Breaking Ranks

It’s been about a year of no work or income for unvaccinated Nova Scotians working in “high risk” settings. But does the province’s vaccine mandate hold any water?

Last year, when Nova Scotia’s COVID-19 vaccine mandate deadline rolled around, the veteran nurse with 22-years-experience in occupational health, travel, and infectious disease medicine, felt strongly that her chances of a serious adverse event from the vaccine itself outweighed any benefits. At the time, the mandate, which applied to 80,000 public sector workers, including teachers, healthcare, long-term care workers, and paramedics, stipulated that employees were required to have at least a first dose of vaccine by November 30, with a requirement to show proof of full vaccination 70 days later. Anyone who did not comply would be place on unpaid administrative leave.¹

You may recall, the public sector mandate—requiring vaccination to access employment—roughly coincided with the more general proof of vaccine policy that came into effect across the province in early October, requiring Nova Scotians to show physical or digital proof that they were “fully vaccinated” in order to access what were deemed “non-essential” venues, including restaurants, bars, sports venues, gyms, theatres, and cinemas.

While the proof of vaccination policy and the mandate for public sector employees were both dropped in late February 2022, the mandate still applied to those working in “high risk” settings, including this nurse, who spoke to me on the condition of anonymity.

In an interview, she explains how she had “several bad allergic reactions” from previous vaccinations and had a medical note exempting her, moving forward.

“It was an allergy to either polyethylene glycol (PEG) or Polysorbate [80] – they couldn’t say for certain.”

There was no skin-testing done at the time of her initial vaccine reactions because the test has a low accuracy rate, she says. When she was forced to get allergy testing to prove she had a “valid medical contraindication for COVID-19 vaccination,” in order to obtain an exemption to the government-imposed mandate—a subject we’ll return to—the test came back negative.

“For people suspected of PEG or Polysorbate allergy, it’s unlikely it’s going to show positive, but that doesn’t mean the allergy doesn’t exist. It just means you don’t react to it on your skin,” she says.²

Lack of transparency on scientific rationale

At the time, many who refused the vaccines were characterized by the media and by politicians as being “anti-vaxxers.” The term no longer applies to just those opposed to all vaccination. It now includes those who might oppose some vaccines or oppose mandatory vaccination.³ While there was plenty of anger and intolerance directed at the unvaccinated—by the media and politicians alike—there was very little, if any, effort to understand their often, legitimate reasons for refusing the shots.

It’s a subject I touched on in a two-part series here and here.

This nurse tells me the derogatory label of “anti-vaxxer” does not apply to her.

If you get a hepatitis vaccine, you’re not going to get hepatitis. So how could they push something like the COVID vaccine when it doesn’t stop transmission, not to mention trampling on people’s bodily autonomy? I've always advocated for my patients, even if they made a decision I didn't personally agree with, it's none of my business. It's their body. Our job [as nurses] was to provide patients with information and let them make their own informed decision. With this, nobody's questioning anything. I've been in management, and you have a duty to your employees to advocate on their behalf, but everyone's just doing as they're told.

After not doing as she was told, she was put on administrative leave without pay.  

“Essentially, they ended my career. I can’t get a nursing job anywhere in Nova Scotia. I could work at any hospital in New Brunswick or Newfoundland but I’m not allowed to work here in Nova Scotia. Do we have different science here?”

Currently, Nova Scotia and British Columbia are the only two provinces/ territories in Canada that are still enforcing the vaccine mandate on health professionals. In Ontario, while the requirement was lifted by the province back in March, hospitals are still allowed to enforce them. One recent news report stated that staff shortages—exacerbated by hospital mandates—have forced Emergency Departments to close and that even COVID-19 positive health care staff were working because the needs were so “critical.”

Here in Nova Scotia, the still-in-force Mandatory Vaccine Protocol for “high risk settings” only requires the 2-shot primary series. When I asked the Department of Health and Wellness (DHW) a number of questions including what the current rationale was for maintaining the mandate, given that other provinces have dropped it, the spokesperson replied:

“The Department is engaging with these workplaces regarding next steps for the vaccination protocol as we move ahead in our COVID-19 management plan.”⁴

Seeing that the mandate might not be rescinded in this province soon enough, the nurse put her property on the real estate market. “It sold within days, thankfully, as heartbreaking as that was. We got a much smaller place because we knew we could put a large down payment and not have to worry about trying to pay a mortgage and bills on one salary, basically.”

Now she’s working at a call centre.

Protesters gathered at the Peace and Friendship Park, Halifax, January 23, 2022. Photo: Linda Pannozzo.

‘Valid medical contraindications’ very limited

Another person I spoke to worked as a social worker in a disability support program when the vaccine mandate came into effect. Her field is considered a “high-risk” setting and is included in the Mandatory Vaccination Protocol.⁵ When she decided she didn’t want to get the vaccine, her career as a child welfare and family support worker—something she did for more than two decades—was abruptly put on hold, along with her pay. She tells me she didn’t want the vaccine because she was “terrified” of what it might do to her.

At 19 years of age, she was diagnosed with Raynaud’s syndrome, which results in restricted blood vessels and restricted blood flow to the extremities of her body including her hands and legs. As well, her mother’s side of the family has a history of congestive heart failure. Her mother, grandmother, and two of her mother’s sisters have died of it.

I'm terrified of getting a blood clot [from the vaccine] because of the Raynaud’s and blood vessel restriction. Common sense tells me that I would be even more at risk of a blood clot than the average person who doesn't have this condition. And having a maternal history of congestive heart failure tells me that I could be more at risk of getting myocarditis or pericarditis. With all the scientific information on adverse reactions I was not going to risk it.⁶

In mid-September, 2021, a few weeks before the proof of vaccine policy came into effect, Nova Scotia’s Chief Medical Officer of Health, Dr. Robert Strang, issued a memorandum to all health care providers indicating what would qualify as a “valid medical contraindication” for COVID-19 vaccination. If anyone, including health care professionals, wanted an exemption from the policy or the mandate, there were only a small number of medical reasons that met the criteria.

The Department of Health and Wellness (DHW) prepared a template for physicians and nurse practitioners to “certify that patients meet criteria for a medical exemption.” Based on Strang’s memo, the only way someone would be allowed an exemption was if they had a proven allergy to any of the components of the COVID-19 vaccine, or a “history” of a serious adverse event following the first dose of a COVID-19 vaccine, including a severe allergic reaction, thrombosis, thrombocytopenia, capillary leak syndrome, myocarditis, or pericarditis.

In other words, except for an already proven allergy, there was nothing that would exempt you from having the first shot.

For the social worker, neither of her conditions were considered “valid” reasons to forego vaccination.

When the government eventually revoked the proof of vaccine policy for the public, and reversed the vaccine mandate for other government employees, the social worker thought she’d be called back. But despite the fact that she worked from home 2-3 days a week, and that she was willing to undergo regular testing on the days she was in the office, she was told she would not be given an accommodation, and would not be returning to work, unless she got vaccinated.

“Many of us who were placed on unpaid leave believe we are being punished,” she says.

As the bills started mounting, she cashed in thousands of dollars of RRSPs just to "keep afloat" and was not able to access Employment Insurance benefits—something she had paid into for 40 years—because she was categorized as someone who left her job "without cause." She says this forced her into early retirement.

She says her life has been “devastated.”

Chief Medical Officer of Health, Dr. Robert Strang, sent this memorandum to all health care providers on September 17, 2021, in advance of the proof of vaccine policy, which would bar anyone who wasn’t “fully vaccinated” from accessing what were deemed “non-essential” venues. The policy (and mandate for “high risk” settings) allowed exemptions for individuals who had “valid medical contraindications” against receiving COVID-19 vaccine. Photo submitted.

Foundational principles of medical ethics replaced with ‘coercion or threat,’ say workers on unpaid leave

I also spoke to a dietitian on administrative leave. She said that although her career spanned 36 years, the vaccine was not “worth risking her life over.” Her main concern was the principle of bodily autonomy and that no one should be “making decisions about what’s best for my body.” She was also concerned that at the time, the vaccine had only been authorized on an emergency use basis.

“I started hearing about the vaccine injuries and deaths and I did some research on adverse reactions and potential side effects of the ingredients,” she says.  

“I did not get vaccinated because I felt it was in my best interest not to.”

I also interviewed two younger nurses, again on the condition of anonymity. One of them graduated with a nursing degree in 2019, but already had a law degree and eight years heading up a non-profit organization.

She didn’t want to get vaccinated because she felt she couldn’t give informed consent.

“That is not achieved under duress, coercion or threat,” she says.

Worried that the “new [vaccine] platform had no long-term safety studies, and had possible short-term risks,” the nurse says she wanted to “err on the side of caution.” She describes how close family members have experienced adverse events: “My step mother got diagnosed with pericarditis after her second shot, and my father developed Guillain-Barré Syndrome after his second shot.” They both received medical exemptions for future COVID-19 vaccines, she says.

“Being on this unpaid leave has been devastating. I have not only lost out financially—still paying off my student loans and living on my line of credit—but mostly my mental health has deteriorated and I have lost my sense of self.”

Another young nurse I spoke to says she didn’t want the vaccine because she believes she was already vaccine injured from a flu shot and now has autoimmune disorders and high inflammatory markers. She also came down with COVID in January, 2021 and again in August. But the government won’t recognize natural infection, even though it’s been shown to offer long-term (though not permanent) natural immunity.⁷

Something experimental like the mRNA vaccines could have been very harmful for me. But when I learned about the mandate and that we’d be losing our jobs if we didn’t take it, I went into a really deep depression, having severe panic attacks, because I had all these finances to worry about. It’s a constant worry. I wanted to file a grievance, but the union [CUPE] denied it. But this is what I’m hearing from fellow health care workers who are in the same boat as I am: all the unions have been the same, and are not fairly representing us.

The nurse points out that immunity from the primary series wanes, and many health professionals who are still working had their shots early on in 2021.

“Technically, they’re not even vaccinated. So how come they can continue to work? It feels like control and punishment at this point.”

Struggling to get by, she had to find another job and could only find one that pays just above minimum wage. “That’s not what I went to school for. I worked hard to get where I am. Now I’m just left with a huge student loan, that I can’t afford. I've lost hope for my future and my children's future. This whole experience has taken that that hope away.”

NS Chief Medical Officer of Health, Dr. Robert Strang at a COVID briefing. 

How many are still on unpaid leave in Nova Scotia?

A Freedom of Information request dated November 7, 2022, that was previously released and is posted on the public portal site states that as of December 1, 2021, an estimated 1,379 government employees (1.9% of the total) were put on unpaid leave “across all sectors,” with 323 of them employed by Nova Scotia Health (NSH), 195 in long-term care, 96 in home care, and 6 in adult day programs. By February 10th, the release shows a decrease with 263 NSH employees and 148 long-term care employees on unpaid leave, representing 1.3% and 1.2% of the totals, respectively. Information for the IWK and other sectors (including home care, emergency health services, and Nova Scotia Hearing and Speech) were redacted, but the total as of February 10th in all sectors was 801.  

The only real update I managed to get for this article was from NSH, who said there are currently 127 nurses and other health care professionals on administrative leave as a result of the vaccine mandate.

According to the Public Service Commission, there are fewer than 5 employees in the civil service still on leave as a result of their vaccination status. According to Michelle Lucas, the managing director of Communications Nova Scotia, the number captures people who work directly for government departments (Justice or Community Services, for example). It doesn’t represent the broader public service. Lucas says employers would hold that information.

When I ask her who those employers would be, she says: “Employers that work with vulnerable populations under the protocol are responsible for following it and they would track HR information about their employees. There are many employers in long-term care…sometimes they are individual facilities (like Melville Lodge) and some may oversee several homes (like Shannex). I think unions may be interested in this information if their members are affected, so you could check in with NSNU, NSGEU and CUPE, but that will only get you a portion of the full picture.”

I decided to take Lucas’ advice and contact the unions to see what I could find out.

The Nova Scotia Government Employees Union (NSGEU) declined comment.

A spokesperson from the Canadian Union of Public Employees (CUPE) wasn’t able to tell me how many of their members were still on administrative leave due to the vaccine mandate. Grievances have been filed, she says, but this too was a number she couldn’t provide.  

Janet Hazelton is the president of the Nova Scotia Nurses’ Union. She says her union doesn’t have numbers for how many of their members are on administrative leave.

“We're not provided with any of that information. It's no different than how many nurses would be off with the flu or having surgery. The only leaves we’re told about are maternity leaves,” she says.

According to Hazelton the only numbers she’s aware of are the nurses who have filed a grievance. She can’t tell me that number because she says it’s so small that it would infringe on their privacy rights. Two of the nurses I spoke to said they filed grievances with their unions, but were denied. So, the number of grievances—even if Hazelton (or CUPE, or NSGEU) were to divulge it—wouldn’t provide the whole picture.

I ask Hazelton what her understanding is of the rationale for the mandate: “I'm assuming it's to keep both the patients and the nurses or the staff safe or safer. If they had the vaccine, they're less likely to get COVID, obviously, and if they're less likely to get it, they're less likely to give it to their patients.”

This is a subject we’ll return to.

She adds: “We still have as much or more COVID in our hospitals than we had and now most people are vaccinated. I've known lots of people, and I have many nurse friends, that have had COVID twice, at least twice, and some have had it three times.”

Hazelton says only the primary series was mandated for health professionals, not the booster.

I asked if the nurses’ union advocated on behalf of the nurses who didn’t want the vaccine by supporting their requests for accommodations, like undergoing regular testing. Given that both vaccinated and unvaccinated people can get and transmit the virus, testing and use of PPE seem to be a much more effective way of protecting vulnerable patients, I say. But Hazelton doesn’t really answer the question.

She says the unvaccinated nurses who were able to get an exemption and continue to work are in “work isolation,” which means they have to wear the full array of personal protective equipment (PPE) all the time.

I also ask her about the use of travel nurses and if the mandate was exacerbating that. Both the CBC and Saltwire recently reported that the province is spending tens of millions of dollars on private contract nurses because of the shortage, at least double the hourly wage of public sector nurses.

Hazelton replies:

The use of travel nurses has been a thing for a long time and it's because of the nursing shortage. I don't believe that that we have enough out [on administrative leave because of the mandate] that it would make a difference if they were all back. I don't think the numbers are that high. There are 1,600 [nurse] vacancies in this province so that's why they’re using travel nurses. Every province is the same. In the early nineties, we were telling governments, you have to increase the seats, you have to increase the seats or we're going to have a nursing shortage. Nurses’ unions have been saying this for a very long time. In the early nineties they laid off nurses. We were saying, ‘That's dumb, you shouldn't be doing that,’ and here we are.

We also have a lot of nurses leaving the profession because of violence. The amount of violence in health care is unacceptable. We have nurses off with mental health more than ever before. It was the stress of COVID. Over the last two years, we've been everything to patients. We've been their parents, we've been their children, we've been their only support because their families weren't allowed in. So, it's been really, really hard. Early on, nurses were scared. I had nurses sleeping in their RV's because they were so paranoid about taking the virus home to their families. It's just been a really, really rough two years. A lot of them just said, ‘Enough.’ We lost a lot of our senior nurses. We've always had a shortage but COVID exacerbated it.

I ask Hazelton if and when the mandate is revoked, will the union try to negotiate back pay for the nurses. “I'm not sure. It would depend on how they took them back and what the rationale would be. I would have to seek a legal opinion because I wouldn't do something unless I knew it was going to have some reasonable success.”

One of the three nurses interviewed for this piece said that even though it’s just making the news now, use of contract or “travel” nurses isn’t anything new: “Everyone keeps going on about, ‘Make sure you get vaccinated because you don’t want to overrun the hospitals.’ I’m sorry, but that’s garbage. Our hospitals have been overwhelmed for years now.”

The nurse tells me that it all started when they closed the Registered Nursing schools across the country, replacing them with a smaller number of university bachelor programs, that are not only longer programs, but graduate fewer nurses. 

“So now there’s not as many nurses, and we’ve got an aging population… and everyone acts like it’s a big surprise. When I worked in the hospital during COVID, that’s the least amount of people I’ve ever seen in the hospital. I’ve never seen it so empty. So, to say it was overwhelmed because of COVID, that’s not true. But nobody’s allowed to talk about it, even though we can see it.”

The nurse tells me that even if the vaccine mandate is dropped, she won’t be returning to her job.

I ended up diagnosed with depression in the past year and the psychologist who diagnosed me feels it’s related to not being allowed to work and being told I’m ‘dirty,’ not being allowed to go anywhere, being shamed for not getting vaccinated, told I don't care about my patients. For anyone who says, ‘You had a choice, now deal with the consequences,’ there was no choice. There was coercion and threats but no choice.

Kevin Bardosh, professor at the School of Public Health, University of Washington. Photo submitted.

Kevin Bardosh is the corresponding author of a now peer-reviewed study published in the British Medical Journal. I interviewed him for the aforementioned two-part series “In the Fog of COVID-19” when his study was still a pre-print. Bardosh and his co-authors hypothesize that punitive measures, such as vaccine mandates, which were implemented in tandem all over the world, could turn out to be counterproductive, causing damage to public health, rather than the other way around. 

The paper lists a number of possible long-term impacts from vaccine mandates including how they can actually backfire and lead to a reduction in the uptake of future public health measures, including routine vaccinations. Also, mandates and proof policies that restrict access to employment, education, and civic life impinge on human rights and “promote stigma and social polarization,” which in turn adversely affects health and wellbeing. The paper cautions that measures like mandates should be “used sparingly and carefully to uphold ethical norms and trust in scientific institutions.” Ultimately the paper calls for an evaluation of these consequences.

As touched on earlier, many of the concerns held by those who chose not to be vaccinated were legitimate ones. This is from the BMJ paper: 

Unvaccinated or partially vaccinated individuals often have concerns that are based in some form of evidence (e.g. prior COVID-19 infection, data on age-based risk, historic/current trust issues with public health and governments, including structural racism), personal experiences (e.g. direct or indirect experience of adverse drug reactions or iatrogenic injuries, unrelated trauma, issues with access to care to address adverse events, etc.) and concerns about the democratic process (e.g., belief that governments have abused their power by invoking a constant state of emergency, ignoring processes of public consultation, and over-relying on pharmaceutical company-produced data in their decision-making) that may prevent or delay them from choosing to vaccinate.

All of the people I spoke to—3 nurses, one dietitian, and a social worker—expressed at least one of these concerns.

In his 2022 book Pandemic Surveillance, Queen’s University professor, David Lyon pointed out that in the United Kingdom during the pandemic, the Equalities and Human Rights Commission warned that being obliged to carry a COVID-vaccine status certificate could “easily produce” a “two-tier society,” maybe even a “two-tier world” based on the “visibility produced by the data.” Lyon, who is also the director of the Surveillance Studies Centre, writes that such measures could “further exclude groups whose take-up rate is lower, including migrants, those from ethnic minority backgrounds, and lower socio-economic groups.”

The key point Lyon is trying to make here is that measures, such as vaccine passports and by extension, mandates, make people “more visible” and this visibility would “have an impact on the lives of such groups.”

Most of the people I spoke to for this piece expressed concerns about how they’ve been made visible by the mandates, ostracized by their colleagues and others in their communities. For them, their health information is not private and it’s been used against them.

Lyon also points out that while there are many variations on the “vaccine passport,” they all required health, personal ID data, plus in many cases a “digital wallet” that could “present the credential in the form of a QR code.”⁸ He argues that in addition to “worries about the privacy and security of such innovations, must be added challenges of inequity, discrimination, exclusion and stigmatization.”

Furthermore—and this point has a great deal of bearing in the case of the unvaccinated still on unpaid leave—“the idea of an ‘immunity’ passport suggests that those who carry one are ‘safe,’ but this simplistic binary hides many subtleties. For one thing, no one knows, at present, how long the effects of the vaccines will last. We are talking ‘tendencies’ toward safety; these are soft—in no sense hard—distinctions,” Lyon writes. 

Recently, Bardosh echoed this point, stating that vaccines “did not durably stop transmission,” and that the effect of the vaccines waned after a few months. He also notes that clinical outcomes from COVID-19 infection was “strongly based on age and health status,” that “safety signals in young people, including myocarditis, complicated universal recommendations, and that prior infection “provided strong protection against reinfection.”

“This was all known before mandatory Canadian policies began,” writes Bardosh.

David Lyon, director of the Surveillance Studies Centre at Queen’s University. Screen shot taken from video, “Personal Data, Surveillance and Contagion.”

Mandatory vaccines should result in even ‘stronger protections for those individuals who experience consequences that lead to permanent harm,’ say experts

In the spring of 2021, around the same time that there had been rumblings across the country that a vaccine “passport” might become part of the strategy to deal with the pandemic, the scientific justification, legality, and ethics of such a move were being analyzed by civil liberties experts, as well as Canada’s privacy commissioners. In a joint statement about vaccine passports, the commissioners stated that in order for them to be justified, they must be necessary to achieve their intended public health purposes and they also had to be continually monitored to ensure they continue to be justified. In other words, there must be evidence of their effectiveness.

At the time that the mandate was imposed, between 89 % and 99% of employees in key sectors had provided proof of vaccination. “I’m encouraged by the rates so far and I want to thank all of the employees who are vaccinated and doing their part to keep the vulnerable people they work with safe from COVID-19,” said Premier Tim Houston in a release.

Keeping vulnerable people safe from COVID-19 would seem to be the “intended public health purpose,” in this case. 

But at that point in the pandemic – early November of 2021 – before the OMICRON variant emerged on the scene, we already knew that vaccine efficacy of the primary series was waning, and that fully vaccinated individuals with DELTA breakthrough infections could efficiently transmit the virus, including to fully vaccinated contacts. It seemed like a stretch to make the claims that a) mandates and proof policies that exclude the unvaccinated were creating anything close to virus-free spaces; or b) getting vaccinated would protect others.

Furthermore, as already mentioned, noticeably absent from the discussion at the time (or now, for that matter) was the role natural immunity might play in protecting individuals who had already been infected with the virus. It is now known that antibodies can persist for up to a year after natural infection. It has also been estimated, using infection-acquired seroprevalence studies, that more than 70% of Canadians have now been infected at least once with SARS-CoV-2. In Nova Scotia, it’s closer to 65%, where the rate of increase during the OMICRON wave was much higher than in other jurisdictions.⁹

Another recent study indicates the initial 2-dose series—which is all that’s required for those in “high risk” settings here in Nova Scotia—may not be very effective against the OMICRON variant.

This also begs the question of why the government didn’t require workers in “high risk” settings to keep up to date on their vaccinations, given the evolution of variants, and the availability of booster doses: there are now 3 boosters—including the latest bivalent one by Moderna. The government policy lacks coherence, and the department is unwilling to provide any indication of the science it might be rooted in.

We also know a bit more now about how risk—from COVID the disease and from the vaccine— is distributed in the population. A recent study in the journal Vaccine, sheds some light on this by looking at what’s publicly available from Pfizer and Moderna’s randomized trial data, and concludes “the excess risk of serious adverse events [from mRNA vaccination]… points to the need for formal harm-benefit analyses, particularly those that are stratified [by age and demographic group] according to risk of serious COVID-19 outcomes.”

Knowing there are real risks—even if they are rare—means informed consent cannot be a step that is bypassed.

An essay that was recently published in the Journal of Medical Ethics argues that university policies that mandate COVID-19 boosters for young adults must undergo a risk benefit assessment as well as an ethical analysis. The issues raised by the authors—a team of bioethicists, epidemiologists, legal scholars and clinicians—while specific to universities, are also very relevant to the subject at hand: what are the ethics of enforcing vaccines as a precondition of employment?

The authors make the case that mandates are unethical for the following reasons:

“1) They are not based on an updated (Omicron era) stratified risk-benefit assessment for this age group;

2) They may result in a net harm to healthy young adults;

3) They are not proportionate: expected harms are not outweighed by public health benefits given modest and transient effectiveness of vaccines against transmission;

4) They violate the reciprocity principle because serious vaccine-related harms are not reliably compensated due to gaps in vaccine injury schemes; and

5) They may result in wider social harms.”

Furthermore, the paper makes three salient points that are worth touching on here. The first deals with proportionality, which is a key principle in public health ethics.

“To be proportionate, a policy must be expected to produce public health benefits that outweigh relevant harms, including harms related to coercion, undue pressure, loss of employment and education and other forms of liberty restriction.”

Second, vaccine requirements should be based on age-stratified and sex-stratified risk-benefit analysis and should also consider the protective effects of prior infection.

The essay acknowledges that a standard ethical argument in favour of vaccine mandates has been the protection of others. But in such a case, the vaccine would have to prevent transmission.

“Yet it is increasingly clear that current vaccines provide, at most, partial and transient protection against infection, which decreases precipitously after a few months, with limited effects on secondary transmission,” write the authors. Even the US Centre for Disease Control and Prevention (CDC) states, "anyone with Omicron infection, regardless of vaccination status or whether or not they have symptoms, can spread the virus to others."

A third point the authors make that I’d like to highlight here, is that of reciprocity. They argue that mandatory vaccines should result in even “stronger protections for those individuals who experience consequences that lead to permanent harm, because their free choice regarding vaccination has been limited.” But a “functioning and fair” COVID-19 vaccine injury compensation programme does not currently exist, they write.    

Canada’s privacy commissioners were clear: vaccine requirements “must be decommissioned if, at any time, it is determined that they are not a necessary, effective or proportionate response to address their public health purposes.”

I think at this point in the pandemic, it’s  0 for 3.

1. In early October of 2021 the Department of Health and Wellness (DHW) updated the vaccine mandate to include provincial correctional services and the regulated child-care sector. Those who were partially vaccinated by the November 30 deadline could be subjected to other health and safety measures, including testing.

2. For more on the sensitivity of skin testing for allergies to PEG/ polysorbate: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8324467/

3. Meriam Webster dictionary defines anti-vaxxer as “a person who opposes the use of some or all vaccines, regulations mandating vaccination, or usually both.”

4. Here is the list of questions I sent to the Nova Scotia Department of Health and Wellness. None of the questions were answered:

1.     What is the government basing the vaccination protocol on, which deems those with only a primary series safe around “vulnerable citizens,” — when at this point the primary series (by pretty much all scientific accounts) would be highly ineffective at either stopping infection/ transmission or reducing severe outcomes?

2.     Why doesn’t the government recognize prior COVID infection (natural immunity) among health care professionals as another way of achieving immunity?

3.     How many nurses and other health care professionals are currently on administrative leave as a result of the vaccine mandate?

4.     The “protocol” you provided in the earlier email makes a number of assertions about infectivity and transmissibility of COVID by vaccination status (primary series). Can you provide me with the scientific studies or references these assertions are based on?

5. The mandatory vaccination protocol for high-risk settings applies to:

• Hearing and Speech Nova Scotia

• workers in residential care facilities and day programs funded by the Department of Community Services (Disability Support Program) and adult day programs funded by the Department of Seniors and Long-term Care

• workers in Department of Community Services facilities and people providing placements for children and youth in the care of the Minister of Community Services (excluding foster family placements)

• paramedics, LifeFlight nurses and some staff at Emergency Health Services (EHS)

• correctional officers, youth workers, staff volunteers, contractors and service providers who work in or provide service to adult and youth correctional facilities

• physicians and other service providers to organizations that are required to follow the COVID-19 Protocol for Mandatory Vaccination in High-Risk Settings (PDF) (like hairdressers and contractors)

6. To get a sense of the variety of adverse events reported for the Pfizer/ BioNTech’s COVID-19 vaccine (BNT162b2) as of February 28, 2021, go to the company’s “Cumulative Analysis of Post-authorization Adverse Event Reports.”  Pfizer’s safety database is limited in its scope, as it only contains cases of adverse events “reported spontaneously to Pfizer, cases reported by the health authorities, cases published in the medical literature, cases from Pfizer-sponsored marketing programs, non-interventional studies, and cases of serious AEs reported from clinical studies regardless of causality assessment.” The report itself notes the post-marketing adverse drug event reporting has limitations including: the reports are submitted voluntarily and therefore “the magnitude of underreporting is unknown.” It notes that some of the factors influencing whether an adverse event is reported include: “length of time since marketing, market share of the drug, publicity about a drug or an adverse event, seriousness of the reaction, regulatory actions, awareness by health professionals and consumers of adverse drug event reporting, and litigation.”

It should also be noted, the Pfizer report doesn’t include self-reported adverse events, such as those that would be included in the Vaccine Adverse Event Reporting System (VAERS) in the US, which will accept a adverse event report from patients, parents, caregivers and healthcare providers.

The Pfizer document notes in Table 7 that up to that point in time (Feb. 28, 2021), adverse events of special interest included anaphylactic reactions, cardiovascular events, dermatological events, haematological events, hepatic (liver) problems, facial paralysis, immune-mediated/ autoimmune events, musculoskeletal issues, renal issues, neurological events, thromboembolic events, stroke, and pregnancy-related events. See the appendix (pages 30-38) for an alphabetical list of “adverse events of special interest.” 

Here in Canada, the Public Health Agency of Canada (PHAC) maintains a health-infobase on “reported side effects following COVID-19 vaccination.” Serious and non-serious adverse reactions are presented by vaccine, and by age and sex. Thrombosis with thrombocytopenia syndrome (following an AstraZeneca shot) and myocarditis and pericarditis (following vaccination with an mRNA vaccine) are listed as “adverse events of interest.” Unlike the VAERS in the US, PHAC does not accept reports by affected individuals or their family members. Reports of adverse events are only accepted from health care professionals (doctor, nurse, pharmacist).

7. Numerous studies and papers suggest that natural immunity and vaccine-induced immunity for COVID-19 are broadly comparable. For further reading here is a selection:

SARS-CoV-2 Natural Antibody Response Persists for at Least 12 Months in a Nationwide Study From the Faroe Islands, Infectious Diseases

Comparing SARS-CoV-2 natural immunity to vaccine-induced immunity: reinfections versus breakthrough infections, Clinical Infectious Diseases

Differential effects of the second SARS-CoV-2 mRNA vaccine dose on T cell immunity in naïve and COVID-19 recovered individuals, Cell Reports

The unnaturalistic fallacy: COVID-19 vaccine mandates should not discriminate against natural immunity, Journal of Medical Ethics (British Medical Journal)

8. Here in Nova Scotia, they were called “proof of vaccine,” but in other places they were referred to as “immunity passports,” “vaccine passports,” and mysteriously, “green passes.”

9. According to the COVID-19 Immunity Taskforce: “Infected individuals respond by making antibodies against multiple viral proteins, including the nucleocapsid and the spike proteins. In North America, all vaccines currently approved and in use are based on the spike protein and its receptor binding domain. Thus, when an individual has antibodies that recognize the nucleocapsid protein, it can be interpreted as a sign of past infection. In contrast, when an individual has antibodies that recognize the spike protein, it could be due to either vaccination or infection.”