Some governments have launched plans to fine the unvaccinated. Experts caution against the approach.
A growing number of governments are offering people a stark choice: Get vaccinated or pay up.
Austria’s lower house of parliament on Thursday approved a coronavirus vaccine mandate for all adults starting Feb. 1, with violators facing up to 3,600 euros ($4,000) in fines.
In Greece, starting this week, people over age 60 who decline the vaccine can be fined 100 euros ($113) per month. Italians who are older than 50 must also get vaccinated or face fines and suspensions from work, beginning next month.
In Canada, meanwhile, the hard-hit province of Quebec said last week that it was considering a plan to hit adults without at least a first dose of coronavirus vaccine with a “significant” financial penalty.
“It’s a question of equity,” Quebec Premier François Legault said at a news conference. “These people put a very important burden on our health-care network, and I think it’s normal that the majority of the population is asking that there be a consequence.”
Early data from Quebec, Greece and Italy appears to show that announcing these measures contributes to an immediate uptick in vaccinations. But scientists and rights groups warn that they could come at a cost for governments, potentially alienating skeptical people and fueling distrust.
European countries, in particular, have tightened restrictions on unvaccinated residents in recent weeks in an effort to vaccinate holdouts and curb the spread of the fast-moving omicron variant. The fines mark a notable step further.
Austrian Health Minister Wolfgang Mueckstein said that the law was “urgently needed” to close the vaccination gap and return to normalcy in a country where roughly 72 percent of the population is fully immunized, the Associated Press reported.
“This is how we can manage to escape the cycle of opening and closing, of lockdowns,” he told the Austrian parliament Thursday.
The chamber’s approval paves the way for Europe’s most far-reaching vaccine mandate. Starting in mid-March, police will demand proof of vaccination and people who cannot provide it may be fined up to 600 euros ($685). Those who ignore reminders to get vaccinated and contest their penalty could be forced to pay several thousand dollars.
Pregnant individuals, people with valid medical excuses and those who have recovered from the coronavirus in the previous six months will be exempt. Austria will also allocate nearly $1.6 billion to efforts to encourage people to get vaccinated.
In Greece, revenue from the new fines will go to the health system, the government said.
“We have chosen obligation as a last resort,” a Greek health ministry source said, calling the approach “effective.”
When the mandate was announced in late November — with a Jan. 16 deadline for complying — 520,000 Greek citizens over 60 were unvaccinated. Since then, 220,000 of them have received their shots or made an appointment to do so, according to the Greek health ministry. Now, close to 90 percent of people over 60 are vaccinated.
The Italian government announced a vaccine mandate in early January to reduce pressure on hospitals as omicron surged. Less than 10 percent of the population was unvaccinated as of Jan. 18, according to the Italian health ministry, but unvaccinated people occupied two-thirds of intensive-care beds and 50 percent of other beds in Italian hospitals.
Starting next month, anyone older than 50 who forgoes the vaccine will be slapped with a one-time penalty of $113.
After Feb. 15, workers over 50 who can’t prove they have been vaccinated face suspension without pay and fines of between 600 and 1500 euros ($680 to $1700).
Nearly 200,000 people older than 50 received their first vaccine dose in the roughly two weeks after the measures were adopted, according to health ministry figures.
While the measures stirred a backlash, some in Italy want the penalties to be heavier.
In Quebec, details about the “health contribution” are scarce, and officials admit they’re still working through the legal issues. Legault said that it would probably exceed $100 and would not be imposed on those with medical exemptions. Specifics are expected in a bill to be introduced next month.
The Jan. 11 announcement was followed by a spike in first-dose appointments, from an average of roughly 4,400 appointments recorded in the previous five days to more than 7,000 per day from Jan. 11 to Jan. 13. The number of daily appointments has since dropped, according to data from the provincial health ministry.
Québec Solidaire, a provincial opposition party, criticized the measures as “radical.” Cara Zwibel, acting general counsel of the Canadian Civil Liberties Association, said it would punish and alienate “those who may be most in need of public health supports.” Several provinces assured residents that they would not head down a similar path.
Prime Minister Justin Trudeau declined to comment on the plan at a news conference last week, saying he needed more details.
Several other governments have previously used financial penalties to encourage people to get inoculated. Mauritius passed a rule in June requiring workers in some sectors to be vaccinated or face a steep fine. Unvaccinated workers and employers in Fiji can be fined and the government limited unemployment aid to those who have received the vaccine.
Rights groups such as Amnesty International have decried these policies as discriminatory and counterproductive.
Scientists and public health experts warn the punitive approach could backfire.
Maxwell Smith, a bioethics professor at Ontario’s Western University who led the drafting of the WHO’s policy brief on the ethics of covid-19 vaccine mandates, said that while some vaccine-hesitant people often get cast as privileged adherents to conspiracy theories, some might face barriers to vaccine access or come from marginalized groups that have experienced discrimination by the health-care system in the past.
“Owing to that they will tend to be more distrustful and perhaps more hesitant to be vaccinated when they see measures like this in place,” he said.
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Benedetta Armocida, president of Italian global health association Saluteglobale.it, said some unvaccinated Italians are organizing “covid parties” to try to acquire immunity through infection.
Armocida blames Italian officials for not doing enough to respond to concerns about the vaccine and convey the rationale behind the new, stricter requirements.
“If a person considered getting a disease rather than getting vaccinated, then there’s something missing in the communication,” she said.
The World Health Organization’s Europe branch said in a statement that countries can set their own policies, but does not “recommend distinguishing between vaccinated and unvaccinated groups because that will go further in terms of exacerbating inequities in the population.”
Ivo Vlaev, a professor of behavioral science at the University of Warwick who has advised the British government on its pandemic response, urged authorities to better communicate relative risks, to emphasize what people gain by getting vaccinated and to rely on trusted messengers in skeptical communities.
“Trust in health authorities is the main driver of compliance,” Vlaev said. “If you undermine trust you are actually undermining the driver, the lubricant of compliance.”
