Back of the Queue

In April 2021, both Simon Coveney and Leo Varadkar made open threats to all persons who refuse the AstraZeneca COVID-19 vaccine: they would be put to the back of the vaccine queue.¹² I couldn't find this direction outlined on hse.ie or on any official government document.

Coveney's statement is of particular interest, because it appears to contradict itself. He said "People should trust the system because the decisions are being made by public health experts, not by politicians, when it comes to who gets what, and when."³ He followed this immediately with a clarification that refusal to accept AstraZeneca would move someone to the back of the queue. Effectively, Coveney says "Trust the system, the choices are made by health experts," and then outlines an important choice which seems to be made by politicians based on logistics rather than health. Health officials aren't saying that people should be moved to the back of the queue. Politicians are.⁴⁵

There are a number of pieces of advice put out by public health experts which suggest that you do not use heavy-handed threats to improve uptake of vaccines, including on hse.ie. The HSE's own documentation specifically suggests a strategy of "keeping the door open" to people who refuse or are hesitant about a vaccine. It suggests that vaccine hesitancy should be dealt with by having "a skilled conversation that is collaborative and person-centred. A participatory approach."⁶

If you threaten people who are concerned with the AstraZeneca vaccine in this way, you will reduce their chances of enrolling, rather than pushing them to take AstraZeneca when offered. If these people don't want to take AstraZeneca, and they are told they will have no say on the medicine they receive, it seems likely they will pass up the opportunity completely. If you allowed medical experts and patients take a more pragmatic approach based on their concerns, you would have far more positive effects.

If I was told I could have AstraZeneca in one week or Pfizer in one-plus months, I'd take the AstraZeneca in one week. I asked that same question to about 20 people over Zoom and with the exception of one woman in her early thirties, everyone said they would do the same.

Engaged consent is not the same as "pick and choose vaccine," and we don't have to sacrifice treating people as individuals with concerns in order to maintain pace, as Coveney suggests. "If you've no concerns over the vaccine you receive, use this portal. If you've been worried about what you've been reading, engage with your GP. As politicians, we have decided to step away from nasty threats, but here's some positive stats." That's a better message.

The Nursing and Midwifery Board of Ireland outlines the importance of respecting patient autonomy: "You should protect and promote the autonomy of patients: respect their choices, priorities, beliefs and values. Decisions to refuse care or treatment should trigger further discussion and be respected in the context of the person's capacity."⁷ Great advice from medical professionals, not politicians. The threats from Coveney and Varadkar don't align with it.