Are Covid vaccine mandates ethical? Here’s what medical experts think

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Protesters gather for vaccine mission on November 20, 2021 in New York City.

Stephanie Keith | Getty pictures

Ethical motivation

Julian Savulescu, director of Oxford University’s Uehiro Center for Practical Ethics, said the main reason for implementing coercive measures during a pandemic was to prevent harm to other people.

“You have no right to shoot a gun in the air and risk injuring other people and in the same way you can not shoot Covid who can kill other people in a crowd,” he said in a phone call.

But according to Savulescu, four ethical conditions must be met to justify coercive policies such as vaccines or worm mandates.

“First, the problem must be significant, so you have to have a serious emergency or real risk of harm to people. Second, you have to have a safe and effective intervention,” he told CNBC. “For the third, [the outcome] must be better than fewer freedoms and more restrictive measures. And finally, the level of coercion must be proportionate to the level of risk and the safety and effectiveness of the intervention. “

Savulescu said in his opinion that mandatory Covid vaccine for an entire population did not meet these requirements. Because the immunizations are not 100% effective in reducing transmission, he said they do not provide an extra level of protection to others that justifies such an extreme level of coercion.

“But there is a second way you can justify coercion, which is less common, and that is when you have a health system that will collapse if you do not prevent people from getting sick,” he said. “Then you can use coercion to stop people from getting sick, not to prevent them from infecting other people, but to stop them from using the limited healthcare resource in an emergency.”

This can be used to justify making Covid vaccines mandatory, he said, but only when the policy was applied to those people who would most likely need hospital care or intensive care if they got the virus.

Vivek Cherian, a physician at Amita Health, agreed that in order to be ethically motivated, the overall benefit of a vaccine mandate must outweigh the risks.

“The ethical dilemma, especially in the United States, is the inherent conflict between an individual’s autonomy and freedom and the value of public health,” he said. “Considering that more people will be vaccinated [it would] leading to fewer deaths, there is an ethical justification for the overall good. “

But in the United States, Cherian said, “there is almost no chance we will see universally needed vaccine mandates.”

“This is because we do not currently have it for any vaccines,” he said. “What we are most likely to witness are some communities that require it, such as federal workers, the military or private companies. States are likely to eventually order Covid vaccine requirements to go to public schools, in addition to the many other vaccines currently available. required. “

While the countries that introduce nationwide vaccine mandates are in the minority, several countries – including the United Kingdom, the United States and France – have made Covid vaccination mandatory for healthcare professionals.

Britain’s Health Minister Sajid Javid has explicitly excluded from extending the vaccine mandate to the wider population of the country.

Al Dowie, a professor of medical ethics and law at the University of Glasgow, said mandatory vaccination was not in itself controversial “depending on the context”, noting that doctors in the UK are already expected to be inoculated against common infectious diseases.

“Coercion is ethically defensible when the risk to public health is high enough,” he said in an email. “Health care is a risk-laden phenomenon and there must always be a residual risk. The question is what level of risk is considered acceptable.”

Coercion vs. incentive

While some governments have opted for aggressive mandates, others have instead sought to increase vaccination intake by offering individuals incentives to be vaccinated.

For example, Ohio State’s “Wax-a-Million” lottery program, which got people to participate in a $ 1 million raffle after being given their chance, was hailed as a “resounding success” by Gov. Mike DeWine. New York and Maryland later launched its own lottery programs to stimulate vaccine intake, however a study from doctors at Boston University School of Medicine later found no evidence that Ohio’s lottery incentive had increased.

Alternative research has found that financial incentives can be useful to encourage immunization. A Swedish study was published last month found that paying people the equivalent of $ 24 increased vaccination intake by 4%. Researcher told CNBC that this, however, was “a little extra motivation to get vaccinated,” rather than a tool to change the minds of avid skeptics.

During the pandemic, several governments, including those of USA, Japan and Hong Kong, has given millions of citizens checks worth between $ 930 and $ 1,280 in an effort to keep their economies afloat. Savulescu said he suspected offering people one-time payments of the same value would increase vaccination rates and protect economies by preventing further shutdowns.

“How effective these interventions are is poorly understood and is likely to depend on the culture, the level of incentive or coercion, the ability to enforce it in a way, and so on,” he said. “I generally think it’s better to start with incentives rather than go straight to coercion.”

Cherian said that while it was not an unethical strategy at its core to offer incentives to increase vaccination, he was skeptical of the effectiveness of both coercive and incentive tactics.

“Those who support public health will be willing to get the vaccine regardless of the consequences or incentives,” he told CNBC. “Those who are on the fence can get incentives. But for individuals who for some reason are extremely opposed to being vaccinated, coercive policies can actually have the opposite effect, making these individuals even more distrustful of the vaccines that someone is trying to do. “


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