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Some governments have launched plans to fine the unvaccinated. Experts caution against the approach.

Sotiria Xanthopoulou, 90, receives a dose of the Pfizer-BioNTech coronavirus vaccine in a mobile vaccination unit in Thessaloniki, Greece, on Jan. 7. (Alexandros Avramidis/Reuters)
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More governments are offering people a stark choice: Get vaccinated or pay up.

Austria’s lower house of parliament on Thursday approved a coronavirus vaccine mandate for all adults starting Feb. 1, with violators facing as much as $4,000 in fines.

In Greece, starting this week, people older than 60 who decline the vaccine can be fined $113 per month. Italians who are older than 50 must also get vaccinated or face fines and suspensions from work, beginning next month.

In Canada, meanwhile, the hard-hit province of Quebec said last week that it was considering a plan to impose a “significant” financial penalty on adults without at least a first dose of coronavirus vaccine.

“These people put a very important burden on our health-care network, and I think it’s normal that the majority of the population is asking that there be a consequence,” Quebec Premier François Legault said at a news conference.

Early data from Quebec, Greece and Italy appears to show that announcing these measures contributes to an immediate uptick in vaccinations. But scientists and rights groups warn that they could come at a cost, potentially alienating skeptical people and fueling distrust.

European countries, in particular, have tightened restrictions on unvaccinated residents in an effort to vaccinate holdouts and curb the spread of the fast-moving omicron variant.

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“This is how we can manage to escape the cycle of opening and closing, of lockdowns,” Austrian Health Minister Wolfgang Mückstein told his country’s parliament Thursday.

The chamber’s approval paves the way for Europe’s most far-reaching vaccine mandate. Starting in mid-March, police will demand proof of vaccination, and people who cannot provide it may be fined as much as $685. Those who ignore reminders to get vaccinated and contest their penalty could be forced to pay several thousand dollars.

Those who are pregnant, have valid medical excuses or have recovered from the coronavirus in the previous six months will be exempt. Austria will also allocate nearly $1.6 billion to efforts to encourage people to get vaccinated.

In Greece, revenue from the new fines will go to the health system, the government said.

When the mandate was announced in late November — with a Jan. 16 deadline for compliance — 520,000 Greek citizens older than 60 were unvaccinated. Since then, 220,000 of them have received their shots or made an appointment, according to the Greek health ministry. Now, close to 90 percent of people older than 60 are vaccinated.

The Italian government announced a vaccine mandate in early January to reduce pressure on hospitals as omicron surged. Less than 10 percent of the population was unvaccinated as of Jan. 18, according to the Italian health ministry, but unvaccinated people occupied two-thirds of intensive-care beds and 50 percent of other beds in Italian hospitals.

Nearly 200,000 people older than 50 received their first vaccine dose in the roughly two weeks after the measures were adopted, according to health ministry figures.

While the measures stirred a backlash, some in Italy want the penalties to be heavier.

In Quebec, details about the “health contribution” are scarce, and officials say they’re still working through the legal issues. Specifics are expected in a bill to be introduced next month.

The Jan. 11 announcement was followed by a spike in first-dose appointments, from an average of about 4,400 appointments recorded in the previous five days to more than 7,000 per day from Jan. 11 to Jan. 13. The number of daily appointments has since dropped, according to data from the provincial health ministry.

Québec Solidaire, a provincial opposition party, criticized the measures as “radical.” Cara Zwibel, acting general counsel of the Canadian Civil Liberties Association, said it would punish and alienate “those who may be most in need of public health supports.”

Canadian Prime Minister Justin Trudeau declined to comment on the plan at a news conference last week, saying he needed more details.

Several other governments have previously used similar financial penalties. Mauritius passed a rule in June requiring workers in some sectors to be vaccinated or face a fine. Unvaccinated workers and employers in Fiji can be fined, and the government limited unemployment aid to those who have received the vaccine.

Rights groups such as Amnesty International have decried these policies as discriminatory and counterproductive, and scientists and public health experts warn that a punitive approach could backfire.

Maxwell Smith, a bioethics professor at Ontario’s Western University who led the drafting of the World Health Organization’s policy brief on the ethics of vaccine mandates, said that although some vaccine-hesitant people often get cast as adherents to conspiracy theories, some might face barriers to vaccine access or come from marginalized groups that have experienced discrimination by the health-care system.

“Owing to that, they will tend to be more distrustful and, perhaps, more hesitant to be vaccinated when they see measures like this in place,” he said.

The WHO’s Europe branch said in a statement that it does not “recommend distinguishing between vaccinated and unvaccinated groups because that will go further in terms of exacerbating inequities in the population.”

Ivo Vlaev, a professor of behavioral science at the University of Warwick who has advised the British government on its pandemic response, urged authorities to better communicate relative risks, emphasize what people gain by getting vaccinated and rely on trusted messengers in skeptical communities.

“Trust in health authorities is the main driver of compliance,” Vlaev said. “If you undermine trust, you are actually undermining the driver, the lubricant of compliance.”

Coletta reported from Toronto.

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