by Anthony Skelton

Ending the pandemic will require mass vaccination for COVID-19. But will it be achieved simply by leaving vaccination to the voluntary choice of individuals? If not, is it permissible for institutions or states to mandate vaccination for COVID-19?

It is not uncommon for institutions or the state to mandate public health measures (including vaccination and helmet use). Mandates typically involve placing sanctions on individuals for non-compliance, including exclusion from certain environments and fines. (Considered here are mandates like this rather than campaigns to force vaccination by means of significant criminal sanction.) Mandates interfere with individual liberty and autonomy, and while this counts against them, it still might be possible under certain circumstances to justify them ethically.

The WHO’s policy brief, Covid-19 and Mandatory Vaccination: Ethical Considerations and Caveats,  published on 19 April 2021, clarifies the ethical considerations that ought be taken into account when thinking about a mandating vaccination for COVID-19. Associate member Maxwell Smith took the lead in drafting the policy brief and Sally Bean and (core member) Anthony Skelton (among many others) contributed to it.

The policy brief lists six such ethical considerations:

  1. Necessity and proportionality. A mandate must be necessary to achieve important public health goals specified by a legitimate public health authority (e.g., herd immunity or protection of the most vulnerable). A mandate is not justified if those public health goals can be achieved in its absence (e.g., through education and information campaigns).
  2. Safety. A vaccine must be found to be safe on the basis of sufficient scientific evidence for the populations for whom it is mandated (e.g., children).
  3. Efficacy and effectiveness. Vaccines must be scientifically verified to be efficacious (e.g., scientifically verified to prevent transmission) and effective in achieving important public health goals (e.g., achieving herd immunity; protecting the most vulnerable).
  4. Sufficient supply. There must be a steady, reliable supply of vaccines freely available to those for whom it is mandated. Mandates in the absence of supply will not achieve public health goals and may exacerbate existing health and other inequities.
  5. Public Trust. Institutions or states must consider the effects of mandates on public trust in science, COVID-19 vaccines, and public health measures more generally (including vaccination). A mandate will be counterproductive if it erodes public trust in vaccines.Priority ought to be given to the effects on public trust amongst vulnerable populations who may have been victims of historical injustice in the health care setting.Special care should be given to nurturing that trust.
  6. Ethical Processes of Decision making. Deliberation about mandates amongst public health authorities must be transparent and use step-wise ethical decision making engaging all relevant stakeholders, including and especially vulnerable and marginalized populations.

Vaccination for COVID-19 is key to ending the pandemic. If states or institutions consider mandating vaccination, the preceding considerations should be explicitly evaluated and discussed through an ethical analysis by policy developers in conjunction with all relevant scientific, medical, legal, and practical considerations.

For further reading, see this recent post on the ethics of mandatory COVID-19 vaccination for children.

Pictured above: Individuals line up to receive COVID-19 vaccinations. Photo credit Macau Photo Agency via Unsplash.