(Image: Mitchell Squire/Private Media)

Mandates exist everywhere in our lives. You wake up in your house built in line with a mandated code, perhaps paid for with rent and a mandated bond submitted to an independent authority.

You might drive a car with your mandated insurance, using your mandated driver’s license, and drop your kid off at public day care, where it’s mandated they’re vaccinated under a “no jab, no play” policy, or at school, which follows a mandated curriculum.

You go to work in your mandated dress code, eat food from a store that adheres to mandated health codes and cross the road at the mandated pedestrian crossing.

Maybe after work you go to a pub or a concert, where you have to adhere to mandated behaviour codes — dress correctly, don’t be abusive to staff, don’t get too drunk. 

Refusing to adhere to these mandates can result in you being refused entry or kicked out, being fired from your workplace or even being thrown in jail.

But when it comes to medical mandates, like those being pushed for COVID-19 vaccines, many balk at the idea of being told what to put in their body. Why is the reaction to mandated medicines so visceral — and are they fair? 

A short list of existing medical mandates

  • The “no jab, no play” policy removes entitlements and childcare subsidies from unvaccinated families
  • Health workers are required to be protected from most diseases, including receiving annual influenza shots
  • Arrivals in Australia have to hold an international vaccination certificate if they’ve stayed overnight or longer in country designated to be yellow fever infected. Many countries require similar proof of vaccination to secure a visa
  • Plumbers have to be up to date on their Hepatitis B vaccinations.

What makes medical mandates different?

Australia is a pretty compliant country. We have one of the highest childhood vaccination rates in the world, partly thanks to the “no jab, no play” policy.

While hesitancy is higher for COVID-19 vaccines than other vaccines both in Australia and around the world, many support government mandates. One study found 66% of Australians will take a COVID-19 vaccine voluntarily, while 73% agreed the government should require a COVID-19 vaccine for work, travel and study. 

But that doesn’t mean there hasn’t been a backlash to even discussions of a vaccine mandate outside of clinical settings. La Trobe University social psychology lecturer Dr Mathew Marques told Crikey there is a backlash any time a mandate is introduced, from when smallpox vaccines became mandatory in England in the late 19th century, to banning smoking indoors, to “no jab, no play”. 

When it comes to medical mandates, Marques said, people confuse rights with privileges. Having a mandated driver’s license to drive is a privilege, as is living in a society without community spread of COVID-19 due to vaccination rates. 

“There does seem to be by some people this kind of reaction that ‘it’s my body and therefore my choice’,” he said. 

“But at the same time, you’re weighing up an act that would be in the public good against what may be an individual freedom or liberty that may counteract that public good.” 

But, he stressed, the backlash is usually among a small minority of people. 

There’s a lot more to be done before mandates can be introduced 

Senior lecturer at the School of Public Health and Community Medicine at the University of NSW Dr Holly Seale told Crikey there was a lot more work to be done before public discussions about vaccine mandates can take place. She said while most people support vaccine mandates in clinical settings, such as for health and aged care workers where there’s a duty of care, more wide-ranging mandates were uncharted territory. 

“The use of the mandate really needs to be carefully considered about whether or not that is the most appropriate way forward,” she said. 

“Is the risk to the employer or employee sufficiently high to warrant going down the path of a mandate, or are there better ways to go about getting the support of vaccine acceptance?”

It’s also too early to implement mandates given that the preferred vaccine is not available to many people, while others have struggled to navigate the vaccine booking system or get an appointment, Seale said. 

When companies are discussing vaccine mandates, Seale said it would be crucial to have end-users in the room talking about their appetite, and ways to design and implement a strategy. Another key concern is enforcing mandates — staff have to be trained to deal with confrontation, and there has to be a way of checking who is vaccinated or not. 

“If we do introduce policies that haven’t really been thought through from both the consumer, the end-user, but also the company who’s responsible for overseeing it, that’s really when we’re going to have problems,” Seale said.