A recent consultation from the Department of Health has left some people asking if vaccines will be mandatory. The short answer? Maybe, maybe not, it depends. And, if it does happen, it would only be in special circumstances. If you’re curious about what this means – and what it doesn’t mean – read on.
Should Stormont force people to take vaccines?
This has been a hot topic in recent weeks. Politicians have raised this matter in the Assembly. Similar questions have done the rounds on social media and been debated by journalists.
The discussion hinges on proposals for a new Public Health Bill that is considering measures around mandatory vaccinations, among many things.
But what exactly is being proposed, and what is the timeframe for any changes?
- Consultation
Public consultations are a standard part of changing policies and creating new legislation. They provide an opportunity for members of the public, businesses, professional bodies, trade associations, experts, campaigners or just about anyone to give their views on a set of proposals.
Consultations gather feedback, opinions, and evidence. Consultations are not a vote. They are not something any given side of a debate can win. Instead, they are a chance to raise issues and explore options.
When it discussed this matter on 11 October, BBC Radio Ulster’s show Good Morning Ulster suggested there was already firm opposition to “this draft public health bill”.
That’s not really correct. As yet, there is no draft bill – but there is going to be one eventually, and this consultation itself said it was seeking “views on specific policy proposals that will underpin the provisions to be included in the Bill.”
So, what exactly does it say?
- Forced vaccinations?
In his foreword to the consultation, Health Minister Mike Nesbitt wrote:
“A review of the current Public Health Act (Northern Ireland) 1967 highlighted the need to update our public health legislative framework in order that Northern Ireland can respond to 21st century public health emergencies.
“The overarching principle of the draft Bill is to protect the population against various forms of infection and contamination including biological, chemical and radiological, in addition to infectious diseases, which is the focus of the 1967 Act.
“This all hazards approach will enable broader surveillance, supporting more timely and effective interventions, controlling the further spread of infection and contamination generally and if needs be, in an emergency…
“This consultation sets out the proposals which will underpin a new health protection legislative framework for Northern Ireland, and which are based on the recommendations of the Review of the 1967 Act and learning from recent public health emergencies.”
The consultation proposes that the new bill, when drafted, will:
- be based on the all-hazards approach, in alignment with other UK jurisdictions, for the protection of people from known or yet to be discovered hazards, infections or contamination;
- update certain powers around restrictions on employment, quarantine, isolation and medical examination;
- clarify roles and responsibilities for different authorities; and
- provide underlying human rights based principles under which powers of intervention would be exercised.
“Powers of intervention” – these are perhaps the key words. Such interventions could include seizure of contaminated goods, forced quarantine of individuals and, yes, mandatory vaccinations.
If anyone wants to dive deep into the consultation, the whole thing is here. It runs to 79 pages so, while it’s not exactly a quick read, it is manageable – but still contains too much information for an article like this to cover every single detail.
Instead, to illustrate the tone and content of the document, this explainer will focus on one issue that has generated so much discussion: vaccinations.
- Jabs
The words vaccination and vaccinated only occur five times throughout the document.
The first two appearances are in a section discussing possible new public health powers the Department of Health believes are needed to update the old 1967 Public Health Act.
Under the subheading “Restrictions/ emergency powers”, the consultation states that domestic regulations “may be made for the purposes of preventing, protecting against, controlling or providing a public health response to the incidence or spread of infection or contamination in Northern Ireland”, before listing several requirements that could amount to a “special restriction or requirement” imposed on an individual, including:
- require a person to vaccinated [sic] or to receive other prophylactic treatment
The document then states:
“The second mention of the Specific provision will be made prohibiting regulations that impose or enable the imposition of a requirement that a person undergoes medical treatment. Medical treatment does not include vaccination and other prophylactic treatment.”
The remaining references to vaccines come under the subheading “Limitations: Regulations imposing restrictions or requirements”. On matters of domestic health, it says:
“Regulations that include provision imposing a requirement on persons to be vaccinated or to receive other prophylactic treatment must:
- provide for exemptions from that requirement; and
- include provision about how a person who is entitled to an exemption is to evidence that entitlement.”
On international travel regulations:
“Regulations made under this suite of provisions (international travel) may not include provision requiring a person to undergo medical treatment. Medical treatment does not include vaccination and other prophylactic treatment.
Regulations that include provision requiring persons to be vaccinated or to receive other prophylactic treatment must:
- provide for exemptions from that requirement; and
- include provision about how a person who is entitled to an exemption is to evidence that entitlement.”
And that’s it. That’s every mention of every derivation of the word vaccine contained in the entire document.
- Central argument
When it comes to vaccinations, the document is light on details – very light, in fact, in that it doesn’t really have any.
The consultation draws a distinction between vaccines and other medical treatments more generally (which it says will not be made mandatory). However, is not the main issue of substance.
The document says that there may be occasions whereby a person or persons will be forced to take a vaccine. It also says that, in such cases, there must be certain exemptions from that requirement, and that the process whereby a person can show they are exempt must be laid out in law, and that “the regulations must provide for a right of appeal to a court of summary jurisdiction against any decision to impose a special restriction or requirement.”
A weakness of the consultation is that it does not say is what those cases might be or provide much specific detail about what any exemptions might be.
However, as mentioned above, the consultation begins by saying these proposals must “provide underlying human rights based principles under which powers of intervention would be exercised.”
More on that later.
- Closed
The consultation closed on October 14. Officials – and, of course, the Health Minister – will now sift through all the responses and consider them when developing the policy.
However, that does not mean the public has no more say in what happens. Public policy exists in a constant state of possible query and revision. There is a word for how this continuous appraisal is carried out: politics. That will include debate in the chamber and in committee rooms as the bill attempts to navigate the many stages between its introduction and achieving Royal Ascent.
As you’ll see below, since the closure of the consultation this issue has been raised by elected representatives from different parties. Expect those discussions to continue. And, if you want to raise your voice in support of or opposition to some or all of what is being proposed, you can and should contact one (or more) of your local MLAs.
The closure of this consultation does not represent the final closing of a door. As mentioned above, this wasn’t even the first consultation on an updated Public Health Bill. The first one, Review of the Public Health Act (Northern Ireland) 1967 (as noted by the Health Minister in his foreword quoted above), resulted in 18 recommendations which provided the framing for the recent consultation.
The previous consultation took place in 2015, so this particular piece of legislation is not exactly motoring through Stormont (albeit the Executive collapsed for three years at the start of 2017 and had to deal with the pandemic almost immediately upon its return, so there are some big reasons for any delays).
Therefore, while this part of the legislative process is over, the debate over the new bill has not ended. And, given the range of political attention the consultation itself received, this discussion could easily continue for another year or more.
- Stormont
On 15 October, during a questions session with the Minister of Health, SDLP MLA Colin McGrath asked Mike Nesbitt “in light of the significant number of objections to the public health Bill, the consultation on which closed yesterday, to detail what weight will be placed on the responses received”?
In his response, the Minister said:
“I have not yet had a briefing on the number of responses, so I am not even aware of that, never mind whether they are positive or negative. I am aware of the strong campaign against some of the proposals. I re-emphasise that, because we are moving from the 1967 Act, which gave cover only for a number of infectious diseases, to all-hazards protection, which includes biological, chemical and radiological hazards, I felt that it was important to put all the options on the table for a public consultation. It is not for me to decide in advance that I will rule out any option. Indeed, had I not included some of those options, there might have been another campaign to ask why I had not done so.
“I point out to those who think that some proposals are draconian that the 1967 Act already provides for a magistrate’s order that a person suffering from a notifiable disease that presents a serious risk to others can be removed or detained in hospital for a specific period. It empowers authorised officers to “do all acts necessary” to give effect to that order…
“No Bill has been written, and the Bill’s composition will be dictated to an extent by the public’s reaction to that consultation process. However, it will also be up to the Assembly and the Committee for Health to decide the shape of the Bill. Again, I do not feel that I am the only person making decisions here.
“I shall use the consultation to try to shape the Bill. You know that I am personally not in favour of forced vaccinations, but it happens. During COVID, for example, over-50s in Italy were subjected to forced or compulsory vaccinations. I will shape the Bill as I feel best, but I will bring it to the Chamber and to the Committee, and I will ask you to help me to shape it so that we get the right balance between protecting population health and upholding human rights and personal liberties.”
More recently, the Minister has also answered some relevant written questions from DUP MLA Stephen Dunne.
The first question, answered on 21 October, asked the Minister “to detail his Department’s expected timescale for the review of findings from the public consultation on policy proposals to inform the development” of the new bill. The Minister was unable to provide a timeline, saying:
“My Department have received a high volume of responses to the public consultation… the process to consider the responses has commenced, the timeframe to complete this review, given the high volume of responses, is still under consideration at this early stage.”
Answering a second question from Mr Dunne, the Minister referenced a factfile published by DoH on 4 October about the consultation’s aims.
That factfile is a short read in which the Department acknowledges the “significant interest” in this consultation and also what it describes as “some misunderstandings” that have “developed around some aspects of the consultation.” It also states:
“As the public consultation makes clear, there would be significant safeguards to protect individual rights. A magistrate’s court order would be required for a wide range of actions including entering a dwelling, requiring a person to undergo a medical examination, be kept in isolation or remain in hospital.
“Existing legislation already enables an application to be made for a magistrates’ court order to require that a person who has an infectious disease be removed to hospital or detained there or not to carry on or participate in any trade, business or occupation.
“The Health Minister has stated publicly that he does not favour any mandatory vaccination powers being introduced. This option has been included in the public consultation to give people the opportunity to have their say. It will be for the Minister to decide what would be included in the Public Health Bill that goes to the Executive and Assembly.”
Anyone who has read this far in this explainer might also want to read that factfile in full.
- Rights review
As currently formulated, human rights are are held in tension with each other.
The question is balance. Sometimes, in a given situation, one right can take precedence and win out entirely. At other times, there is compromise.
This matter is about rights concerned with individual liberty versus rights concerned with broader public health (noting that the public, en masse, is comprised of a great many individuals).
Where should the balance be between someone’s right to choose their own healthcare and people’s right to exist in space where public health is protected? This is a tricky question to answer (and you won’t find one in this article).
Vaccinations are always an exercise in personal health – but can be seen to contribute to general public health by reducing or even eliminating the spread of disease.
In a fact check from earlier this year, we outlined both how Northern Ireland’s rates of measles vaccinations have fallen below recommended levels and how NI saw its first case of the disease since 2017. Put simply, there are times when one person getting vaccinated will save a different person’s life.
- What next?
There can be three types of opinion on this matter:
- Everyone should always be free to refuse healthcare, including vaccination, should they wish (individual liberty trumping public health, no matter the circumstances).
- All vaccines that benefit public health overall should be mandatory (overall population health trumping personal choice, every time).
- Both individual liberty and public health are important and, when those rights are competing, a balance needs to be found.
This consultation indicates that the Public Health Bill is at least exploring ways to operate within the third option. By stating that even mandatory vaccination programmes must have room for exemptions, the second option has apparently been ruled out.
The questions behind all this – whether there should be any compromise of rights and, if so, what that balance should be – are interesting and grave.
How bad do the public health implications have to be from some people choosing to not get vaccinated that enacting forced vaccinations becomes the right thing to do?
If hundreds of people are going to be saved from serious injury or death, is that enough? Thousands? Hundreds of thousands? A million people (which is over 50% of the local population)? Can an answer based solely on numbers even adequately address what is being discussed, or does that lack nuance?
The right to choose medical treatment is not just about abstract personal liberty. What if that treatment goes wrong? The vaccines for COVID-19 may have been of great benefit to public health but in some cases taking a vaccine may have caused harm or contributed to the death of the person who took the jab (see here, here and here). What are the moral and ethical implications if and when someone is forced to take a vaccine, and then dies as a result? How should we, as citizens, feel about that?
- Conclusion
One of the core aims of the consultation – and, ultimately, the upcoming Bill – is to create a legal framework whereby Northern Ireland can respond to major unforeseen health crises (such as a pandemic) that may include new health risks that no-one has ever heard of or that don’t even yet exist.
Considering this issue is not straightforward. Any draft Public Health Bill that is tabled will have to present robust legislation that puts into effect a practical response to complex questions of the kind mentioned above and more.
Remember also that vaccinations are only one of a great many strands being considered for the updated Bill. The questions considered above are a small subset of something much greater in scope – nothing short of a “a new legislative framework [for] health protection, which is the prevention and mitigation of the impacts of infectious disease, environmental, chemical and radiological threats on individuals, groups and populations.”
The consultation that recently closed did not provide any answers, but nor did it seek to. It was a high-level series of proposals meant to spark discussion. Answers, insofar as they are possible, will come later.
That work is continuing now and, according to the Health Minister, the job is so significant that he cannot yet produce a timescale. This is an important (and emotive) issue but the discussions and debates are not finished.
FactCheckNI wants everyone to feel encouraged and confident about taking part in civic life – but it’s a very good idea to do that from an informed position, with the best possible understanding about what is, and what is not, being proposed. If you want to get in touch with further information, or simply to ask some questions, please do.
