Public health in Ecuador: Mandatory vaccination against COVID-19 and vaccine certificate

Abstract

The compulsory COVID-19 vaccine and the requirement of the certificate in Ecuador constitute policies that depend on the governability and governance of the central power, which drags political, socioeconomic, legal, environmental, health, and sanitation crises from previous administrations and its own. Policies framed in a paternalistic health model, which is justified in the case of the mandatory vaccine, by the risk and damage of SARS-Cov2, which forced autonomy into the social order, and which have generated debate. There is a 7.8% of the population dissenting to the vaccine for epistemic reasons of lack of knowledge of its functioning, and ethical-political reasons such as individual freedom, religion, thought, and the scope of State`s power. Statistics show that most of the people hesitant to immunization are historically discriminated collective subjects such as Afro-Ecuadorians, and Montubio indigenous people. Most of them belong to the lower social class, and live in the periphery, which prior to the pandemic, lacked health infrastructure. Demonstrating how the determinants of health influence and combine in a diverse biosocial complex, creating vulnerabilities and privileges. The pandemic exposes the inequalities and problems of the paternalistic model of the National Health System. Therefore, through the dialectic method, the article analyzes the positions opposed to imperative immunization, and proposes a third one based on a syndemic model of health, which considers the biosocial complex, whose normative minimum are human rights, freedom, dignity, and bioethical principles, mainly vulnerability, interdependence, cultural diversity, pluralism, and social justice.