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Back-to-work vaccine?

We have a number of points to consider for this week: 1.) MECQ (modified enhanced community quarantine, the second strictest level) ends for the NCR+ Bubble this week; 2.) research indicating that an extension of the MECQ until May 31 can further bring down the number of daily cases; and, 3.) the Indian variant of COVID-19, which spreads easily, has been detected in the country.

Dr. Guido David of OCTA Research has been quoted as saying in a news report that daily cases in Metro Manila could go down to about 1,000 by the end of May, from the current 2,000, if the MECQ would be extended until May 31. The concern with this, of course, is that an MECQ extension will continue to dampen economic activity as well as workers’ income.

Data from the Philippine Statistics Authority (PSA) showed that gross domestic product (GDP) fell by an annual 4.2% in the quarter ending March. The five consecutive quarters of GDP decline to March 2021 is the longest Philippine recession since economic output shrank for nine consecutive quarters from late 1983 to end-1985.

The Department of Health (DoH) has also reported that the Indian variant of COVID-19 has been detected in two OFWs who returned in April from the Middle East. Another 12 seamen in a ship now docked off Cavite have also tested positive for COVID. Their ship previously made a port call in India. The World Health Organization (WHO) has recently reclassified the triple-mutant Indian variant as a “variant of concern” at the global level.

Given these, should Metro Manila and its neighboring provinces scale down quarantine restrictions starting May 15? From the present MECQ, should NCR+ (Metro Manila, Rizal, Laguna, Cavite, Bulacan) step down to the less restrictive GCQ (general community quarantine) status? Or, should it keep the MECQ status for two more weeks, at least? Tough call for the government, all things considered.

In the case of Makati City, where I live, for the period May 3 to 8, we had a drop in cases for six consecutive days, with active cases falling from 1,285 to 994. However, active cases started going up again on May 9 (1,006), May 10 (1,028), and May 11 (1,038). Another 44 cases were added to the active count in the last three days, or an average of 15 cases daily.

Of course, Makati is just one city, and the trend here is not necessarily indicative of the trend for NCR+. However, the active case count of 1,038 as of May 11 approximates the 1,072 cases reported on March 30, just as ECQ started in NCR+. To compare, on March 1, there were only 435 active cases in Makati. On March 28, just before ECQ, we had 934 cases. On May 11, we had 1,038. And this was after two weeks of ECQ (enhanced community quarantine, the strictest level) and almost four weeks of MECQ. In short, in Makati City, after six weeks, we are worse off.

It is in this light that I find interesting the April 2021 Working Paper by University of Chicago economist Casey Mulligan titled, “The Backward Art of Slowing the Spread? Congregation Efficiencies during COVID-19.” He analyzed data to test the presumption used to justify lockdowns, stay-at-home orders, or the ECQ status — that the workplace was less safe than the home. Thus, the economy should be shut down and people should stay indoors.

His findings? Well, in many instances, workplaces actually became safer than homes because businesses had the incentive or the motivation as well as the capital to invest in so-called “mitigation protocols,” to ensure workers’ safety and to allow for continued business operations. On the other hand, households were less likely to adopt similar levels of precaution and actually go beyond the minimum.

“The available data from schools, hospitals, nursing homes, food processing plants, hair stylists, and airlines show employers adopting mitigation protocols in the spring of 2020. Coincident with the adoption, infection rates in workplaces typically dropped from well above household rates to well below. When this occurs, the sign of the disease externality from participating in large organizations changes from negative to positive, even while individuals continue to have an incentive to avoid large organizations due to the prevention costs they impose on members. Rational cooperative prevention sometimes results in infectious-disease patterns that are opposite of predictions from classical epidemiology,” Mulligan wrote.

He added, “Micro evidence contradicts the public-health ideal in which households would be places of solitary confinement and zero transmission. Instead, the evidence suggests that ‘households show the highest transmission rates’ and that ‘households are high-risk settings for the transmission of [COVID-19].’ Schools, businesses, and other organizations implemented a range of prevention protocols — from adjusting airflow to installing physical barriers to monitoring compliance to administering their own testing services — that households did not, and perhaps could not. Something in these organizations greatly reduced the spread.”

Given this argument, and the mounting economic losses we have been suffering, should we now let more workers back in their offices or places of work? Should we allow more businesses to resume operations? More important, should we require workers to be first vaccinated before making them go back to their workplaces?

On Feb. 16, the Straits Times’ Indonesian Correspondent Wahyudi Soeriaatmadja reported that “Indonesia has made coronavirus vaccination for citizens compulsory,” and that “people who are eligible for vaccination but refuse a jab can be penalized” with fines, delays or suspension of social aids, or delays or suspension of access to public services.

I am not aware of any local law or jurisprudence that allows for mandatory vaccination. However, the 1905 US Supreme Court case of Jacobson v. Massachusetts affirmed the authority of the state to compel vaccination. After an outbreak of smallpox in Cambridge, Massachusetts in 1902, the local government passed an ordinance requiring all adults to be vaccinated or revaccinated against smallpox, or pay a fine of $5.

The US Supreme Court at the time affirmed the state’s authority to pass laws protecting public health, public safety, and the common good. “The rights of the individual may at times, under the pressure of great dangers, be subjected to such restraint to be enforced by reasonable regulations as the safety of the general public may demand,” it noted.

Even the US Equal Employment Opportunity Commission, last December, reportedly issued guidance stating that employers were legally allowed to require employees to be vaccinated before they return to offices. In a way, vaccination can also indirectly address the concern that further easing of quarantine restrictions or allowing greater capacity for businesses and transportation can lead to more deaths.

If the state’s regulation of healthcare is intended to ensure the protection of lives and the promotion of the greatest public good, but at the same time acknowledging that COVID-19 vaccines are generally “experimental,” can we morally make inoculation compulsory for all, or even for just certain sectors like healthcare workers?

It is in this line that I reiterate my call for legal, ethics, and medical experts to start chiming in on whether COVID-19 vaccination should be mandatory or compulsory, and to what extent. We can compel people to wear masks and face shields. We can impose lockdowns, restrict movement and work, and compel people to stay home. Question is, legally, ethically, and morally, can we also compel them to be vaccinated?


Marvin Tort is a former managing editor of BusinessWorld, and a former chairman of the Philippine Press Council

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