Protesters against vaccination demands on November 20, 2021 in New York City.
Stephanie Keith | Getty Images
Julian Savulescu, director of the Uehiro Center for Practical Ethics at the University of Oxford, said the main rationale for applying coercive action during a pandemic is to prevent harm to others.
“You are not allowed to shoot a pistol in the air at the risk of harming other people, and likewise, you cannot shoot Covid, which can kill other people in the crowd,” he said in a phone call.
But, according to Savulescu, four ethical conditions must be met to justify coercive policies, such as demands for vaccinations or masks.
“First, the problem has to be serious, so you have to have a serious emergency or a real risk of harm to people. Second, you must have a safe and effective intervention, ”he told CNBC. “Thirdly, [the outcome] it should be better than fewer freedoms and more restrictive measures. Finally, the level of coercion must be proportional to the level of risk and the safety and effectiveness of the intervention. ”
Savulescu said that, in his opinion, the introduction of mandatory vaccination against Covid for the entire population does not meet these requirements. Since immunizations are not 100% effective at reducing transmission, he said they do not provide an additional layer of protection for others that requires such an extreme level of coercion.
“But there is a second way to justify coercion, which is less common, and that is when you have a health care system that will collapse if you don’t prevent people from getting sick,” he said. “Then you can use coercion to keep people from getting sick, not to prevent others from getting infected, but to prevent them from using this limited medical resource in an emergency.”
This could be used to justify the introduction of mandatory Covid vaccinations, he said, but only when that policy applies to people who are most likely to need hospitalization or intensive care if they contract the virus.
Vivek Cherian, a physician at Amita Health, agrees that to be ethically justified, the overall benefits of vaccinations must outweigh the associated risks.
“The ethical dilemma, especially in the United States, is an internal conflict between human autonomy and freedom and public health value,” he said. “Considering that if 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 of seeing universally needed vaccines.”
“This is because we don’t have it for any vaccines at this time,” he said. “Most likely, we will witness how certain communities need it, for example, federal employees, the military or individual enterprises. The states will likely end up mandating Covid vaccine requirements for public school attendance in addition to many other vaccines currently required. “
While countries introducing nationwide vaccination mandates are in the minority, several countries, including the UK, US and France, have made Covid vaccination mandatory for healthcare providers.
UK Health Minister Sajid Javid said bluntly excluded the extension of the vaccination period wide sections of the country’s population.
Al Dowie, professor of medical ethics and law at the University of Glasgow, said mandatory vaccination is inherently uncontroversial “depending on the context,” noting that doctors in the UK should already be vaccinated against common infectious diseases.
“Coercion is ethically justified when the public health risk is high enough,” he said in an email. “Health care is a risky phenomenon and there must always be a residual risk. The question is what level of risk is considered acceptable. “
While some governments have chosen aggressive measures, others have instead tried to boost vaccination rates by offering people incentives to get vaccinated.
For example, Ohio’s “Vax-a-Million” lottery system, in which people competed in $ 1 million in prizes after they got a chance, was called a “resounding success” by Governor Mike DeVin. New York and Maryland later launched their own lottery programs to stimulate vaccine introduction, but the study Doctors from Boston University School of Medicine later found no evidence that the Ohio lottery boosted sales.
Alternative research has shown that financial incentives can be helpful in stimulating immunization. Swedish study published last month found that paying people the equivalent of $ 24 increased vaccinations by 4%. Researchers told CNBC that this was “a little extra motivation to get vaccinated,” not a tool that changed the minds of ardent skeptics.
During the pandemic, the governments of several countries, including USA, Japan and Hong Kongissued checks ranging from $ 930 to $ 1280 to millions of citizens to keep their economy afloat. Savulescu said he suspected that offering people a one-off payment of the same amount would boost vaccinations and protect the economy by preventing further blockages.
“How effective these interventions are is poorly understood and are likely to depend on culture, level of incentive or coercion, capacity for some kind of coercion, and so on,” he said. “I think it is generally preferable to start with incentives rather than go straight to coercion.”
Cherian said that while offering incentives to boost vaccinations was not inherently unethical, he was skeptical about the effectiveness of both coercive tactics and incentive tactics.
“Those who support public health will be ready to receive the vaccine regardless of the consequences or incentives,” he told CNBC. “Those who are stranded can be encouraged. However, for people who, for whatever reason, are adamantly opposed to vaccinations, coercive policies can actually have the opposite effect and make these people even more distrustful of vaccines that someone is trying do. force upon them. “