Can I ask someone if they got a COVID shot? What experts say about vaccine etiquette

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When a west-end Ottawa children’s clothing shop re-opened to in-store shopping last Friday, its owners asked that customers provide visual proof of vaccination — “1st vaccine at least.”

The requirement for proof, however, was quickly dropped after some clients condemned the condition as a form of “segregation.”

So begins the dance around vaccine etiquette.

As some provinces mull over the idea of vaccine passports, Canada’s privacy commissioners have cautioned that, while the benefits could be significant — more personal liberties, fewer restrictions on gatherings — requiring someone to disclose personal health information is an encroachment on civil liberties that shouldn’t be taken lightly.

But what about less formal relationships? When, if ever, is it appropriate to ask whether someone has been vaccinated? And should those who have chosen for non-medical reasons to opt out of COVID shots have a moral duty to tell others, if the situation might justify them knowing?

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In Ottawa, the executive of a men’s softball beer league is wrestling with the delicate issue of an avowed anti-vaxxer in its ranks. Should vaccination be a requirement to play? Is there an obligation to inform the other players? (Under stage one of its reopening plan, Ontario prohibits the playing or practicing of team sports, except for training, and while outdoor sports are safer than indoor, most researchers aren’t willing to state that there is absolutely no risk of transmission.)

In addition to guest capacity limits, some couples are requiring those attending their wedding to be vaccinated. Others are drawing similar lines in the social sands. No vaccine? No lunch date.

Good ethics is really grounded in good science, and we don’t really know all the facts

Much of the tension is based on evidence that getting vaccinated not only dramatically protects people from getting seriously sick with COVID, but the assumption, supported by emerging data, that it lowers the chance they can spread the virus to others.

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Conversely, those who choose not to be vaccinated pose a risk to themselves, to those who can’t be vaccinated such as newborns and the immune-suppressed, and to a small proportion of the vaccinated, because, while the authorized vaccines are very good at preventing lab-confirmed COVID illness, they aren’t 100-per-cent effective.

“Good ethics is really grounded in good science, and we don’t really know all the facts,” said University of Toronto bioethicist Kerry Bowman.

“I mean, if a person is fully vaccinated, meaning double doses, are they truly of no significant risk, or any risk, to the people around them? All indications are that they are likely not, but we don’t know that for absolute certain.”

While he isn’t trying to dodge the deeper questions, a lot of it turns on risk, he said. “If you look at the baseball player, you also have to look at, what is the chance of infection? Is it an outdoors game? Is it an indoor dinner party?”

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From an ethical point of view, people could have reasons for not being vaccinated that are absolutely none of my business

“From an ethical point of view, people could have reasons for not being vaccinated that are absolutely none of my business, or yours either, or anybody’s,” Bowman said. There could be religious objections, though they tend to get exaggerated. He’s looked into the matter quite thoroughly, “and none of the world’s major religions have any problems with vaccines.”

Some might be nervous about the rare risk of thrombosis, blood clots that have been associated with the AstraZeneca shots, or myocarditis, heart inflammation experienced by a small but higher-than-expected number of adolescents and young men after their second dose of the mRNA vaccines from Pfizer/BioNTech and Moderna.

“Even if a person says, ‘I’m just terrified of these remote risks,’ you could say that’s not a good reason. But it’s their reason, it is what it is, it’s their body,” Bowman said.

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At the extreme end are vaccine refusers who are not open to a change of mind no matter the scientific evidence, and who tend to have conspiratorial ideation — the shots alter DNA, or Bill Gates-created microchips will be injected into the inoculated. About seven per cent of adult Canadians have told pollsters they will not be vaccinated.

The U.S. Centers for Disease Control and Prevention guidelines state that fully vaccinated people can visit with the unvaccinated, but having unvaccinated members within a group is raising messy tensions. Advice columnists are being asked whether a spouse has grounds to refuse to host his wife’s anti-vaxx sister and husband. “Based on the sheer volume of questions similar to yours, it has become increasingly obvious to me that many people are using the vaccination question as a way to finally stop spending time with people they don’t like,” the Chicago Tribune’s Amy Dickinson recently wrote.

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Health information is personal information. “There’s no question about that and it’s really up to an individual what’s disclosed and what’s not,” Bowman said.

“And what do you say? Are you doubly vaccinated? Did you have AstraZeneca, or Pfizer? How far do you go with this?”

Most people are freely offering their vaccine status “left, right and centre,” Bowman noted. “I don’t think anyone is holding back.” People are putting “fully dosed” in Twitter bios and online dating profiles.

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“I personally, and I stress the word personally, am not sure I could look anyone in the eye and ask them their vaccination status. Every instinct in me tells me it’s none of my business,” Bowman said.

But he also believes it would be entirely acceptable for a host or hostess planning a capacity-compliant dinner party to note in the email invitation that “we request that anybody who accepts this invitation be fully vaccinated. Thanks for your understanding.” And no further inquiry beyond that.

“That could include the baseball thing, by the way,” Bowman said. “And no one is on trial. No one is put on the spot — are you vaccinated or not?” Some people might lie, thinking people will never find out. “But mostly people are going to go along with that.”

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New York University bioethicist Arthur Caplan, who has argued for vaccination mandates (receiving a COVID-19 vaccine is voluntary) said there are circumstances that justify people knowing. “If my mom was in a nursing home and I went to visit I would want to know whether the people taking care of her are vaccinated.”

If you are not vaccinated and someone asks you, you should be ready to give an honest answer

“It’s time to belly up to the ethics bar, here,” Caplan said. “If you are not vaccinated and someone asks you, you should be ready to give an honest answer.

“That doesn’t apply if you’re just wandering around in the street and somebody says, ‘Have you been vaccinated?’ Vaccinated against what? Smallpox? Tetanus? COVID? I don’t have to answer you. There’s no reason for you to know.” It’s tactless and obnoxious, he said.

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“But it is my business if I’m trying to look out for my own welfare, or the welfare of my relatives, the welfare of my neighbours next door who might be at risk and show up at a party or barbecue. I don’t have patience for not giving an honest answer.’”

Yankee stadium has vaccinated and unvaccinated sections. Bruce Springsteen has announced a vaccine mandate for his intimate “Springsteen on Broadway” show. Audience members will need to be fully vaccinated with a FDA-approved vaccine, which means, as the Toronto Star reported, Canadians who received the non-FDA approved AstraZeneca vaccine won’t, for now, be allowed in.

The closer the quarters, the higher the risk of transmission. “I think the unvaccinated may feel somewhat embarrassed, or they feel like they’re going to be persecuted or stigmatized,” said Caplan, founding head of the division of ethics at NYU Langone Medical Center.

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“But to some extent, if the store says shopping is opened to the vaccinated, they have that right.” Is it discrimination? “No, it’s prudence. Being prudent is not discriminating.”

Being prudent is not discriminating

In more social settings, those opposed to vaccination should have the courage of their convictions, he said, “and talk to friends and neighbours and people in more close situations honestly.

“Maybe they’re not going to let you in the wedding. Maybe they’ll seat you at a section where other unvaccinated people sit,” Caplan said. But they should be forthcoming. “I would say, ‘I am going to this function and I want you to know this,’ just like I might say, ‘I’m coming to this function and I have tuberculosis. I may be coughing a lot, is that OK with you?’”

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The U.S. is beginning to see an increase in places requiring vaccination, including hospitals, universities and some businesses, more than was true a month or two ago, an uptick Caplan believes is due to data showing how effective the vaccines have been, and worry over more contagious variants of the virus. “People are nervous about that here,” he said.

Bowman hopes the vaccination wrangle is a fleeting problem for the summer of 2021. Canada’s vaccination rates are rising — nationally, 65 per cent of the eligible population has received at least one dose. Still, the early enthusiasm may be waning in some pockets. Alberta and Manitoba are now dangling vaccine lotteries as an incentive to boost rates.

While the global situation is still not good, Bowman’s hope — and it’s hope, not a scientific prediction — is that, sometime around Labour Day, “if we’re over 80 per cent vaccinated (in Canada), and double vaccinated, the numbers of cases are just going to crash, so much that the presence of the virus in our society is close to nothing, and people won’t care so much.”

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When did people start believing in anti-vaccine conspiracy theories, and how do we fight them? Find out on the first episode of our six part series, COVID Conspiracies.