Quebec's recent move to tax people who refuse COVID-19 vaccinations reopened debate about the merits of such penalties.
Premier Francois Legault said that choosing to remain unvaccinated has consequences for the health care system and not all Quebecers should foot the bill.
Roughly one in 10 adults in Quebec remain unvaccinated, yet they account for an outsized share of COVID-19 hospitalizations and about half of all intensive care patients.
With hospitals postponing surgeries and some 20 000 health workers sick with COVID-19, fining those who refuse vaccinations becomes "a question of fairness," Legault said.
The new "health contribution" will apply only to unvaccinated adults without medical exemptions. The government is still working out the details, but Legault said the levy would be "significant" and higher than $100.
Do penalties boost vaccination rates?
Some experts argue that increasing penalties for unvaccinated people may further entrench those opposed to vaccination. Others say that governments should focus on building trust in vaccines and offer rewards for getting the shots instead.
"If you're unvaccinated because you don't trust the government or you don't trust the pharmaceutical industry, it's unlikely that [penalties] will have an influence on your decision," explained Eve Dube, a medical anthropologist working at the Institut national de sante publique du Quebec. "When you push too hard on people that have important distrust issues, you run the risk of a backfire effect, making them even more strongly opposed to vaccination."
In such cases, Dube said, "one-on-one counselling is one of the most effective interventions for vaccine hesitancy."
But the unvaccinated are not a monolith, and financial penalties may win over people who are "complacent or those who don't feel that the risk: benefit ratio is in favour of vaccination," she said.
Research on the effectiveness of vaccine mandates, financial penalties and other negative incentives in the context of COVID-19 is still limited.
However, a 2020 study of European policies on vaccination against measles and pertussis published in Pediatrics found that mandatory vaccination and higher fines for noncompliance were linked with higher vaccine uptake. Mandating vaccination against measles was also linked with a lower incidence of the disease in countries that didn't allow people to opt...