Recently, there has been much talk of making vaccinations compulsory or creating vaccine passports to limit the movement of individuals who may have chosen not to get vaccinated. This article will look at these proposals and will seek to understand if it is morally right to force vaccination on the unwilling or to restrict their movement.
Vaccines Carry Risks
Firstly, let me say that I am not an anti-vaxxer by any means. I have been immunised regularly over the entirety of my life for a wide variety of diseases. I generally get the flu shot each year, and I have booked in for the COVID vaccine. Yet, despite this, I remain cautious about new vaccines. The truth is that despite the best efforts by researchers and government agencies, the testing on pharmaceuticals is not foolproof. This is shown by the multiple cases of tested and approved drugs later found to have dangerous long-term health effects (Onibalusi, 2019; CDC, 2021).
Essentially, all drugs have side effects that vary depending on the physiology of the individual. Due to the huge diversity of the human genotype, it is not possible for every possible side effect to be identified in testing. Thus, testing allows only for an educated assessment of the general risk profile of the product to be made. When the product is utilised in the real world, the side effects can be monitored, and a further assessment of the safety and efficacy of the product can be made. What this means is that, with every drug or medical product, no matter how rigorous the testing, a residual risk remains.
This is the reason for the principle of informed consent in the medical profession. Informed consent is a recognition of the risks involved in a medical procedure and a recognition that the patient has the right to judge for themselves if they wish to assume that risk. Mandates, i.e. compulsory vaccination, remove the judgement of the individual from decisions that affect their health, instead, placing the decision with the state. The critical difference between a state-level health decision and an individual decision is the focus. The individual naturally focuses on the risks and benefits to themselves and their family. At the state level, the focus is on the so-called ‘common good’, i.e. the aggregate benefit to the whole of society.
There is a Difference Between “Your Good” and the “Common Good”
This may not seem to be a fundamental difference, yet even when the outcome is the same, the rationale is different. For an example, we need to look no further than the AstraZeneca vaccine, which has been used to vaccinate most of the UK. The risk of complications from the vaccine is very low at around 8.3 per million or 1 per 120,481 after the first shot, and 2.3 per million or 1 per 434,782 after the second shot. This leads to those being vaccinated having a 1.3 times higher chance of blood clots compared to the unvaccinated, while the risk to those who have contracted COVID-19’s risk was eight times that of the unvaccinated (Bateman, 2021).
From a state-level perspective, this level of risk is minuscule, and the 1.5 deaths per million shots is a price worth paying, even if COVID is not spreading in the community. Yet from an individual perspective, the picture can be quite different. In Australia and New Zealand, where strong border controls and a fair helping of good luck have stopped the virus from spreading, the take up of AstraZeneca has been low, with most folks who are not in the high-risk category opting not to get the jab. These individuals judge that their risk of contracting COVID and dying is lower than their risk of complications from the shot. In my view, they are probably wrong as, despite our success, the odds of dying from COVID in Australia so far have been 1 in 27,879. Yet for that one person in a million, they would be right. This reluctance has led to a slow vaccine rollout in Australia as most of the population waited for the arrival of Pfizer vaccines before registering to be inoculated.
This slow uptake has led some pundits to call for compulsory vaccinations in at least some sectors of the economy. They argue that it is the best way to protect the vulnerable in our community and that the risk of complications is low. In this case, the risk is low, but once the principle that the state can require you to undergo medical procedures has been conceded, where does it stop? If the state can dictate that you must undergo medical procedures for the community’s apparent benefit, your personal autonomy will be compromised. Consider that, in this case, it is a vaccination that is required to protect the communities’ interests. But what is there to stop the state from demanding more and more say over what you can and cannot do? What other personal choices could be subsumed by the state in the name of the ‘greater good’? But let’s consider the argument for mandatory vaccines.
Mandatory Vaccines and Vaccine Passports
The argument for mandatory vaccines generally lean on the idea that we have a responsibility to the people in our community and thus should consider not only our own interests but theirs as well. By not getting vaccinated, the argument goes that we place others at risk who may not be able to get the vaccine or who are non-responsive to it. Thus, the argument is that society should be able to force compliance through punishments or restrictions on the individual’s freedom to work or travel.
This is essentially what the much-touted vaccine passports amount to — by imposing sweeping restrictions on those who choose not to get vaccinated, we effectively make vaccines compulsory by stealth. This can be seen as the clear intent in that if individuals do not submit to receive a vaccine, they will not be able to enjoy the general benefits of civil society, and in some cases, they will not be able to pursue their occupations. But do societies have the right to compel their members?
Compulsion in Societies
A fundamental principle of the moral system espoused here is that we should make the decisions that maximise the long-term chances of survival for our families. Therefore, when we consider whether society should be able to force individuals to get vaccinated, we are asking when society can compel its members to do things that they don’t want to do.
That there must be situations where compulsion can be used is apparent due to the nature of the community. Each community exists for the purpose of promoting the survival of the individual members. Inherent in the achievement of this purpose is the need for common rules and standards of behaviour that, if violated, result in punishment. These common expectations create a coercive normalising pressure on the community members to conform to societal norms.
Depending on the society in question, the strictness of the norms may vary greatly. If the norms are very lax or non-existent, then we call the society individualistic and anarchistic. While if the norms are exacting, it is termed collective and authoritarian. No matter where a society sits on this continuum, its advocates claim that it will result in the best long-term outcome for its members. Now, in particular situations, each may be right, and each may be wrong. In a crisis, an individualistic and anarchistic community might struggle, where a collective and authoritarian nation might succeed. However, in other situations, the authoritarian-collectivist nation might stagnate and fail while the individualistic-anarchistic community may thrive and grow.
In the end, exactly where on the continuum a society should sit is a matter of personal judgement. However, as I mention in the Code, the society that is ideally structured to support the community’s welfare will have traits that are resistant to the formation of factions and have strong limits and controls on the exercise of power. From this view, any new power given to the community or state over the individual members should be viewed with caution.
More Power to the State
Have no doubt that is what we are talking about here. Fundamentally, we are debating if we should give the state the right to decide what medical treatments we should have and when we should have them. We already provide the state with the right to determine what medical treatments we can have and what products we can buy in the shops. Do we really want to give bureaucrats the right to make medical decisions for us?
Now, I know that vaccine mandates have existed in the English-speaking world since 1857, when the smallpox vaccine became mandatory in England (Batniji, 2021). And yes, I recognise that the government forcing you to get a medical procedure that is unarguably in your benefit does promote your long-term survival. Yet I am concerned about how many other choices could be taken from us for the same reason.
The Slippery Slope
In this case, we are told that, in the opinion of the state, getting vaccinated will reduce the risk to our health, our families and our communities. Incidentally, I agree with this view and am getting vaccinated. If we accept that, based on the strength of this opinion, the state can force us to get vaccinated, why can’t they force us to do other things that, in their view, will reduce the risks to ourselves, our families and our communities?
Drinking and smoking can be harmful to all these groups. Should they be banned as many other drugs have been? Being overweight is detrimental to your health and harms your families’ and communities’ interests through increased medical costs. Should unhealthy food be banned, or should you be forced to exercise and diet? Even playing computer games, playing contact sports or being anti-social could be argued meets this criterion for harm. Should you be punished for doing these things? Maybe I seem like I’ve fallen off the deep end, but that’s exactly what the Chinese Social Credit System aims to do (Lee, 2020).
Now, I am not suggesting that this is on the cards for the English-speaking world, but it troubles me that the logic used for compulsory vaccination could easily be used to justify all kinds of other interventions ‘for your own good’. Today, it might be the COVID vaccine; tomorrow, it will likely be all vaccines, and a few years from now, who knows?
Business Mandates: Even Worse than Government Mandates!
Even more troubling than state-level mandates is the growth of business level-mandates, i.e., individual businesses who have decided that they will tell their workers how to manage their health. At least states have a semblance of accountability and, at least in the Western World, are theoretically answerable to the citizens. Businesses have none of this accountability. If they are allowed to impose their views on healthcare onto their employees, I am left wondering how we can call ourselves free.
I get that businesses exist to make money, and I understand that when employees are sick, it comes with real costs. But, again, you could use the same argument for so many other things people do in their personal time that do not promote productivity at work. If we allow them to dictate this, where does it stop? Let’s also not forget that business has a poor record on making decisions that prioritise employee health over profit (see Teflon, Asbestos, Baby food, etc.). To let people who have every incentive to put your health second make decisions that affect your health and your family seems like the height of foolishness to me.
Alternatives to Mandatory Vaccines
In the end, though, compulsion leads to resistance. In California, a vaccine mandate was trialled for school-aged children in 2016, and while ‘the proportion of children attending kindergarten who were not up to date on their vaccinations halved, the number of unvaccinated children being educated at home in California almost quadrupled and the number of medical exemptions exploded’ (Drew, 2019). If our aim is (as it should be) to encourage as many people as possible to choose to get vaccinated or make other healthy choices, then making it compulsory may not be the best way to do it. After all, most recreational drugs have long been banned, yet there is still a huge drug problem. Perhaps instead of mandates or passports (mandates by stealth), there are other effective measures available that could be utilised instead.
Education and Availability
Firstly, education about the effectiveness, testing and relative risks of vaccines should be prioritised, and the availability of vaccines should be expanded. This is as the evidence shows that nations with ‘high levels of vaccinations, such as Portugal and Sweden, do not have mandates. What they have instead are populations with high confidence in vaccines and healthcare systems that provide easy access to their services’ (Drew, 2019).
I can only speak from personal experience here, but I can attest that my flu vaccine uptake increased when it became available each year at my workplace. I am not alone in availability leading to higher vaccination rates. In the UK, vaccination rates are lowest in socially disadvantaged areas and communities in which people frequently move around (Drew, 2019).
The other issue is that many people who are hesitant about vaccines struggle to get answers to their questions and thus often choose not to get vaccinated. Instead of writing them off as anti-vaxxers, why not increase ‘efforts to facilitate meaningful conversations between concerned people and healthcare professionals? (Drew, 2019).
These key criteria for vaccine uptake could be achieved if dedicated vaccine hubs were established. Or alternatively, if chemists/pharmacists were trained and authorised to immunise people in the shopping malls of suburbia rather than requiring people to find time to go and visit a doctor.
Use of Rapid Tests
Another key method that could be used to protect public health while maintaining individual liberties is the use of rapid tests, especially in high-risk environments such as hospitals and nursing homes. These tests are relatively cheap, reasonably effective, and are likely to be more effective if coupled with temperature checks.
Use of PPE
In high-risk settings, the use of PPE such as masks and gloves, especially if the individual is not vaccinated, could again lower the risk of transmission.
Adequate Sick Leave
Another tool that would reduce the spread of contagious diseases would be if generous sick leave was provided so that workers were not incentivised to attend work when they are sick. In my country, every winter, the cry goes up that you should not go to work sick, but every year, millions of us do. The reason is simple — if I get a cold and dutifully stay home until all my symptoms disappear, then my annual quota of sick leave will be used up, leaving me with none in reserve if I become too sick to work later. Thus, I have no incentive to stay home and a strong incentive to go to work when I am sick. The incentive to work sick is even stronger with the 4.6 million casual or self-employed workers in Australia who don’t have sick leave. To say don’t work when you are sick is easy, but when people have the choice to work while sick or to not pay their bills, they will work sick every time.
I am not insensible to the risks of COVID or other communicable diseases to our communities. Nor do I doubt that vaccination is likely the best method to reduce the risk of the spread of communicable diseases. Yet, for all this, I cannot support mandatory vaccinations. The available evidence suggests that mandates are not the silver bullet they are often supposed to be.
Furthermore, I worry about the flow-on effects from abdicating the right to make personal medical decisions to bureaucrats or, worse yet, business people. While now the impetus behind mandatory vaccines are good ones aimed at the best outcome for the community and the individual, we must be careful of giving too much power over our lives to others. The advocates claim it is for just this emergency. But that’s the thing about emergencies — there is always another one around the corner. Today, it is COVID… tomorrow, who knows?
Personally, I am going to get vaccinated, but many people I know are undecided. I respect their choice and will fight if necessary for their right to make their own health choices. After all, they and we are supposedly free citizens of a democracy.
Why not Subscribe for regular articles and exclusive updates?
- (2021, 08 05). Retrieved from CDC: https://www.cdc.gov/vaccines/vac-gen/side-effects.htm
- Bateman, T. (2021, 7 30). Retrieved from Euro News: https://www.euronews.com/next/2021/07/29/astrazeneca-covid-19-vaccine-blood-clot-risk-similar-to-pfizer-spanish-study-finds
- Batniji, R. (2021). Historical evidence to inform COVID-19 vaccine mandates. The Lancet, 791.
- Drew, L. (2019, 11 27). Retrieved from Nature: https://www.nature.com/articles/d41586-019-03642-w
- Lee, A. (2020, 09 09). What is China’s social credit system and why is it controversial? Retrieved from SCMP: https://www.scmp.com/economy/china-economy/article/3096090/what-chinas-social-credit-system-and-why-it-controversial
- Onibalusi, S. (2019, 08 19). Retrieved from Huffington Post: https://www.huffpost.com/entry/3-drugs-with-the-most-sev_b_11619296
First Published on https://www.andrew-stadtmauer.com/ on the 6th of September 2021