Are passports mandates the best way out of the pandemic?

YES Vaccines protect us regardless of setting

The results of the mass vaccine campaign are being seen in the real world. There are six times less cases, 30 times less hospitalizations, and 48 times less ICU stays amongst the vaccinated compared to the unvaccinated in Ontario.

While masks, physical distancing, ventilation, testing and tracing have been important measures in this pandemic, they are affected by error and behaviour. Knowing that transmission occurs prior to onset of symptoms and asymptomatic individuals, many of our other tools have limitations given people may be infectious without knowing.

Vaccines are unique, once administered, they continue to work to protect us regardless of the time and setting. The safety of vaccines is well established, with nearly 5.7 billion doses of vaccines given globally.

Vaccinated individuals represent a small percentage of all cases, and hence, using vaccine mandates essentially integrate the lowest risk individuals in a single setting, thereby reducing the probability of encountering an infectious case.

Despite evidence noting viral loads at peak may be similar amongst breakthrough vaccinated and unvaccinated (the Provincetown study), data globally suggests overall lower viral loads, a shorter duration of infectivity, and lower levels of cultivatable virus in breakthrough cases — all of which suggest vaccinated individuals transmit less efficiently even if infected.

This is the rationale for vaccine mandates and certification systems, particularly in high-risk settings, to reduce the probability of an infectious individual entering and transmitting.

In health-care environments, vaccine mandates are paramount. These settings use other controls to reduce spread, but the reality is distancing is often unachievable, some patients cannot tolerate masking, and health-care needs to remain open without obstructions.

Adding to this, while many patients are vaccinated, caring for vulnerable patients — such asthose who cannot be vaccinated (particularly children) and those with COVID-19 — adds to the urgency of using all tools available.

Clearly, mandates here ensure safety in patient care. This also extends into areas of high vulnerability for outbreaks or high contact to unvaccinated groups, such as shelters, educational settings and high-risk workplaces.

The use of vaccine certificates in highrisk non-essential settings is also justified through this principle. Establishments such as restaurants, bars, gyms and theatres, when masks are down and there is movement, create environments where optimal control measures cannot be used for optimal protection.

These environments deserve the right to operate during this phase of the pandemic. However, these are also environments where spread has occurred. Mandatory vaccines within these settings lower the risk of an infected individual being inside, offering optimal protection against outbreaks and closures.

The justification for vaccine mandates and certificates in these settings is from a safety standpoint alone, in reducing the infectious burden risk in a world where health-care utilization remains a potential threat, as we witnessed in Alberta.

Many countries have also integrated negative testing or recent recovery from COVID-19 as alternatives to vaccination, and they should also be considered. Benchmarks on when to release these measures, when health-care utilization is not overwhelmed and protection is offered to all levels, is important for transparency.

Equity needs to be established into settings into ensuring no mandates are imposed on essential settings, such as retail, grocery, pharmacy and individual health care,where other mitigations can greatly reduce the risk of infection.

While one of the positive spinoffs of an increased vaccine uptake, it does not replace the efforts to combat vaccine hesitancy, misinformation and access in undervaccinated communities where passports may not move the needle.

Ultimately, navigating the Delta variant, in the context of maintaining an open economy and functioning healthcare and education sectors requires us to use all tools available. While the virus is more dangerous than 2020, the rollout of vaccines has also mitigated risk significantly.

Vaccine mandates and passports provide a solution to mitigate spread in this phase of the pandemic and should be deployed in settings as part of a mitigation tool to reduce the risks of lockdowns and maintaining some degree of normalcy.