Some unvaccinated Australians won't be able to browse in the shops until 2023. That's a worry

Unvaccinated Victorians have a grace period of about three weeks to go on a shopping spree before they’re no longer permitted to enter non-essential retail^[1] from November 24, according to the state’s roadmap out of restrictions.

The roadmap^[2] says all retail is now open to everyone after Victoria hit the 80% double-dose milestone last week. However, when it hits the 90% milestone, those who aren’t yet vaccinated won’t be allowed into non-essential retail, and stores will be responsible for policing this.

Premier Daniel Andrews warned unvaccinated Victorians could continue to be locked out “for the entirety of 2022^[3]”. By contrast, New South Wales is set to allow non-essential retail for unvaccinated people from December 1^[4].

Ethically, the situation in Victoria is a problem, especially when the state’s vaccination rates are so high.

Vaccination clearly the right thing to do

There’s little doubt vaccination against COVID is a proportionate and morally good thing to do. The most important reason for this is the vaccines have proven effective^[5] in reducing severe illness and death.

This has two consequences. First, if you’re vaccinated, even if you do contract the virus, you’re at much lower risk of severe disease and hospitalisation.

Second, if you only have a mild infection, you don’t end up needing costly, intensive and potentially long-term treatment. This alleviates the burden on the health system, making more resources available for people with other serious conditions.

Read more: How well do COVID vaccines work in the real world?^[6]

Excluding unvaccinated people not justified

Despite the clear reasons for why one ought to get vaccinated, it’s conceivable a person has other objections to vaccination (apart from medical reasons^[7] that would make vaccination a bad idea for them).

So, the question arises about what kinds of force, especially by states, are morally acceptable. When do the limitations on a person’s freedom of movement or association go too far, morally speaking?

Read more: Lockdown returns: how far can coronavirus measures go before they infringe on human rights?^[8]

The answer can be a movable feast because it depends on what we know about the virus and vaccines as much as on ethical reasoning.

In the current circumstances, however, it would seem excluding unvaccinated people from non-essential retail is not morally justifiable.

First, there’s the obvious contradiction in allowing unvaccinated people to access retail at 80% vaccination rate and not at 90%. Then one needs to consider the actual risk to vaccinated people and to the health system that allowing unvaccinated people access to non-essential retail would entail.

While vaccines reduce the risk of infection^[9] and more importantly the risk of severe illness, Delta transmission can still occur even among a vaccinated population.

UK research, published recently in medical journal The Lancet Infection Diseases^[10], found vaccinated people who caught Delta were similarly likely^[11] to transmit to their household members as unvaccinated people. Each infected about a quarter of their household.

A recent Dutch pre-print^[12], which is yet to be independently verified, found 12-13% of household members of a fully vaccinated person, who tested positive for COVID during a time of Delta dominance, also tested positive for the virus regardless of whether the contacts were vaccinated or not. This is about half of what the UK study reported, which is a discrepancy that arises from differing methodologies.

The point, however, is clear. In a shop where everyone is vaccinated, if one of those vaccinated people has the virus, these two studies suggest they’re just as likely to infect vaccinated people as they are to infect unvaccinated people.

The Dutch study also showed only 11% of vaccinated household contacts were infected from an unvaccinated index case. This means vaccinated people in a retail space don’t seem to be more at risk of contracting the virus from unvaccinated customers if they themselves are fully vaccinated.

It’s worth noting, though, these studies measured spread of the virus within households, and it’s not entirely clear how this would play out in retail spaces. One would expect, however, that because households tend to include longer and closer exposure, the rates of transmission would be lower still in retail spaces.

Read more: How contagious is Delta? How long are you infectious? Is it more deadly? A quick guide to the latest science^[13]

Nevertheless, these studies suggest that the risk of contracting the virus is primarily borne by the unvaccinated person. According to the Dutch study, the unvaccinated person is twice as likely as a vaccinated person to contract the disease from another unvaccinated person, than from a vaccinated person. And, as has been well-established, unvaccinated people are at higher risk of severe disease or death^[14].

In other words, vaccinated people in a restaurant or shop don’t seem to have anything more to fear from an unvaccinated person than a vaccinated person.

The unvaccinated person, by contrast, should be wary of contact with anyone.

It’s unvaccinated people who carry the risk

What becomes relevant from an ethical point of view in the situation Victoria finds itself in is an estimate of what the likely burden will be on the health-care system of very sick, unvaccinated people.

And, whether that outweighs the real challenges to individual choice and risks of social division and stigma, as well as the moral and emotional burden on often low-paid and young workers in retail and hospitality who would have to police people’s vaccination status^[15].

Read more: Soon you'll need to be vaccinated to enjoy shops, cafes and events — but what about the staff there?^[16]

It would be interesting if someone were able to conduct a prospective study to see whether there’s a significant increase in severe disease amongst unvaccinated people in the next three weeks since the 80% target was hit and retail is open to all.

With high vaccination rates the emphasis should still be on communicating the benefits of vaccination, both for the individual and for others. This continues to appropriately respect individual autonomy. It’s morally acceptable to require vaccination in high-risk settings, such as for health and aged-care workers^[17].

However, blocking access to retail or restaurants for unvaccinated people goes too far given the risk primarily carried in the current situation seems to be their own. If vaccination rates were very low, or the disease more deadly, such measures could be necessary. But this seems unnecessary at a rate of 90% vaccination expected soon in Victoria.

That said, those who choose not to get vaccinated still have a moral obligation to take other precautions against contracting or transmitting the virus, such as wearing masks, social distancing, checking in, staying home if they’re unwell, and getting tested.

To not do so would be to act in a morally irresponsible way.

References

1. ^{^} no longer permitted to enter non-essential retail (www.theguardian.com)
2. ^{^} The roadmap (www.coronavirus.vic.gov.au)
3. ^{^} for the entirety of 2022 (www.afr.com)
4. ^{^} December 1 (www.nsw.gov.au)
5. ^{^} proven effective (theconversation.com)
6. ^{^} How well do COVID vaccines work in the real world? (theconversation.com)
7. ^{^} medical reasons (theconversation.com)
8. ^{^} Lockdown returns: how far can coronavirus measures go before they infringe on human rights? (theconversation.com)
9. ^{^} reduce the risk of infection (www.thelancet.com)
10. ^{^} published recently in medical journal The Lancet Infection Diseases (www.thelancet.com)
11. ^{^} similarly likely (www.theguardian.com)
12. ^{^} A recent Dutch pre-print (www.medrxiv.org)
13. ^{^} How contagious is Delta? How long are you infectious? Is it more deadly? A quick guide to the latest science (theconversation.com)
14. ^{^} higher risk of severe disease or death (www.cdc.gov)
15. ^{^} workers in retail and hospitality who would have to police people’s vaccination status (theconversation.com)
16. ^{^} Soon you'll need to be vaccinated to enjoy shops, cafes and events — but what about the staff there? (theconversation.com)
17. ^{^} health and aged-care workers (theconversation.com)