Sidelights | Looking Back at Vaccination Policies through COVID-19: Balancing Herd Protection and Individual Choice

At the end of 2019, COVID-19 was first discovered in Wuhan, Hubei Province, China, and rapidly spread globally, evolving into a worldwide pandemic. As of June 20, 2022, over 539 million confirmed cases and more than 6.318 million deaths had been cumulatively reported worldwide, with a case fatality rate of approximately 1.17%, making it one of the major epidemics in human history.

In Taiwan today, the number of daily confirmed cases has exceeded ten thousand, and the government continues to promote policies such as vaccination and increasing vaccination coverage. All citizens are required to hold a vaccine passport to enter specific venues in accordance with regulations, among which those who have not received three or more doses of vaccines are not allowed to enter.

Taiwan's current vaccination policy is formulated based on a press release issued by the Centers for Disease Control of the Ministry of Health and Welfare on December 8, 2021. The press release stated: "Starting from January 1, 2022, vaccination requirements for COVID-19 will be strengthened for personnel in certain venues (fields) who, due to the nature of their work or service, 'come into contact with unspecified persons or are unable to maintain social distancing,' in order to strictly guard the community defense line." The press release further stated:

The Central Epidemic Command Center stated today (the 8th) that due to the ongoing severe international pandemic and the increased threat of the Omicron variant, and considering that domestic COVID-19 vaccination capacity remains sufficient, in order to actively prevent the risk of community transmission, starting from January 1, 2022, workers and practitioners in venues and fields under the jurisdiction of central ministries and local governments who belong to those maintaining medical and epidemic prevention capacity, high-contact risk workers, those maintaining national security and normal social functioning (i.e., categories 1, 2, 3, and 7 of public-funded COVID-19 vaccination recipients), as well as workers in correctional institutions and funeral facilities (as detailed in the attachment), due to the characteristics of their work or service involving "contact with unspecified persons or inability to maintain social distancing," will be subject to strengthened COVID-19 vaccination requirements to jointly safeguard the health and safety of our nationals. The regulatory principles are as follows:

1. Workers and practitioners in the aforementioned venues and fields under the jurisdiction of central ministries and local governments should all receive 2 doses of the COVID-19 vaccine for 14 days or more (must receive the 2nd dose by December 17, 2021 at the latest); new hires who have not fully received 2 doses of the vaccine for 14 days or more prior to their initial service must provide a negative proof of a self-paid antigen rapid test (including home rapid tests) or PCR test taken within 3 days.

2. If personnel were previously confirmed COVID-19 cases and hold an isolation release notice issued by health authorities within the past 3 months, they may temporarily be exempt from submitting proof of COVID-19 vaccination. However, they shall promptly complete their COVID-19 vaccination as soon as 3 months have passed since their release from isolation, and new hires must provide a negative self-paid PCR test result taken within 3 days prior to their initial service.

3. If personnel are evaluated by a physician who issues a certificate stating that COVID-19 vaccination is not recommended, or if they are unable to get vaccinated due to personal reasons, they may only provide services after testing negative on a self-paid antigen rapid test (including home rapid tests) or PCR test once a week, and new hires must additionally provide one negative self-paid PCR test result taken within 3 days prior to their initial service.

The Command Center emphasized that to ensure all personnel in relevant venues and fields meet the above regulations starting from January 1, 2022, relevant ministries and local governments will strengthen supervision. Relevant venues and fields are urged to encourage workers and practitioners who have not completed their COVID-19 vaccination to promptly complete 2 doses of the vaccine by December 17, 2021.

Just as mentioned in the first paragraph regarding the government's mandatory vaccination policy, the public might question whether it infringes upon individual freedom of choice. However, facing such a contagious virus, many believe that getting vaccinated is an urgent priority. The government launched a vaccine reservation system in the early stages of the pandemic in 2021, with households scrambling to make reservations and even queueing up early in the morning waiting for residual doses. People were arranged to be vaccinated in the order of categories 1 to 10, but we must ask: has the public's knowledge about "vaccines" and the reservation situation reached a balance?

Under such circumstances, before people might have formed clear thoughts, many had already been vaccinated and stamped with a "qualified" medal by clinics large and small, as if vaccines were an unquestionable good thing. Indeed, vaccines can prevent many diseases, but do people truly understand the development and experimental verification processes of these vaccines, as well as the risks involved in large-scale vaccination? Now, mRNA vaccines have been promoted under a large-scale system, but how was such a proactive policy achieved? This brings up the interaction between knowledge and power.

Large-scale vaccination, while potentially bringing some side effects to individuals, holds significant benefits for society as a whole. This approach represents comprehensive societal control over potential infection risks, having every individual participate in vaccination to achieve the purpose of protecting the overall community. It can be said that this is a policy of "enforcement in the name of protection."

Different countries have adopted varying policies toward the pandemic. The outbreak in 2020 may have merely been the prelude to 2021, and with Taiwan's daily confirmed cases exceeding ten thousand in 2022, the government's strengthened control over vaccination coverage also reflects the evolution of its response strategies. However, compared to the initial widespread trust in vaccines, quite a few people today have begun to have doubts about vaccines. These concerns include unpredictable side effects and the ongoing occurrence of severe cases. The government seems to rationalize its governance policies through the technology of knowledge-power and associate it with political power. The more reasonable these policies sound, the more beautifully hidden the technology of political power is.

At the policy level, the mandatory vaccination policy for personnel in categories 1, 2, 3, and 7 has sparked controversy. Governance needs to be accompanied by truth, but there are various differing perspectives regarding the truth about vaccines. Many professionals, including medical professors, have advised people not to get vaccinated. Many healthcare workers may feel they have no choice, as refusing vaccination could affect their employment. Even when the FDA first publicly released the safety data report for Pfizer's vaccine, which contained 1,291 side effects, the truth about vaccines remains multifaceted. Under such circumstances, can the government still continue to enforce the policy?

Regarding the government's mandatory vaccination policy, some hold differing opinions. In the absence of consensus, is such a policy governance, or is it closer to authoritarianism? In the current sensitive political climate, vaccine discipline has permeated society; must policies be allowed to trample arbitrarily without restriction, thereby affecting individuals who have already made their choices? From past pestilence discipline to today, history seems to be constantly repeating itself. Balancing the benefits of large-scale vaccination with individuals' freedom of choice, many countries have implemented mandatory policies, but in the absence of a globally unified truth, we need to deeply reflect on these issues and balance the relationship among knowledge, power, and individual freedom.