Front Burner - Pros, cons of Quebec’s proposed anti-vax tax

Episode Date: January 14, 2022

This week, Quebec Premier François Legault announced a new reason for people to get their jabs: His government would place a significant tax on the unvaccinated. The announcement came a day after Legault accepted the resignation of the province's public health director, Dr. Horacio Arruda — leading some to ask if this bold plan was merely a distraction from the political strife within the province. CBC Montreal’s Sarah Leavitt explains what exactly has been going on in Quebec under the Omicron wave. We then talk about the tax and if it’s even a good idea. For some frustrated with people who won’t get the shot, the controversial proposal was welcome news. But bioethics scholar Bryn Williams-Jones at Université de Montréal disagrees. He tells us why, in his view, this kind of tax is a legal and moral minefield.

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. Hi, I'm Angela Starrett, filling in for Jamie Poisson. If you look at what's happening in other countries or other states, everybody is trying to find a solution, a question of equity, because right now, these people, they put a very important burden on our health care network. This week, the Quebec premier, François Legault, made a big move.

He said they were going to start taxing people who weren't vaccinated. And for epidemiologist and cardiologist Christopher Labos, it was welcome news. It's definitely one of the most important things that we need to be doing. And so it's nice to see the government sort of move away from their previous narrative, which was that vaccines are important, but that they are essentially optional. The pandemic hasn't just strained hospitals, but every part of the medical system, including his clinic. It's difficult for me because it takes longer to get tests done. So it creates a significant domino effect that is problematic because you're not providing the quality of patient care that you would actually want. But is a tax of the unvaccinated the best way to get that patient care back?

Or does it open an ethical can of worms? And what's the reason the premier is pushing this now? That's what we're tackling today. Sarah Levitt, a colleague with CBC Montreal, has been looking at Quebec's COVID-19 response for well over two years now. She's joining us now to put this vaccine tax in context. Hello, Sarah. Hi. So this announcement of a vaccine tax, I guess, made a pretty big splash. What do we know about it so far? Well, to be honest, not a whole lot because the premier hasn't given a ton of information. But we do know this is going to be a tax on those who have not yet been vaccinated with

a first dose. At least that's the first step. And what we know is about 90% of Quebec's population has been vaccinated with a first dose or has an appointment to do so. So this is really, this tax is really targeting that 10%. Of course, there will be something for those who have like a medical exemption or a reason for not getting the vaccine. But Premier François Legault wouldn't comment on the amount. He said it would be more than 100. His words actually were it would be a significant amount. But how it will work and how it will be taxed is still up in the air.

So still lots of questions around how this will work. 90% seems really high for a province. 90% seems really high for a province. So I want to talk, I guess, about the context that this announcement is coming from, because following the news out of Quebec, it sounds like the province has really been struggling under this fifth wave. Can you right, in the numbers that we're looking at, the statistics. So like we used to at the beginning of this pandemic paid a lot of attention to daily case counts. But Omicron has changed that because the transmission within the community is just so widespread that the province is really looking at hospitalizations because that's the most impact on the healthcare system. And so that's why every decision that it's made in these past few weeks around the tax, the restrictions, etc., have been related to hospitalizations because they're the highest that they've ever been throughout this entire pandemic. And especially when you look at those in the ICU, the numbers continue to creep up? The wave of hospitalization is expected to peak in the

next coming days. This means that the measures we have put in place have worked. We are going in the right direction but we have to remain very careful. The number of hospitalizations is still very high and will maybe continue to increase for the next few days.

And most of the hospitals in the province have had to cancel surgeries, scale back services, and then add to all of this the fact that there are thousands and thousands, like even tens of thousands of health care workers that are off sick because it's become such a big problem. And the government reacting there saying that in certain cases, COVID positive health care workers can come back to work if they're not too sick. Wow. Yeah, we have had that here, too. And it's quite shocking the level of strain and the sacrifices that have been made. And the government in Quebec has responded in ways that have sometimes been controversial, I guess. Can you walk me through how they've handled this specific wave? criticism right off the bat before Christmas. When it was becoming clear that Omicron was here and that cases were increasing, there was criticism that the government wasn't taking

it seriously. The premier had even said at one point holiday gatherings can be up to 20 people. people obviously the unpredictability of this is one problem but they they they basically looked at the numbers and looked at what was happening and things changed quickly but it didn't happen all at once there was an announcement one day about fewer people gathering and then two days later it was restricted to even more so the initial reaction to what the government has been doing is that the government took it too slowly. But now that criticism has kind of almost completely flipped because the government announced the curfew was coming back. And that was on New Year's Eve that the curfew came back. Many really, really angry about that. And not just because, you know, they want to celebrate New Year's Eve. They don't recognize the seriousness of the situation. No, it was more the fact that no study was done from the government on the effectiveness of the curfew that was in place last year. in place last year. Many argued that the curfew now is really a huge encroachment on rights

and that the curfew is now being lifted. Public health has recommended that we reopen schools next Monday. This is a good news, important, very important for our children and I'm happy to announce that we'll lift the curfew next Monday. So the question is being asked, why was it even there in the first place? And I guess this all leads up to something that happened only a day before the unvaccinated tax gets announced. Your top public health official, Horatio Arruda, resigned. In his resignation letter accepted last night by the premier,

Arruda says in the context of an uncertain and constantly evolving situation, public health made the best possible recommendations we could to support the government. The recent targeting of the credibility of our scientific rigor has no doubt caused an erosion of public confidence. Do we know why? So that was huge news and there's a lot of speculation as to why. And there's probably more than one reason, to be honest. But Dr. Horatio Arruda himself stated in the resignation letter that he handed in

that there had been a lot of questioning over decision-making and science, and that that had in turn led to erosion of public trust. So he offered to resign. But he did say that he was willing to stay on. This was just an offer of a resignation, but Premier Legault accepted it. And that's led many to kind of assume that Arruda is sort of being served up

as this sacrificial lamb or scapegoat for all that has gone wrong and all the criticism that's happened in the past few weeks. But also, you know, it's not an easy job. And I guess the announcement comes right after that resignation. Can you tell me about that? The announcement that we're talking about right now? Yeah. So the tax obviously was this bombshell, but let's just go back. So the tax was announced Tuesday. But Monday night, the bombshell news that night was that Arruda was resigning. It was shocking. The premier says, OK, we're going to hold a press conference tomorrow to talk about it. OK, so Tuesday happens. The press conference is being held. The expectation is to kind of get an explanation as to why Arruda is leaving so abruptly. Why now when we're in the middle of a

really serious situation? But at the press conference, besides a brief thank you to Arruda, Legault moved on and drops another bomb, the tax on this unvaccinated. And he does that with almost no detail, like explaining that they're looking into it and they're not sure how it'll be applied, but that this is something that they're going to do. And it became worldwide news. CNN covered it. It was in The Guardian. wide news. CNN covered it. It was in The Guardian. And the way it was announced with such few details, some say that it was very much meant as a distraction from the Arruda news and also to serve as a sort of trial balloon. So Legault saying, you know, let me announce this big thing with no details, take stock of the reaction, and then maybe, you know, maybe walk it back later. episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections.

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And what have you been hearing from Quebecers on this idea of an unvaccinated tax? So mixed reviews. Obviously, those who are unvaccinated, not entirely happy about this news. about this news. For some who are vaccinated, the question is, is this the way to go about it? Obviously, they want people to be vaccinated, but is this the way?

Is a tax the way? And there's been this, it fits into the narrative of what's been happening in Quebec the past few weeks, that there's growing discontent with the restrictions that are punitive to all Quebecers, regardless of vaccination status.

So, for example, the curfew, restaurants closing, etc. And so the idea of restrictions that would really affect just those who are unvaccinated is interesting to many, but some questioning whether the tax is the way to go about it. And you've also heard from MPs, professors and lawyers who say this is not the way to go. What are some of their arguments? Well, Trudeau didn't really want to comment. At the provincial levels,

they're looking at measures that will work for them. This Quebec proposal is something that obviously everyone is paying attention to right now, but there are still many details to know. And the details will be important in how this works, how it balances the values and the rights that we all cherish as Canadians with the necessity of keeping people safe. But his MP, Joel Lightbound, did.

In a tweet, he sort of alluded to the fact that this tax may be counter to the Canadian Health Act, for example. And that's something that lawyers are also wondering. Can this tax even be done? Is it even legal? And I guess that all depends on how it works. Even Legault himself said they were consulting with experts to see how it could work and how it could be legal. Then there's the questions around the ethics surrounding it. One argument, for example, is that while, you know, something like cigarettes or alcohol is taxed, you're still getting something out of it. So you go to the corner store, you pay for your cigarettes.

They cost more because you're paying the tax with it. But you walk out of the store with your cigarettes. This tax, though, is paying for something you don't get. And I mentioned earlier that this targets the 10% who aren't yet vaccinated with a first dose. But some researchers like Dr. Simon Bacon have been looking into why they haven't. For those that aren't vaccinated at the moment, you know, the biggest issues that they're still coming up with is safety and efficacy of the vaccines. And these kind of measures really don't address that.

So, you know, if you don't address the issue, I'm not sure you're going to get too far ahead. The government, though, has been looking at appointments made for first doses these past few days, and they are way above average. On average, it's about 1,500 appointments per day for your first dose. And lately, they've been way higher at 1.7 thousand. So even if this tax doesn't come into being, they're looking at those appointments that are being made as proof that even talking about the possibility of a tax is a success. Well, thank you so much, Sarah. This has been excellent.

I really appreciate you taking us through this. Thanks for having me. Joining us to go further into some of those concerns is Bryn Williams-Jones. He's a scholar of bioethics and public health at the University of Montreal. Hi, Bryn. Hi there. I'm curious, what are your main concerns with attacks like this?

Fundamentally, it's an issue of social justice and inequity. My deep held problem is around the fact that the people who are going to be hit with this tax are probably almost certainly going to be those least able to deal with it. And it's probably also not going to do what's expected. So it's both inequitable and almost certainly going to be ineffective. And what do you mean when you're saying least able to deal with it do you mean with the fines it would deal with the fines and the fact that we have evidence that the people who are most reticent to get vaccinated are in certain cases they're afraid of it so there's issues around information around education but they're there also tend to be those

people who are in the least favored aspects of society. So they're the working poor, new immigrants, people who are new to the country, and we mobilize them to help us during the crisis. But then there are also those who need the most help to ensure that they can participate as full members of our society. We're starting to see good literature coming out now on why people are vaccine hesitant or anti-vax. And there are multiple reasons. But one of the things that comes up is fear and a lack of control.

And that lack of control is about your entire life. Lack of control is about your entire life. So people who feel disadvantaged in their life, unable to have control, are also more likely to be fearful of things like vaccination. People are saying, hey, look, they should know by now all the education is being done. So now we have to pull out the big stick. Maybe, but I think this is the wrong stick. So that's where I say as an ethicist and talking to my colleagues in public health, think about the other measures that we could do that are either punitive or more positive. The other good example to reduce transmission, we've come out with vaccine passports that limit access to certain environments. Again, it's shaping behavior. It's given very strong messages and has been actually very effective.

It's given very strong messages and has been actually very effective. Restaurants, sporting areas, recently in Quebec, access to liquor, if you go into a liquor store, or marijuana. You had to show a passport. That massively increased participation in vaccination. riffing off all of that, Dr. Christopher Labos, who listeners heard in our intro, he doesn't see how this is any less invasive than the vaccine passports, which have been around for months, and Quebec just expanded the use of the pass. Yeah, I certainly would have thought that if you were somebody who was not vaccinated, certainly the payment is going to put less restrictions on your movements. I would have thought there would have been more opposition to expanding the vaccine passport

rather than to imposing a fee on people who are unvaccinated, because it seems to me that restricting people's movements and where they can go is the more intrusive of the two interventions. What do you think about that? I don't agree. I think that that individual choice linked to a passport, we can adjust our behaviors accordingly. We're constraining people by making more and more of this requirement.

So it's a strong measure, but it's less punitive in the sense that it's not hitting your pocketbook. We've also seen on Twitter at least one prominent doctor, Andrew Brizorari, argue that this could undermine the Canada Health Act by implicitly telling some people to pay more for health care than others. What are your thoughts about that argument? What are your thoughts about that argument? It's the possible implication of this sort of strategy because we're making a financial link to health. In Canada, normally, we don't do that. So other behaviors, we're limiting movement, for example, but we're not making a monetary connection. The moment we start saying, if you don't do something, you will have to pay for it. And it's linked to health is problematic because normally in Canada,

when we're in need of a treatment, we present our health insurance card that's from the province. We go, we receive care and we shouldn't be paying out of pocket. We haven't made that connection of individual behavior and the cost of health, which is the case in the U.S. and in other private medical systems. And I mean, when we're speaking about, you know, a financial penalty like this, is there any way it could be structured to avoid undermining those principles of universal health care? I think we have to be very careful about if we do it, how we do it.

So, for example, do we ensure that this is the least prohibitive measure for the goal that we are seeking to attain? That notion of proportionality is essential. So technically, how do we do that? I don't know how we would do that effectively. Technically, we need to look at the data privacy issues. We need to look at ability of people to contest it. What happens if we get the wrong person, the wrong data? The possible harms can be very large if we don't think through it extremely carefully. And again, how much time are we going to be doing trying to get this thing to roll out and work properly instead of working on other measures that we know work, but that are being underinvested? We can keep doing better. What we have to keep doing, though,

is continuing to reach out to different cultural communities, people who may come from countries where you don't trust the state because the state is dangerous. Well, by showing that the state is trustworthy, is there to help you, you build trust. When you bring out the big stick and you start sanctioning, that fits into other models linked to corruption or to a punitive state that doesn't care for its population, but that sanctions instead. So those positive messages, they take time to implement properly, but they're incredibly effective and have to be done continuously. Bryn, this has been such a fascinating conversation. Thank you so much for sharing all this with us today.

A pleasure. That's all for this week. And if you got this far, you probably liked the show. So feel free to give us a five-star rating on your podcast app. FrontBurner is brought to you by CBC News and CBC Podcasts. Our producers are Simi Bassi, Imogen Burchard, Ali Janes, Katie Toth, and Derek Vanderwyk. Our sound design this week was by Mackenzie Cameron and Nooruddin Korane. Joseph Shabison wrote our music.

The executive producer of Frontburner is Nick McCabe-Locos. I'm Angela Starrett filling in for Jamie Poisson, and I'll talk to you again soon. For more CBC Podcasts, go to cbc.ca slash podcasts.