But that bureaucracy is what I mean with friction that defines what opting out means. Being invited to immunization and having ease to refuse is still opt in to me.
refusals to vaccinate are already part of someone’s record
Maybe I am just unaware but what I understood from what goes into the record is that someone saying “no thanks, vaccines are a lie” is indistinguishable from “the healthcare system wronged my community so I don’t feel safe with this”. If those cases are indeed already distinguishable and I'm just mistaken, then I'll be gladly corrected because it means that we are already equipped to to make vaccination mandatory, because all we need is to have the due process to accommodate the concerns of the second group.
That's not really it, and I didn't say anything of sorts. It just has to be something more than not showing up or just saying "no thanks" without any extra information. Nothing is going to be foolproof and that's not the point either, after all any anti-vaxxer can always self identify as First Nations for a day just to escape vaccination and healthcare workers won't have (shouldn't have) the tools to crosscheck information. So by all means have a "I don't trust the vaccine" as an option to opt out to make sure data is as clean and trustworthy as possible.
I'm also not talking about punishments, and I don't really know what kinds of vibes you've been reading into all of this but I'm defending the most benign and widespread healthcare mechanisms ever: add a little bit more fiction to make it opt out, use that opt-out process to collect more data, use this data to move forward with campaigns to boost confidence and adoption, and continue to increase the expectations of vaccination for access to public infrastructure in which non-vaccinated people are putting others at risk.
Saying that this would aggravate healthcare worker shortages and trigger court cases is a bit dramatic