The unintended consequences of COVID-19 vaccine policy: why mandates, passports and restrictions may cause more harm than good

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The BMJ

Since 2021, mandatory proof-of-vaccination policies have been implemented and justified by governments and the scientific community

to control COVID-19. These policies, initiated across the political spectrum, including in most liberal democracies, have spread glob- ally and have involved: workplace mandates (eg, a ‘no jab, no job’ US federal mandate); green passes/vaccine passports that limit access to social activities and travel (eg, Israel, Australia, Canada, New Zealand and most European countries); school-based mandates (eg, most North American universities); differential lockdowns for the unvaccinated (eg, Austria and Australia); the use of vaccine

metrics in lifting lockdowns and other restrictions (eg, Australia, Canada and New Zealand); differential access to medical insurance and healthcare (eg, Singapore); and mandatory population-wide vaccination with taxes, fines, and imprisonment for the unvaccinated (eg, the Philippines, Austria, Greece) (see table 1).

The publicly communicated rationale for imple-menting such policies has shifted over time. Early messaging around COVID-19 vaccination as a public health response measure focused on protecting the most vulnerable

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