We’re close, so close … but yet so far. There is a little light at the end of the tunnel, but with the advent of the Delta variant, that light has blurred. So much has changed in our lives since Sars-CoV-2 decided to take a liking to us.

I will never forget this text from by brother, Andy, in the early hours of January 20, 2020: “Joe, you up? Hey Joe, this 2019-nCoV is a real nasty bug. Here are my calculations about its growth rate…” I think I’ll frame that text!

It is remarkable, however, how well we have harnessed science and the knowledge we have accumulated over the past 20 years to develop Covid-19 vaccines that are by far the safest and most effective ever available to mankind. Had the same technology — as well as antibiotics — been available in 1918, it is very unlikely that the death toll from the Spanish flu would have been anywhere close to the estimated 50 to 100 million that resulted.

Thus far, we in Bermuda have fared quite well compared with many other developed countries. The solid, science and data-driven decision-making by our government has gone a long way towards keeping the mortality and morbidity from Covid-19 down to a minimum. However, a significant reason for our success has been the enviable availability of sufficient quantities of some of the best vaccines developed to protect against Sars-CoV-2, a luxury out of reach for much of the world.

At the time of writing, only 28.5 per cent of the world population had received at least one dose of a Covid-19 vaccine and only 1.1 per cent of people in low-income countries had received at least one dose. In Bermuda, 65.83 per cent of our population is fully vaccinated; compare this to Canada (59.01 per cent), Britain (56.16 per cent) and the United States (49.17 per cent).

So, why is it so important to make every effort possible to convince the unvaccinated to roll up their sleeves? Having one third of our population unvaccinated allows the virus to circulate, placing at risk those who are not eligible to be vaccinated, such as children and those who are not well protected by the vaccine — like the immune-suppressed. Furthermore, if the virus has a playground, more variants may emerge, possibly rendering vaccines less effective.

Organised societies function by agreeing to live within a set of rules and regulations that define and limit the rights and duties of each member; we call this arrangement a “social contract”. Some of these rules are explicit and are encoded into law, but others are implicit and are based on trust and the assumption that we all want what’s best for the greatest number. Social contract is why most of us stop at red lights and stop signs … even at 3am when no one else is around; we don’t smoke in public places and avoid driving while impaired. We try to do the right thing and refrain from actions that may harm others.

Nearly every aspect of our collective and personal lives is now threatened by the Covid-19 pandemic. The virus is transmitted from person to person by aerosolisation. Contagiousness is proportional to the number of viruses aerosolised, which in turn is proportional to the “viral load” — number of viruses in the mouth and nose — in the person who is infected.

The reason we are so worried about the Delta variant is that the viral load in an infected person can be up to 1,200 times greater than for other variants. (It’s still a bit early but public health experts are now starting to lose sleep over the Lambda or C.37 variant of Sars-CoV-2, which may pose the same threat as the Delta variant.)

Considering the social contract we have all implicitly agreed to live by, is it really a matter of “personal choice” to remain unvaccinated in the midst of a pandemic? Most of us readily give up our personal choice to run a red light, drive while impaired or smoke in public spaces, and we give up those rights to minimise risk of harm to others. Considering the dangers of Covid-19 and the remarkable effectiveness and safety of the Covid vaccines, should we not consider it a breach of the social contract to remain unvaccinated?

Governments and organisations all over the world must decide on the best mix of persuasion and coercion to implement in their strategies to get people vaccinated. In an increasing number of European countries, the pendulum is swinging in the direction of coercion. Surprisingly the same seems to be happening in America, “land of the free”, where an increasing number of healthcare organisations, state and municipal governments, and universities have started implementing Covid vaccine mandates. The American-as-apple-pie companies — Disney, Walmart and Google — have already mandated Covid vaccines for their employees.

Here in Bermuda where vaccines have been available for free to anyone who wants one, regardless of means or situation in life, I fear we may have used up our entire supply of persuasion. Where the Government goes from here is anyone’s guess, but surely, it is high time to begin the discussion on vaccine mandates.

• Joseph Froncioni, MD is an orthopaedic surgeon