of the most highly-vaccinated countries in the world, partly due to the various measures we have taken, including setting up mobile vaccination teams, home vaccination teams and enabling walk-in vaccinations. 

However, for various reasons, there remains a minority of individuals who are unvaccinated. As we transit into a COVID-19-resilient nation, more economic and social activities will resume, which means these individuals are at higher risk of being exposed to the virus and falling severely ill. Hence, it will be more prudent for them not to take part in higher risk activities, such as big events and dining in restaurants in the company of other persons. However, if they really wish to, they can take a pre-event test before participating in these higher-risk activities.

For now, the differentiated measures are necessary to keep unvaccinated individuals and vulnerable people in our community safe. As we achieve a very high level of vaccination, reaching or approximating herd immunity, it is possible to remove the differentiated measures.

In the meantime, it is important to continue to explain that these are public health measures to protect unvaccinated individuals and not let the policy be mistaken or misrepresented as discriminatory.

If the goal of "protecting the unvaccinated" is true, the most puzzling aspect of VDS measures is the differential treatment given to these two groups of people: (1) those who are eligible but voluntarily unvaccinated, and (2) those who are medically ineligible for vaccinations.

Indeed, the medically ineligible are consistently exempted from VDS, whereas the voluntarily unvaccinated are consistently affected by VDS.

This apparent public health goal is even more puzzling once we consider the removal of PET as an option (including for both the voluntarily unvaccinated and medically ineligible persons). It would seem that the medically ineligible are unnecessarily exposed to exceptional risk as a result.

The goal of "protecting the unvaccinated" is also questionable in light of MOH's own statements. As MOH stated in its press release dated 8 November 2021: "We are taking a stronger stance against those who choose not to be vaccinated, be it through the VDS, or by requiring them to pay for their medical bills." [Emphasis added]

These statements, coupled with the very real consequences of VDS measures, leaves one with a strong sense that the real intention behind these measures is to exert pressure upon people to take the COVID-19 vaccine. However, it falls short of being directly mandatory, since there is no fine or jail term imposed for refusing to take the vaccine.

Government's Position on Mandatory Vaccination

The Government has thus far refrained from making COVID-19 vaccination mandatory, even though it has not ruled out the option. In December 2020, Prime Minister Lee Hsien Loong announced that the Government accepted the expert committee's recommendation to make vaccinations voluntary.

On 1 November 2021, Senior Minister of State for Health Dr Janil Puthucheary stated the Government's views on mandatory vaccination: 

Sir, making COVID-19 vaccination compulsory is a significant move. It should be carefully considered. We would have to consider a number of factors: vaccination coverage, international practice and the availability or performance of fully registered COVID-19 vaccines.

The introduction of the vaccination-differentiated measures, in a way, is to try and get around some of that problem, to expose the different segments of the population to different risks. But in terms of making vaccination compulsory, it is also quite difficult in terms of the execution.

You can imagine that for something like childhood vaccines, you may say that without it, you cannot have access to play groups or certain school. There is a specific thing that you want to do and for that, you are getting the vaccine. But here, we are talking about all the normal activities of life and so policing it, executing it, implementing it is not without challenges. And the question is, how much benefit will there be?

So, I think it is something to consider but there are a whole lot of complications associated with that. 

Health Minister Ong Ye Kung reiterated this position on 3 November 2021.

These statements leave more questions than answers as to the true purpose of the VDS measures. 

Going Too Far?

In an insightful article on vaccine mandates, Wesley J. Smith identified three distinct vaccine "tribes". The first is the pro-vaccine/pro-mandate "tribe", which has taken the jab and insists that everyone else be inoculated too. The second is the anti-vaccine/anti-mandate "tribe", which refuses to be inoculated and plans to resist all mandates.

Smith regards himself as falling into a third "tribe", the "the pro-vaccine/anti-mandate middle-grounders". This is my position on the matter.

I have received the COVID-19 vaccine (Moderna), and strongly encourage people to be vaccinated against COVID-19. COVID-19 is an unprecedented crisis and global pandemic. I agree with the public health authorities in Singapore that the benefits of COVID-19 vaccination outweigh the risks, and the vaccines are an important tool in fighting against the COVID-19 pandemic.

Nevertheless, in a previous post, I argued that COVID-19 vaccines should not be made mandatory, and that vaccination against COVID-19 should remain voluntary. The thrust of my reasoning is focused on a value judgment and a deeper concern about the damage to valuable trust and social capital in society. My arguments have been set out in the previous post, and I will not repeat them here.

As Smith wrote in his article:

Much like viruses, authoritarianism can spread. In free societies, significant interference with civil liberties is justified only by urgent need-and then should be done in the least intrusive way practicable. A COVID vaccine mandate simply does not pass that test-especially with COVID testing readily available. Indeed, a reasonable compromise to mandates would give people a choice: Either prove you are inoculated and/or have COVID antibodies from a prior infection, or receive regular tests. This would be a far less intrusive regulation, but would still offer significant public health benefits.

I agree. I had drawn attention to the concentration of power in the Government due to the COVID-19 pandemic in my 2020 article published in the Singapore Journal of Legal Studies. These recent steps reinforce that concern.

The differential treatment between those who are eligible but voluntarily unvaccinated, and those who are medically ineligible for vaccinations, is incomprehensible if the goal is truly "to protect the unvaccinated from getting infected and becoming severely ill". The removal of the PET option as an alternative to vaccination in VDS measures is also problematic; it does not serve the goal of protecting those who are medically ineligible for vaccinations. These are a step too far.