18 Feb 2022

Immunologist on health reasons for vaccine mandates

From Checkpoint, 5:42 pm on 18 February 2022

Immunisation Advisory Centre medical advisor Peter McIntyre has told Checkpoint there has been "mandate creep" in schools where children are not mandated to be vaccinated against Covid-19, but are being banned from sports and other extracurricular activities if they are not.

With so many of us vaccinated, is there a medical or health justification to continue with mandates? 

"I think it's obviously a very different situation to the situation we were facing at the end of last year, so Delta was nasty, Delta or infectious and we had much lower vaccination coverage," McIntyre said.

"I think experience around the world has shown that mandates have had that nudge factor of getting [rates] up from a sort of 80 and 85 percent to the 95 percent, which is a fantastic place to be," he said.

"And so New Zealand is confronting a situation now without Delta ... with Omicron and with incredibly high coverage, particularly in the over 50s, which is where it's really, really important ... so I think it is a different landscape. Omicron is a different beast and even with three doses, we don't get as good protection against infection and transmission with Omicron as with Delta and it drops off.

"So I think the argument for [vaccine mandates] was two-fold. It was let's protect the New Zealand health system against severe disease, intensive care admissions, and so on at the individual level and it was let's protect the community by reducing transmission and infection at the broad level. And I think that second one is just much less something we can do with Omicron and we know we're in a fantastic position with the first one, but I think the game has shifted."

Are you suggesting there's some wiggle room in these mandates? Close to 2000 cases today, and only 73 people in hospital and one person in ICU. So there is not a scenario where the health system is overrun, as you've just pointed out, and there are high levels of vaccination rates. So could we adjust these mandates somehow?

"I would say there's probably a three-tier mandate. So the hairy shirt level is employment and losing your job, the next level down is the irritation level of not being able to do stuff you want to do, and then the third level down, which I think to be perfectly honest probably shouldn't have been there in the first place, is a kind of mandate creep where we've been trying to really encourage secondary school students in that 12 to 17 year old age group to step up and get their doses which they have," McIntyre said.

"But schools have overinterpreted that and are imposing all these unnecessary restrictions on kids in that age group, not being able to play sport, not being able to go and participate in school activities, and it's all because of their parents’ decisions which they are being punished for," he said.

"And let's face it, you know, even if they are vaccinated, they are mixing with a whole group of other kids who are very low risk and they're incredibly low risk now they've had their two doses, so I think particularly that third group, the kind of mandate that should never have been there in the first place, so I think that's really an important one to tackle first."

In your view, should unvaccinated children be able to participate in those school events based on what you know about health and medical conditions?

"I think the health risk is now down to incredibly low levels. I mean, I recognise that there will be occasional children in schools who have severe immune problems and may not have been as well protected against the [virus], and that's something which I guess schools have to be aware of and parents have to be aware of in that situation. But even recognising that, I think it's not justified in terms of the really low risk across the board, to be punishing kids for the decisions of their parents," McIntyre said.

What about universities then? Is there a health justification for mandates there? 

"I think that's been part of the whole nudge push last year and again something that we were all worried about was that we'd never get the 20 year olds over the line with high coverage, but that's happened," McIntyre said.

"And so I think again, probably the mandates may have served their purpose with incredibly high uptake amongst that young adult, university student group. But is it justified to say 'you have got to have a booster as well, otherwise you can't come to lectures?' On a health basis, I don't believe it is [justified]."

So from a health perspective, is it time then to review 'no jab, no job' mandates? 

"Well, I'm sure the government is doing that because the prime minister already said that she was reluctant to go down that path. She did it because she had to and I think that was the right decision and I'm sure government is aware that it's something that can't be in place forever," McIntyre said.

"There's still a lot of caution and concern about where's Omicron going, people are nervous, they're not used to this, so I think we have to recognise that and government has to obviously take that into account, but I think something that could be done very relatively quickly is just getting rid of those restrictions on the secondary school students, which I think as I said is a really unfair imposition on them.

"And then the nudge factor in terms of ‘you can't go to a restaurant, you can't go to an event’, I think how that operates could be reviewed and let's face it, if you haven't responded to it now, you're probably not going to." 

Potentially you are saying that the Covid-19 vaccine pass requirement to go to a concert or go to a cafe, that could be reviewed on health grounds?

"Potentially, I think when we get a bit more vision of what's happening with the outbreak and a bit more confidence that that is something that would merit revision," McIntyre said.

"We've still got something like 60,000 adults who haven't had even their first dose. And as a percentage, it’s very small and they're scattered around the country, but they're the people who intensive care units could be seeing wheeled-in and they don't want to see them wheeled in...  so once we've got Novavax available, there's three vaccines to choose from, I think it would be fantastic to get as many of that group over the line as we can as well."