The issue of mandatory vaccination against Covid-19 is firmly in the spotlight. In response to the spread of the Omicron Sars-CoV-2 variant, European Commission president Ursula von der Leyen has said all 27 EU states need to consider the option of mandatory vaccination. Von der Leyen, a qualified physician, said that the spread of the disease and the lack of vaccine take up in parts of the EU meant it should be on the table as a policy response.
In the Republic, the National Public Health Emergency Team (Nphet) is considering whether to introduce mandatory vaccination for healthcare workers. At present, immunisation for this group is voluntary, with unvaccinated healthcare workers redeployed away from patient-facing contact. We are told discussions are focusing on a number of ethical and legal issues.
It is important to be clear what is meant by mandatory vaccination. It does not mean forced vaccination, where people are physically restrained and inoculated against their will. Rather it means that there would be penalties for failing to get vaccinated, such as fines or greater limitations on people’s freedom. But compulsory vaccination creates its own problems. There is evidence that mandates increase vaccine hesitancy rather than reduce it. Compulsion does not always achieve increased vaccine uptake and when it does, it can come at the expense of trust and social inclusion.
Ethicists suggest certain conditions must be met to justify coercive policies like vaccine mandates: the problem must constitute a grave emergency with a real risk of harm; the proposed intervention must be safe and effective; and the level of coercion has to be proportionate to the level of risk and the safety and effectiveness of the intervention. On the face of it, mandatory Covid vaccination does not meet these conditions – in particular when vaccines are not 100 per cent effective at reducing coronavirus transmission.
Each of us is entitled to bodily integrity and to opt out of vaccination. And any limitations on travel, hospitality and social integration need to be rooted in a careful balancing exercise between the public good and individual human rights. Governments have an obligation to focus every effort on providing tailored and trustworthy information about the risks and benefits of vaccines, to encourage as many eligible people as possible to get vaccinated, and to ensure vaccines are easy to obtain and their distribution is equitable.
In response to calls for compulsory vaccination, World Health Organisation chief, Tedros Adhanom Ghebreyesus, said it was understandable for countries to seek to protect their citizens "against a variant we don't yet fully understand". But he urged nations to take rational, proportional risk-reduction measures.
That requires persuasion and incentivisation rather than duress.