Should COVID-19 vaccination be compulsory?


As researchers around the world race to develop a COVID-19 vaccine, bioethicists are once again debating the ethics of compulsory vaccination. When a vaccine for coronavirus finally becomes available, governments will need a strategy to ensure that a sufficient portion of the population is immunised to achieve herd immunity. 

Strategies for promoting vaccination range from nudging and incentives through to the withholding of social benefits and services from non-vaccinating individuals and even compulsory vaccination. In 2017, Italy introduced compulsory vaccination policy for ten vaccines, with parents facing a €500 fine if they failed to immunise their kids. While the policy was controversial, evidence suggests that it led to an marked increase in vaccination rates and has helped prevent outbreaks. 

In the context of COVID-19, then, it is important to consider whether a compulsory vaccination policy could be ethically permissible (if, indeed, we had pragmatic reasons to introduce such a policy).  

Some ethicists stop short of endorsing compulsory vaccination. Yet ethicists from the Uehiro Centre for Practical Ethics at the University of Oxford have suggested that a compulsory vaccination policy could be justifiable. 

Writing in the blog Practical Ethics, Tom Douglas, Jonathan Pugh and Lisa Forsberg use the comparison of lockdown laws to challenge arguments against mandatory immunisation. The authors suggest that a vaccine would be no more invasive or harmful to people than existing measures to combat the coronavirus. Indeed, one could describe a COVID vaccine as a safe and effective alternative to mandatory physical distancing and social isolation. Physical distancing and mandatory quarantine regulations cause huge disruption to people’s lives. As Douglas, Pugh and Forsberg observe, 

“If quarantine were a drug, it’s doubtful it would be approved as safe for widespread use”.

A vaccine, in contrast, is very safe and unlikely to cause major disruption in the lives of recipients. 

Some critics of mandatory vaccination think that bodily integrity is very important, because there’s a strong link between our bodies and ourselves. Yet the impact of a vaccine on bodily integrity is very limited, whereas the alternative -- restrictions on freedom of movement -- are very extensive: 

“...quarantine surely involves a very severe interference with free movement and association. By contrast, requiring someone to receive a single injection of a vaccine involves at most a moderate interference with bodily integrity”.

The authors note that “exceptions would need to be built in for those who are likely to suffer side effects, and—perhaps—for those who have strong moral objections”. Yet “the current orthodoxy—that compulsory medical intervention crosses an ethical line that quarantine does not—ought to be challenged”. 

Oxford bioethicist Alberto Giubilini, an expert on immunisation policy, has also recently written in favour of compulsory COVID-19 vaccination. Giubilini suggests that “this would be the most effective and most ethical way to slowly return to normal life”.




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