To protect properly, COVID-19 vaccines should be given to most people around the world. Only through widespread vaccination will we achieve herd immunity – where enough people are immune to prevent the disease from spreading freely. To accomplish this, some have suggested that vaccines should be made mandatory, although the UK government has ruled this out. But with a high degree of caution in the COVID-19 vaccine the UK and elsewhere, is this the right call? Here, two experts argue for and against mandatory COVID-19 vaccines.
Alberto Giubilini, Senior Research Fellow, Oxford Uehiro Center for Practical Ethics, University of Oxford
COVID-19 vaccination should be mandatory – at least for certain groups. This means that there would be sanctions for not vaccinating, such as fines or restrictions on freedom of movement.
The less stressful it is for a person to do something that prevents harm to others, and the greater the harm is prevented, stronger the ethical reason for making it mandatory.
Getting vaccinated drastically reduces the risk of seriously harming or killing others. Vaccines such as the Pfizer, AstraZeneca or Modern So are those with a 90-95% effectiveness in preventing people from getting sick likely to be effective to prevent the virus from spreading, albeit to a lesser extent. Such benefits would entail very minimal costs to individuals.
Lockdown is mandatory. Like mandatory vaccination, it protects vulnerable people from COVID-19. But, as I have argued in detail elsewhere, lockdown, as opposed to mandatory vaccination, involves very large individual and social costs. It is inconsistent to accept mandatory lockdown, but reject mandatory vaccination. The latter can achieve a much greater good at a much lower cost.
Mandatory vaccination also ensures that the risks and burdens of achieving herd immunity are evenly distributed across the population. Because herd immunity collectively benefits society, it is only fair that the responsibility to achieve it is shared equally among the individual members of society.
Of course, we can achieve herd immunity by mandating less restrictive alternatives than vaccination – such as education campaigns to encourage people to get vaccinated. However, even when we achieve herd immunity, the higher the vaccine uptake, the lower the risk of falling below the herd immunity threshold at a later date. We must do everything we can to prevent that emergency, especially if the costs are low.
Promoting trust and acceptance by better informing people is a good story, but it is risky. Only give people information about vaccines does not always result in increased willingness to vaccinate and maybe even so less confidence in vaccines. On the other hand, we have recently seen a mandatory vaccination policy in Italy successful boost vaccine intake for other diseases.
Mandatory seat belt policies have proven to be very successful in reducing fatalities from car accidents and are now widely endorsed despite the (very minor) risks associated with seat belts. We should see vaccines as seat belts against COVID-19. In fact, like very special seat belts that protect ourselves and protect others.
Vageesh Jain, NIHR Academic Clinical Fellow in Public Health Medicine, UCL
Mandatory vaccination does not automatically increase the uptake of the vaccine. An EU-funded project on epidemics and pandemics, which took place several years before COVID-19, was no proof to support this idea. Looking at Baltic and Scandinavian countries, the project is report noted that countries “where vaccination is compulsory do not usually achieve better coverage than neighboring countries or comparable countries where there is no legal obligation”.
According to the Nuffield Council of Bioethics, vaccination is mandatory can be justified for highly contagious and serious diseases. But while contagious, Public Health England does not classify COVID-19 as an infectious disease with high consequences due to its relatively low death rate.
The severity of COVID-19 is highly correlated with age, dividing individual perceptions of vulnerability within populations. The death rate is estimated 7.8% in people over 80, but only 0.0016% in children nine years and younger. In a liberal democracy, forcing the vaccination of millions of young and healthy citizens who think they are at an acceptably low risk of COVID-19 will be ethically contentious and politically risky.
Public concern about a new vaccine being produced at breakneck speed is entirely justified. A UK survey of 70,000 people found that 49% “very likely” would receive a COVID-19 vaccine as soon as it was available. American surveys Are the same. This is not because the majority are anti-vaxxers.
Despite promising headlines, the trials and pharmaceutical processes surrounding it have not yet been explored. Only on the first trials from Aprilthere are limited data on long-term safety and efficacy. We don’t know how long the immunity lasts. None of the trials was designed to tell us if the vaccine prevents the transmission of serious diseases or viruses.
Ignoring these pervasive concerns would be counterproductive. As an aid to combat anti-vaxxers – estimated about 58 million worldwide and constitutes a small minority of those who are not vaccinated – compulsory vaccines are also problematic. The forces driving scientific and political populism are the same. Antivaxxers don’t trust experts, industry and especially the government. A government mandate will not only be met with unshakable defiance but will also be armed to recruit others to the anti-vaxxer cause.
Early nineties polio was endemic to India, with between 500 and 1,000 children becoming paralyzed daily. The virus was eliminated in 2011. This was not achieved through legislation. It was a consolidated effort involve communities, engage groups with high needs, understand concerns, inform, educate, break down barriers, invest in local delivery systems and connect with political and religious leaders.
Mandatory vaccination is rarely justified. The successful rollout of new COVID-19 vaccines requires time, communication and trust. We’ve come too far, too fast to lose our nerves now.