Protesters demonstrate against vaccine mandates in New York City on November 20, 2021.
Stephanie Keith | Getty Images
Julian Savulescu, director of the Uehiro Center for Practical Ethics at Oxford University, said the main reason for implementing coercive measures during a pandemic is to prevent harm to other people.
“You are not allowed to shoot a gun in the air to harm other people, nor can you shoot a covid that could kill other people into a crowd,” he said on a phone call.
However, according to Savulescu, four ethical conditions must be met to justify coercive measures such as vaccination or masking requirements.
“First of all, the problem has to be significant, so you have to have a major emergency or a real risk of harming people. Second, you need to have safe and effective intervention, ”he told CNBC. “Third, [the outcome] must be better than fewer freedoms and more restrictive measures. Finally, the level of coercion must be proportionate to the level of risk and the safety and effectiveness of the intervention. “
In his opinion, Savulescu said that the requirement for Covid vaccines for an entire population does not meet these requirements. Because the vaccinations are not 100% effective in reducing transmission, they do not provide any additional protection to others that warrant such extreme levels of coercion.
“But there is a second way to justify coercion that is less common and that is when you have a health system that is collapsing unless you prevent people from getting sick,” he said. “Then you can use coercion to keep people from getting sick, not to prevent them from infecting other people, but to keep them from using these limited health resources in an emergency.”
This could be used to justify making Covid vaccines mandatory, he said, but only if the guideline was applied to the people who were most likely to have to go to the hospital or intensive care unit if they contracted the virus.
Vivek Cherian, a doctor at Amita Health, agreed that the overall benefits of a vaccine mandate must outweigh the risk involved to be ethically justified.
“The ethical dilemma, particularly in the United States, is the inherent conflict between an individual’s autonomy and freedom and public health value,” he said. “Given that when more people are vaccinated [it would] lead to fewer deaths, there is an ethical justification for the common good. “
But in the US, Cherian said, there is “virtually no chance that we will see universally required vaccine mandates”.
“That’s because we don’t have any vaccines right now,” he said. “What we are most likely to see are certain communities that require it, such as federal employees, the military, or individual corporations. States are likely to mandate Covid vaccine requirements for public school attendance at some point, in addition to the many other vaccines currently required. “
While countries introducing nationwide vaccination regulations are in the minority, several countries – including the UK, the US and France – have made Covid vaccination compulsory for medical workers.
The British Health Minister Sajid Javid has expressly ruled out an extension of the vaccination mandate to the broader population of the country.
Al Dowie, professor of medical ethics and law at the University of Glasgow, said mandatory vaccination was not inherently controversial “depending on the context”, noting that doctors in the UK should already be vaccinated against common communicable diseases.
“Coercion is ethical when the public health risk is sufficient,” he said in an email. “Health is a risky 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 tried to increase vaccination adoption by incentivizing individuals to vaccinate.
For example, Ohio State’s “Vax-a-Million” lottery program, where people entered a $ 1 million raffle after getting their shot, was hailed as a “smashing hit” by Governor Mike DeWine. New York and Maryland later launched their own lottery programs to incentivize vaccine uptake, but a study by doctors at Boston University School of Medicine later found no evidence that Ohio’s lottery incentive had increased uptake.
Alternative research has suggested that financial incentives could be useful in promoting vaccinations. A Swedish study published last month found that the number of people paying the equivalent of $ 24 increased the vaccination rate by 4%. However, researchers told CNBC that this was “a bit of extra motivation to get vaccinated” and not a tool to change the minds of ardent skeptics.
During the pandemic, several governments, including those of the United States, Japan, and Hong Kong, issued checks from $ 930 to $ 1,280 to millions of citizens to keep their economies afloat. Savulescu said he suspected that offering lump sum payments of the same value would increase vaccination rates and protect economies by preventing further lockdowns.
“How effective these interventions are is little known and will likely depend on culture, level of incentive or coercion, ability to enforce them, etc.,” he said. “In general, I think it’s better to start with incentives than go straight to coercion.”
Cherian said that while offering incentives to promote vaccination was not at its core an unethical strategy, he was skeptical of the effectiveness of coercion and incentive tactics.
“Those who work for public health will be ready to receive the vaccine regardless of consequence or incentive,” he told CNBC. “Those who are on the fence can be incentivized. Indeed, for people who for whatever reason are extremely reluctant to vaccinate, coercive measures can have the opposite effect, making them even more suspicious of the vaccines someone is trying to force them on. “