With the introduction of a distinction between those who are fully vaccinated and those who are not, the latest iteration of the Public Health Regulations marks a significant shift. One concern expressed, including in Tynwald, was that such a distinction is discrimination; another was concern over an element of compulsion. In this slightly more abstract blog, I will discuss some of the issues raised by this shift.
Mandatory vaccination policies are, globally, extremely common. A 2020 survey identified more than 100 countries with a nationwide mandatory vaccination policy, with 59% of those backed by penalties against those who do not comply, with financial and educational penalties (typically refusal of school enrolment, for instance in France) the most common. A number of countries distinguish between vaccinated and non-vaccinated travellers either by requiring vaccination to enter from a high risk country (for instance in Spain), or by altering isolation periods for fully vaccinated persons (for instance in Canada).
What limits are there on incorporating vaccination status into the Manx legal response to the pandemic?
The absolute limit on requiring vaccination under the PHA.
The Public Health Act 1990 s.51(E) prohibits PHRs made under s.51B (which allows PHRs regulating international travel including quarantine and prohibiting the entry of persons) and s.51C (which allows PHRs creating other restrictions on persons, things or premises) from “requiring a person to undergo medical treatment”. Medical treatment “includes vaccination and other prophylactic treatment”. This provision is closely modelled on the UKs Public Health (Control of Disease) Act 1984 s.45E. Neither have been the subject of judicial consideration, which makes interpretation more difficult.
I think there is a distinction for this section between “required to” and “required in order to”. A PHR which required particular classes of person to undertake vaccination, and imposed criminal sanctions for persons who refuse, would be prohibited under s.51(E) – even if proportionate to the public health challenges. A PHR which required persons to undertake vaccination in order to do something, however, would not fall under this absolute requirement, although as discussed below it might fall foul of other, qualified, requirements.
If this view of the scope of s.51(E) is right, then distinguishing clearly in the PHRs between a requirement to, and a requirement in order to, would reduce the risk of a challenge under this provision of Manx law. As noted, however, neither this provision nor the UK equivalent has been explored by the courts, even in passing. If there is significant doubt about the correct interpretation of s.51(E), it may be worth a clarifying amendment to the section.
Limits on requiring vaccination in order to do something else: Fundamental rights.
It is still possible, however, for a “requirement in order to” to constitute a breach of fundamental rights protected by law. The WHO has recently recognised that “threats of imposing restrictions in cases of non compliance … [limiting] individual choice in non-trivial ways by making vaccination a condition of, for example, attending school or working in particular industries or settings” can constitute mandatory vaccination. This type of mandatory vaccination can raise issues when it imposes a burden on a fundamental right.
The Human Rights Act 2001, and the European Convention on Human Rights to which it refers, could be the basis for a number of arguments around for instance Article 8 (the right to privacy) and Article 11 (the right to association). In relation to compulsory childhood vaccination, failure resulting in exclusion from school, the European Court of Human Rights has very recently shown considerable deference to the decisions of the state. A requirement for vaccination in order to do something would be likely to survive ECHR challenge if it could be viewed as proportionate. I return to proportionality below.
Limits on requiring vaccination in order to do something else: Discrimination.
The PHRs now clearly distinguish between vaccinated and non-vaccinated persons, but not every distinction is discrimination. The same PHRs, and their predecessor EPRs, distinguish between people who are infected with coronavirus and those who are not for instance; and in the penal sections between those who have been found guilty of an offence and those who have not. Concerns about discrimination are not so much about the drawing of a distinction per se, but that it is either not lawful, or not just, to do so.
An important point to make here is that we find guarantees against these sorts of distinction across the Manx legal order. Equality norms pervade the legal order, and manifest in particular laws such as the Equality Act 2017, and the Human Rights Act 2001, and can have a subtler impact through the influence of international law. When someone suggests that a particular piece of policy is against the Equality Act 2017 they do not necessarily mean that the Equality Act prevents that policy making; rather they mean that the policy is incompatible with the equality norms it exemplifies (and which are to a large extent also exemplified in the Human Rights Act).
That said, groups protected by the Equality Act, and understandings of discrimination based on the Equality Act, are particularly potent. They also usefully illustrate the importance of proportionality in considering these issues.
Arguments that the unvaccinated per se legally constitute a group capable of being discriminated against are likely to be explored globally. The importance of this is that discriminating against someone because they are a member of a group sharing a protected characteristic is normally characterised as “direct discrimination”. Direct discrimination is very difficult to justify, and the Equality Act only allows justification of most direct discrimination in very narrow circumstances. If vaccinated people are not characterised as a group, however, the idea of “indirect discrimination” is much more important.
Under the Equality Act, indirect discrimination is when a generally applied policy puts those sharing a protected characteristic “at a particular disadvantage” and it is not shown “to be a proportionate means of achieving a legitimate aim” (Equality Act 2017 s.20(2)). To dodge a distraction into the reach of the Equality Act into the PHRs, let us imagine that a restaurant adopts a policy of only allowing 2+2 vaccinated persons access to a confined dining area. Could that be indirect discrimination?
One line of argument would be that the restaurant is indirectly discriminating on grounds of age and of disability. If it is impossible for almost any 18 year old to secure a vaccine , and an 18 year old is refused entry because they are not vaccinated, this could be indirect age discrimination. If a person who is unable because of their disability safely to be vaccinated is similarly refused, this could raise issues of indirect disability discrimination. In both cases, however, the restaurant could seek to “show it to be a proportionate means of achieving a legitimate aim”.
So whether our concern is the impact of distinguishing between vaccinated and non-vaccinated persons in their exercise of fundamental rights, or on indirect discrimination, the central issue is likely to be whether the impact is proportionate.
Proportionality.
This emphasis on proportionality means that accepting a distinction between vaccinated and non-vaccinated persons is not a single decision. Every time the distinction is drawn, consideration needs to be given to whether it is a disproportionate burden on the exercise of fundamental rights, or on a group sharing a protected characteristic. How should this consideration proceed?
The Council of Europe Committee on Bioethics has suggested:
“One should also take into account those individuals who, for medical or other reasons, cannot be vaccinated, and keep in mind that test results (and in the case of travel also quarantine) provide alternative means to vaccination certificates when withdrawal of some public health measures is considered. Furthermore, as underlined in our statement on “COVID-19 and vaccine”, referring to the principle of equitable access to healthcare laid down in Article 3 of the Oviedo Convention, particular attention must be paid to individuals in vulnerable situations and to the exacerbation of inequalities within such groups due to the public health crisis, including in their access to vaccination.”
Every “requirement in order to” laid down in the pandemic laws should be scrutinised carefully with these principles in mind, particularly in relation to the protected characteristics under the Equality Act 2017. Scrutiny should be particularly close where the impact on the non-vaccinated individual is more serious – so to my mind requiring vaccination to go to a nightclub is easier to justify than requiring vaccination to practise a particular profession. It should also be particularly close where there is no alternative route to the same end – so to my mind a requirement that all persons entering the Island be fully-vaccinated would require stronger justification than one which imposes differing isolation.