Time to remove vaccine mandates? Not so fast – it could have unintended consequences

Several Australian states have used mandates to drive up COVID vaccination rates. Governments justified the mandates on the basis of preventing the spread of disease and protecting the vulnerable.

Now many states are rolling back these mandates, with Queensland removing the requirement to show you’re vaccinated before entering cafes, pubs, galleries and other public spaces from tomorrow.

It would be nice to think that when mandates have served their purpose, they can be removed. In practice, removing mandates may affect public attitudes about the importance of vaccination and the likelihood of getting boosters.

Read more: Is it time to rethink vaccine mandates for dining, fitness and events? We asked 5 experts

Remind me, what were the mandates?

Public space mandates involve governments mandating that venues (such as restaurants, libraries and sporting venues) check individuals’ vaccination status and exclude the unvaccinated. This is facilitated by vaccine passports and certificates.

Government employment mandates involve governments requiring workers in specific industries to be vaccinated. Businesses and organisations may also implement their own policies requiring the vaccination of their staff, their clients, or both.

Most states and territories embraced public space mandates and all have required vaccination of aged and health-care workers.

But many are on their way out. NSW eased its requirements last year. South Australia has recently revoked mandates for police, teachers and transport workers. Queensland’s new policy is noted above.

Victoria, Western Australia, and the Northern Territory are sitting with their existing requirements for now.

What could happen next?

It’s unclear what impact removing vaccine mandates will have in Australia. However, we can learn from other public health measures and COVID vaccine mandates implemented overseas.

Seat-belt laws converted a government requirement into a widespread social norm. Car manufacturers reinforced the norm with vehicles that beep at us when we don’t comply.

But just because something has become habitual doesn’t mean we can lose the law. If governments removed the seat-belt law now and expected us to comply because we are informed, educated, and socialised, some people would still conclude that seat belts are no longer important. Removal of a requirement can send a bad message.

Read more: Smallpox, seatbelts and smoking: 3 ways public health has saved lives from history to the modern day

The Italian government learned this when the region of Veneto suspended childhood vaccine mandates for four childhood vaccines in 2007. Officials thought the region’s wealthy and educated population would continue to vaccinate their children if the regional government provided strong education and messaging.

They were wrong. Their strategy worked until there was a national vaccine scare in 2012. Vaccination rates in Veneto plummeted faster than anywhere else in the country.

Eventually, the national government mandated more vaccines for the whole country.

Other countries have already experimented with introducing, removing, and sometimes re-introducing mandates. Some, such as Austria and the United Kingdom, have flip-flopped, providing little opportunity to study the impact of their mandates’ introduction or removal.

Israel, which vaccinated its population promptly with Pfizer to the envy of the world, used a “public space” mandate (with an opt-out of a negative COVID test). The mandate has been switched on and off depending on the disease situation at the time.

Unfortunately, Israelis’ uptake of subsequent doses has dropped over time, but its government still ended the mandate in February.

Mandates are also not without risks and costs. They can provoke reactance, making those who are reluctant to vaccinate more determined not to do so. They may also prompt activism against vaccines and mandates.

High vaccination rates help contain COVID

One of the biggest challenges is nobody knows what the next phase of COVID will look like. Neither infection nor the current vaccines provide long-lasting immunity. We don’t know whether the next strain will continue the trajectory towards less serious symptoms started by Omicron (and helped by high vaccination rates).

Whether we continue to be able to stay on top of COVID and whether the disease continues to remain less severe in most people infected will depend on maintaining high vaccination coverage rates.

Read more: COVID mask mandates might be largely gone but here are 5 reasons to keep wearing yours

Governments across the nation and the world have struggled to get third doses into populations at the same level and with the same enthusiasm people showed towards the first two.

Uptake in paediatric populations is also lagging in Australia – and there are no mandates.

Now adults are being asked to prepare for and accept our fourth doses.

Leading the way

Western Australia has one of the highest rates of uptake in the country, with 76.7% of people aged over 16 triple dosed. This compares with the national average of 52.3%.

It’s no coincidence the state’s employment mandates, which cover 75% of the workforce, require workers have their third dose within a month of becoming eligible.

The WA mandate did not contain three doses to begin with, but it was very easy for the government to build it in.

Faced with rolling back the mandate or keeping it operational for the fourth dose, the government will have to grapple with whether the population continues to support these measures – and there are definitely people who reluctantly accepted two doses and are not prepared to keep having more.

WA’s public space mandate only covers two doses for now.

WA’s COVID vaccination experience has shown that mandates, including for third doses, drive high levels of uptake, and are easy for governments to implement.

However, much of the rest of Australia is moving in an opposite direction to WA in removing its mandates.

As we live through the continued natural experiment of living with COVID – and not allowing it to defeat us – we now move into a new phase of making sense of what to do with the policy instruments governments used.