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Abstract
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Redelmeier et al1 claim that people who had not received any COVID vaccine in Ontario by July 2021 were more likely to be involved in traffic crashes; hypothesize that this was because they are more reckless; and conclude that raising car insurance premiums would be a desirable policy option.
We challenge this paper on its methodology, its conclusions, and its mean-spiritedness.
First, there are several obvious confounders—miles driven, occupation, type of vehicle—any of which probably erode an already modest adjusted relative risk (1.48). Important confounding is suggested by the observations that the same increased risk applied also to unvaccinated pedestrians and passengers.
Second, the timing of the study is critical. The authors state that those who were unvaccinated on July 31, 2021 are “individual adults who tend to resist public health recommendations.” However, Ontario's staged vaccine rollout opened for all in August of 2021,2 meaning that on July 31, 2021, not all Ontarians had access to vaccine (or if they did, it was quite recent), especially not the young and healthy. The unchanged risks of those who were vaccinated in the subsequent 2 months suggests differences in population risk—likely because of uncontrolled differences (eg. type of work, distance driven). Similarly, the lack of risk difference in those over age 65 years (who had the largest period of eligibility prior to the study) argues against the primacy of vaccine hesitancy as an explanation for increased traffic risk.
Third, although the study focuses on the 16% of Ontario residents who had received no COVID immunization by mid-2021, the authors extrapolate their conclusions to the broader category of “vaccine hesitancy.” Arguably, this designation could apply to some or all of the 72.5% of adult Canadians who have not received a COVID vaccine for more than 6 months.3
Fourth, the authors appear to endorse higher car insurance premiums for vaccine-hesitant drivers. It is unclear whether this is intended to be merely punitive or an incentive for vaccination. However, the opportunity for lower car insurance premiums in exchange for immunization would be, de facto, a financial inducement to accept immunization. This would be unprecedented in Canadian vaccine policy and ethically questionable. Furthermore, widespread natural immunity post-Omicron and a better understanding of the failure of the vaccines to provide reliable prevention against infection have undermined any public health rationale for using extraordinary policies to promote COVID immunization ...
Keywords: CoViD-19-Road-Traffic
Language: en |