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Promising results from clinical trials of three coronavirus vaccines have brought new hope for ending the pandemic. But a vaccine, or a combination of vaccines, will not be effective if people refuse to take it.
Experts estimate that at least 60 percent of Americans will need to be vaccinated to stop the virus from spreading to the rest of the population. The question of how to achieve that goal raises a number of logistical and ethical questions. Among the thorniest is whether the vaccine should be mandatory.
A universal national vaccine mandate is unlikely. President Trump has said he wouldn’t issue one, and President-elect Joe Biden said the idea has some merit, but would be difficult to enforce. Individual states, however, do have the legal authority to make a vaccine mandatory. All 50 states require children to receive a number of shots to attend public school. Virginia’s commissioner of health said in August that he intends to issue a statewide mandate when a vaccine is ready. Some governors have said they will block any attempt to mandate vaccinations.
No public official or scientist is advocating for the scenario posited by anti-vaccination conspiracy theorists in which government workers go door-to-door vaccinating American citizens by force. In reality, a mandate would probably be enforced with some sort of penalty, like a fine, or as a prerequisite for accessing a government service.
Why there’s debate
Advocates for a vaccine mandate say it would be the best way to ensure that herd immunity will be achieved as quickly as possible, which could save thousands of lives. Waiting for people to voluntarily get vaccinated may not work, they argue, given the high levels of vaccine skepticism in the country. The enormous public good that will come from herd immunity outweighs the small infringement of individual freedom that comes with a vaccine mandate, some medical ethicists say.
Others argue for targeted vaccine mandates for certain groups most likely to contract and spread the virus, like health care workers or service industry staff. Some who support the idea of limited mandates say it’s better if the requirements come from private companies than from the government.
The idea of a vaccine mandate faces opposition on a number of fronts. Some conservative and libertarian critics believe that requiring any medical treatment represents a violation of personal freedom. Others say a vaccine mandate would be impossible to carry out and could even cause a backlash that makes people even less likely to get vaccinated.
The first coronavirus vaccine could receive U.S. government approval in less than two weeks, though limited supplies will mean decisions on vaccine mandates could come much later.
When the vaccine starts to become more readily available, it could spark heated debate over the rights that individual companies have to mandate that their employees or even their customers be vaccinated. At least three major airlines, for example, have suggested they might require all passengers to provide proof of vaccination before they can fly.
A vaccine mandate would help end the pandemic
“To put this scourge behind us, I believe that our nation should, for the first time ever, require all Americans — or at least schoolchildren and workers in direct-contact jobs — to be vaccinated against this coronavirus.” — Lauren S. Grossman, Stat
Heavy-handed dictates from the government will only cause a backlash
“Fact-based persuasion, which is the basis of good science, is our best hope for stopping COVID-19 and restoring the personal freedom that’s been eroded by the governmental and societal response to it.” — Zach Weissmueller, Reason
A mandate would cause very little individual harm while providing enormous public good
“The less burdensome it is for an individual to do something that prevents harm to others, and the greater the harm prevented, the stronger the ethical reason for mandating it.” — Alberto Giubilini, The Conversation
Vaccines should be required only for certain groups
“Making something mandatory can often backfire. But you might say that if you’re going to work in an old-folks home or have any exposure to elderly people, it would be required.” — Microsoft co-founder and philanthropist Bill Gates to Bloomberg
A campaign touting the benefits of the vaccine would be more effective
“We’ve got enough public paranoia out there already. This is a task that calls for a campaign of public persuasion — ‘Here’s how the vaccine works, here’s how it can affect your body, here’s why it is important that everyone get vaccinated.’” — Jim Geraghty, National Review
The best way to promote vaccinations is to make sure people have access to health care
“The current pandemic reminds us that governments cannot ignore poverty and social exclusion if they are to prevent and manage this virus, others unvanquished and those yet to come.” — Julie Leask, Nature
Any penalties would disproportionately hurt the poor
“By replacing a mandate with strong incentives and programs that tout the benefits of vaccines and provide resources for people to easily receive them, we would avoid harming poor and disadvantaged people.” — Y. Tony Yang and Dorit Rubinstein Reiss, The Hill
Any mandates should be carried out by private companies
“Failing to ensure that Covid-19 vaccines are used would unnecessarily prolong the pandemic. Private initiatives creating narrow mandates that target those most likely to benefit from vaccines, alongside voluntary vaccination, will maximize public health while minimizing the threat to individual liberties.” — Joel M. Zinberg, Wall Street Journal
Supplies will be so limited, debating a vaccine mandate is pointless
“Demand for [COVID-19] vaccines will outstrip supply for a while. This will be the case in all countries, and could last for years, if not indefinitely so, globally. As such, I suggest everyone just forget about mandatory population-wide vaccination.” — University College London Genetics Institute director Francois Balloux
There’s no effective way to enforce a vaccine mandate
“By and large, our immunization schedule begins as children, and we have to show proof of vaccination to go to school. It is a more complicated administrative manner to have a vaccine mandate that applies to adults because there isn’t a point of common intersection with the state or with some agency of the state the way we have with children. … A requirement that people be vaccinated is only as effective as the way of ensuring that they are.” — Health policy and management expert Joanne Rosen
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