If there is a substantive fourth wave of the COVID virus due to the delta strain or any other strains, the impact will be predominately felt in those that are unvaccinated. While currently there is a social understanding about vaccine hesitancy, that understanding may evaporate in the wake of substantive numbers of hospitalizations and deaths.

Considering the delta virus is 1000x more infectious than the original strain [1] those who remain unvaccinated are essentially playing a lottery. The repercussions of which won’t just impact their personal health but will also have perpetual societal impacts due to civil liberties, criminal conduct, and financial repercussions over the next 12-24 months. 

There is already a move afoot in order to establish two classes of citizens based on those that have and haven’t been vaccinated. The idea of a COVID travel passport has been bantered around and is already having ripple effects on everything from travel [2] to concerts [3]. This is further complicated by differing standards for what ‘being vaccinated’ means [4].

All of this however is predicated on the pandemic being an extraordinary event.  So long as it remains an extraordinary event, then society tends to not think of it in terms of being normal. However at some point it will start to become normal. At that point, people will stop thinking of this as being an ‘us’ problem and start thinking of this as being a ‘me’ problem.

Two key shifts will be likely be predicated upon the similar rationals that were used in the wake of HIV. Those being

1. Criminal liability for knowingly spreading the virus, and 
2. COVID as a Pre-existing Conditions for Limiting Medical Insurance

HIV was originally discovered around 1984 [5]. Since then, the Joint United Nations Programme on HIV/AIDS has updated what is referred to as 95-95-95 targets for being able to declare the HIV epidemic over [6]. What the 95-95-95 targets state is that 

1. 95% of all people living with HIV know their status,
2. 95% of those diagnosed receive antiretroviral treatment, and
3. 95% of those on treatment achieve viral suppression. 

It is hoped these targets can be reached by 2030.

At its peak, in Canada HIV had an incidence rate approximately 15 per 100,000 population in 1984 compared to approximately 6 per 100,000 population today. In this interim, laws were passed in both Canada and the US which essentially allow people to be sued and criminally prosecuted for knowingly pass HIV to others [7].

By contrast, COVID has a worldwide incident rate of 2600 per 100,000 population. Or put another way, 433x the infection rate of HIV. Part of that can certainly be explained away by the fact that HIV is not airborne [8] whereas COVID is [9].

Notwithstanding, society doesn’t pass these types of laws curtailing civil liberties based solely on infection rates. If they did then a host of other diseases [10] would have similar laws on the books as HIV rather than relying on the general health and safety laws and agencies (e.g. Ontario Health Protection and Promotion Act).

Law firms are already starting to get enquiries as to whether you can sue for getting COVID [11][12] and the short answer is yes.

The long answer however will be dictated more by government responses to social accountability and whether these types of cases represent an undue burden to the legal system without formal guidance outside of existing case law.

In those circumstances, government is going to turn to existing precedent, based in part on HIV as the closest model, in order to develop a strategy for how to respond.

This implies two things:

The first is that if you are without a record of vaccination, an insurance company will (not may) consider you a high risk for both medical and life insurance and either massively jack up your premiums or deny claims for any related illness if its discovered you have COVID including if you are asymptomatic. 

The second is that if you knowingly are in public without a record of vaccination, and without other protective equipment for the safety of others, and someone you know gets COVID, you may be the one to be found criminally negligent. 

Insurance Industry Response

If you want to check into what many of the insurance companies are doing during the pandemic you can check out America’s Health Insurance Plans (AHIP) blog that outlines current mitigation strategies. Almost all of these activities however are major drains on insurer’s resources. Eventually those insurance companies will need to recoup those expenditures.

They can’t do it now however because a) it would make them look bad, and b) they risk losing large portions of their business due to people’s ability to continue to pay premiums into the future. Essentially damage control is focused on mitigating customer churn as it cost substantially more to attract new customers than it is to retain existing one. To do otherwise would throw the door open to hyper-competition between insurance companies with no one coming out a winner. 

There are only three strategies available to insurers to recoup these types of damage control losses. 1) help pay for and promote COVID mitigation (including vaccines) that remove risk exposure to COVID claims as quickly as possible, 2) raise premiums, and 3) find ways to disallow future claims (i.e. reduce payouts). 

The same as smoking helps limit insurance company liability for cancer, whether you are vaccinated against COVID will work its way into policies related to almost every illness that is directly or indirectly connected to the disease pathways. 

Legislative Response

There are five key elements that drive legislative responses to a crisis of public policy: technology, community values, community awareness, legal system expectations, and international relations [13]. However underlying these legislative changes to our statutes is inherently a question of legislative intent at the time those laws come into being [14]. Such laws in of themselves are a reasoned action [15] designed to influence the intention-behaviour that govern how people act within certain circumstances.

Such laws however are also subject to bias based on ideological polarisation and influential actors that help motivate legislatures towards one extreme or another. Politicians typically bias their legislative agenda’s in responce to their nearest neighbours such as the “political elite, opinion leaders of political interest groups and activists, and incumbent candidates of larger parties that have an impact on, at least, some voter groups” [16].

Government has two key roles. Mobilise resources to address extraordinary circumstances that individuals and businesses are unable to mitigate without central coordination, and to mitigate risks that would lead to extraordinary circumstances happening in the first place.

Right now, government policy is focused on managing the first role. However if we end up having a 4th, 5th, and 6th wave of COVID infections, government policy will need to shift predominantly to the second role.

This will involve a comprehensive review of all policy and legal remedies to enforce compliance mechanisms required to get to that 95-95-95 target. Ergo, new laws and regulations impacting everything from Aviation to Veteran Affairs. 

What Next

What we have therefore is a convergence between a large political interest group (insurance companies), incumbent candidates that are twisting the COVID crisis into an “us vs them” argument, and a crisis of public policy based on community values (mostly economic), social awareness (unless you’ve been under a rock the last 18 months), and international relations (currently focused in travel and tourism). 

If the virus were to be quietly going away with increased global effort towards vaccination then the spectre of legislation may simply come and go. However with the resurgence of the delta virus strain, the indicators are likely that the next 12 months are going to look a lot worse than the last 12 months unless people get vaccinated [17]. 

While we all hate to admit it, quality of life has a price tag on it [18]. 

At a certain point, governments are going to stop relying on people’s good nature and start to introduce laws that mandate compliance and enforcement. Industries, such as health and life insurance, are going to stop seeing customer churn as being damage control and instead as a regular cost of doing business. 

That means – so long as people continue to not get vaccinated, and refuse to wear masks, and do stupid shit like passing on misinformation about microchips, drinking bleach, and that COVID is just like the flu [19] – those policies will irrevocably change what ‘normal’ is going to look like same as it did in the wake of HIV.

 — Kevin 

References

1. Officials say 90% of population needs vaccine to reach herd immunity. (2021, May 10). CBC. https://www.cbc.ca/news/canada/ottawa/covid-19-unvaccinated-final-push-herd-immunity-delta-1.6113769
2. Trudeau mum on launch of vaccine passport but vows system will be ‘simple and efficient’. (2021, July 27). Coronavirus. https://www.ctvnews.ca/health/coronavirus/trudeau-mum-on-launch-of-vaccine-passport-but-vows-system-will-be-simple-and-efficient-1.5525287
3. Escapade music festival will require attendees be fully vaccinated. (2021, July 20). Ottawa. https://ottawa.ctvnews.ca/escapade-music-festival-will-require-attendees-be-fully-vaccinated-1.5516109
4. Worried your COVID-19 vaccine won’t be accepted abroad? Here’s what you need to know | CBC news. (2021, July 28). CBC. https://www.cbc.ca/news/business/covid-19-vaccine-travel-1.6122633
5. Discovery of HIV. (n.d.). history – Office of NIH History and Stetten Museum. https://history.nih.gov/display/history/Discovery+of+HIV
6. Notes from the Field: Impact of the COVID-19 response on scale-up ... (2021, May 26). Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/volumes/70/wr/mm7021a3.htm
7. Criminal transmission of HIV. (2004, October 28). Wikipedia, the free encyclopedia. Retrieved August 2, 2021, from https://en.wikipedia.org/wiki/Criminal_transmission_of_HIV
8. Impossible routes of HIV transmission. (n.d.). aidsmap.com. https://www.aidsmap.com/about-hiv/impossible-routes-hiv-transmission
9. Coronavirus disease 2019 (COVID-19). (2021, May 7). Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/sars-cov-2-transmission.html
10. Deadliest infectious diseases in the world, ranked. (2020, April 2). CBS News – Breaking news, 24/7 live streaming news & top stories. https://www.cbsnews.com/pictures/deadly-diseases-infectious-world-ranked
11. Howard Levitt: Yes, you can sue someone for negligence if they pass COVID on to you. (2021, July 30). financialpost. https://financialpost.com/fp-work/howard-levitt-yes-you-can-sue-someone-for-negligence-if-they-pass-covid-on-to-you
12. ‘I think we’re going to feel the repercussions of this for a long while’— COVID lawsuits start to pile up | CBC news. (2020, October 16). CBC. https://www.cbc.ca/news/canada/sudbury/covid-pandemic-lawsuits-ontario-1.5897317
13. Reasons for change in the law. (2015, July 1). The Engage Wiki. Retrieved August 2, 2021, from https://wiki.engageeducation.org.au/legal-studies/unit-3/area-of-study-1-parliament-and-the-citizen/reasons-for-change-in-the-law
14. Brand-Ekins, 5. (n.d.). The nature of legislative intent. Notre Dame Philosophical Reviews. https://ndpr.nd.edu/reviews/the-nature-of-legislative-intent/
15. The reasoned action approach and the theories of reasoned action and planned behavior. (n.d.). obo. https://www.oxfordbibliographies.com/view/document/obo-9780199828340/obo-9780199828340-0240.xml
16. The great divide: Drivers of polarization in the US public. (2020, October 28). EPJ Data Science. https://epjdatascience.springeropen.com/articles/10.1140/epjds/s13688-020-00249-4
17. Canada needs to Jump-start a stalled first-dose campaign to avoid a fourth wave, experts say. (2021, July 16). CBC. https://www.cbc.ca/news/politics/canada-jumpstart-vaccination-campaign-fourth-wave-1.6106114
18. Putting a dollar value on life? Governments already do. (2020, May 11). https://www.nytimes.com/2020/05/11/upshot/virus-price-human-life.html
19. Newman, T. (n.d.). 29 coronavirus myths busted. Medical and health information. https://www.medicalnewstoday.com/articles/coronavirus-myths-explored