The Greenpass and misuse of the Precautionary Principle

The EU is currently working on Greenpass for EU States

“17 million people across Europe have received the vaccine and there were only 15 events of thrombosis and 22 of pulmonary embolism. This is in total 0.00021% – almost less than one in 480,000 people, which is like for the whole population of Malta there may be one person.”

This pass will show that the person is vaccinated or has immune status for travel. This is a reasonable request and supported by WHO. It is strange how the Council of Europe saw this as a threat to basic human rights, which will limit freedom of travel. If anything, it is the EU which should be concerned, rightly so it is not, as it is the safe and sound way to go during this pandemic. Even in a postpandemic period this should hold true for if we have learned anything, it is the speed with which a virus can travel. Locally we saw how from a complete freedom from the virus before it arrived in Malta, we allowed it to come in by not closing down our border immediately.

But we must now look forward. Madrid has relaxed its lock-down measures and tourism has increased. Now bioethics is not about tourism, one may say – but this is far from the truth, for health depends on the economy and to strike the right balance is not easy. What we need in Malta is to immediately introduce the possession of a vaccination certificate or a swab test done 48 to 72 hours before departure. Some also say that those who have recovered from Covid-19, thus having immunity, ought to be allowed. The third may not be as useful as we imagine due to variants – we simply do not know if they can get it again and thus be carriers. To be sure, even if one is vaccinated, we do not know whether these people can still be carriers. Introducing the first two measures, immediately would give Malta the time to reassure potential tourists and business travellers that Malta is a safe place. The results ought to show this. It will help us recover.

As regards to herd immunity, by summer we may have achieved the 70% mark if things go well. We do not know, to be sure, what percentage is needed for herd immunity. A herd immunity of 95% is needed for the Measles virus, for example, which is why public health authorities make it obligatory. Indeed, should the herd immunity be higher, it will be morally feasible to make the vaccine obligatory. Unfortunately, the media hype and scaremongering going around may not allow that.

What I would also suggest is that the Chief of Public Health restarts the daily updates as the people were reassured considerably when this was done. Once or twice a week is not enough. We are seeing not only a daily development but new issues continuously on the rise – such as the recent concern about the Oxford/AstraZeneca.

Militating against some form of recovery by summer is the fact that many EU States were suspending the Astra-Zeneca jabs without any data based on any regulatory division. This will also certainly delay reaching the herd immunity we need. It is inevitable that there may be serious side-effects (in this case blood clots) when so many vaccines are being dished out. It is normal for many vaccines and one cannot say whether this did not happen because of the vaccine until one gets the results of the investigation. Moreover, the pity is that many will now be afraid of it. The damage may already have been done and if this happens one cannot, under the current circumstances, contemplate conspiracy theories (not that I am a fan) given the competition that may exist between companies or the fact that this is a British vaccine, there were legal issues around agreed-upon numbers and perhaps even a getting-back, as rumour has it, at Brexit. The fact that Germany has joined the countries does not help. One cannot even compare it to the Pfizer vaccine since this was given to a different category of the population.

Some would say they invoked the Precautionary Principle. Well, one would ask, why did we not invoke this principle in the first place and closed down all EU borders and admonishing against travel to and from China? Indeed, China may prudently have chosen to close down its borders. The WHO may have failed in this regard, even though in hindsight we cannot make judgement; everyone saw as alarming, back in November 2018, when China decided to build a hospital in one week! The fact is that using the precautionary principle is feeble and even “dark”, since the benefits of the vaccine clearly outweigh the risks – these countries attesting a “precautionary principle” are putting more lives at risk.

It is an ethical outrage that the drug is even being investigated. Drugs are investigated not to appease public or politicians but when there are scientific foundations to do so. This certainly does not line up with the Precautionary Principle where, albeit one does not have to wait for hard evidence, it can be invoked when the numbers are indicating it. British media quotes Michael Head, a research fellow in Global Health, as saying on CNN that pausing a vaccine campaign during a pandemic, without a very good reason, is simply a bad move and does not make much sense. He acknowledges that the AstraZeneca vaccine has been a political football and that from a scientific point of view it was unedifying to watch – take for example the unwarranted concerns of its efficacy on older people, the anger for the company not being able to deliver the amount required, the blocking of shipments leaving the continent and now the halting of rollouts and none of this coming from Science itself. The Health Care Regulatory Agency in the UK, while still reviewing the claims, said that the frequency of the blood clots does not exceed the number which occurs naturally and the evidence suggests it is not the cause. Yet, up to the time of writing this column, the number of countries continues to increase, which reminds me of the old Maltese proverb InNaghag ta’ Bendu.

We are going beyond the standard practice for safety monitoring of licensed medicines in reporting vaccine events to ensure public safety. Prof. Anthony Serracino Inglott was right to come out immediately and reassure the public. 17 million people across Europe have received the vaccine and there were only 15 events of thrombosis and 22 of pulmonary embolism. This is in total 0.00021% – almost less than one in 480,000 people, which is like for the whole population of Malta there may be one person. If we had to go by the political-oft-used “even for one person”, we may as well close down Mater Dei and all of our health care system. It has been estimated that given the normal number of people who die every year with these conditions, we should be expecting 320 cases per week!

While the health-of-the-public (HoP) is part of public health, public health in its nature, inherently does not look at individual cases but at populations (hence “public”) and is thus more utilitarian in nature. It intervenes in diabetes, for example, when diabetes reaches epidemic proportion and where, therefore, normal primary and secondary care may not be achieving results. Otherwise management of chronic diseases is left to primary care, ideally. But you need good systems management between the health centres and private practice.

Confusing public health with HoP will result in not knowing when severe measures ought to be taken to save as many lives as possible. The sooner we appreciate the utilitarian nature of public health in any disaster situation, the sooner we can educate the public rather than allow what has been happening throughout the Covid-19 pandemic worldwide, where bad decisions are leading to lack of faith in governmental decisions. There are opportunists in such situations who may compound issues. Certainly, there are those few industries to which Covid has provided considerable work and perhaps would not want it to stop and such rumours will benefit them. This is the unfortunate relationship that medicine has with industry. The symbiotic partner may become the parasite when the conditions are right.

The vaccine crises has certainly not helped the Greenpass the same EU is suggesting and the European Union qua Union (not qua Brussels) is not helping.

Pierre Mallia is Professor of Family Medicine and Patients’ Rights and teaches at the University of Malta. He chairs the Bioethics Research Programme of the Faculty of Medicine and Surgery. He also chairs the Bioethics Consultative Committee. This article is his personal opinion and does not represent the opinion of any committee or Board he serves on.