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Cross Post: Why the UK Shouldn’t Introduce Mandatory COVID Vaccination

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Written by Julian Savulescu, Dominic Wilkinson, and Jonathan Pugh

As coronavirus infections surge across Europe, and with the threat of the omicron variant looming, countries are imposing increasingly stringent pandemic controls.

In Austria, citizens will be subject to a vaccine mandate in February. In Greece, meanwhile, a vaccine mandate will apply to those 60 and over, starting in mid-January.

Both mandates allow medical exemptions, and the Greek mandate allows exemptions for those who have recently recovered from COVID.

Other countries, including Germany, may soon follow suit, and the European Commission has raised the need to discuss an EU vaccine mandate. In contrast, the UK health secretary, Sajid Javid, has been clear that the UK will not consider a general mandatory vaccination policy.

The risk of vaccine mandates to public confidence in government is substantial, but there are even more important moral issues. Vaccine mandates are a highly significant infringement of individual liberty and, for some, they cross a line that should never be crossed. But mandates may be justified if they are necessary to achieve a proportionate public health goal and are effective in doing so.

Vaccine mandates can be effective as Italy, the US and Australia have shown for other vaccines. Will they work for COVID? It is unclear. COVID vaccine hesitancy has been driven in part by concerns about the rapid development of the vaccines and concerns about their long-term safety. This potentially generates more resistance, as does the large number of people who have recovered from COVID, and who feel that they are sufficiently protected by natural immunity.

Since the vaccines have only a limited effect on preventing transmission – around a 40% reduction for the delta variant, according to the director of World Health Organization – perhaps the most significant public health benefit that increasing vaccine uptake can achieve is reducing the number of people who become seriously ill with COVID.

In turn, this will reduce the burden on healthcare systems. Importantly, the vaccines provide powerful protection for the elderly, who are the main group putting pressure on hospitals. So if hospitals were at serious risk of being overwhelmed, it might be proportionate to mandate vaccines.

Hard to justify

But unless the public health system is on the verge of collapse, it is hard to justify treating the decision about vaccines differently to the way we treat decisions to smoke, drink alcohol, eat unhealthily, not exercise, and so on. Even though they contribute to pressure on our health system, we nevertheless allow people to make these risky personal decisions.

In continental Europe, it may be more plausible to claim that vaccine mandates could be necessary and proportionate. Austria has a relatively low vaccination rate, with only 67% of the population fully vaccinated, although this rises to 88% for those over 60, who are more vulnerable to severe disease or death. Existing methods have not succeeded, so more restrictive measures might be necessary to increase uptake.

Increasing uptake might achieve a proportionate benefit if it prevents the Austrian health system from being overwhelmed. This possibility has to be considered, given the high number of infections per capita (currently, 621 per 100,000), in a country with relatively low immunity among those vulnerable to severe outcomes. Notably, though, data suggest that Austria has a greater number of critical care beds per 100,000 than the UK, which may mean that it could safely accommodate a larger surge of cases.

In comparison, although only 69% of the UK population is fully vaccinated, Office for National Statistics models suggest that uptake exceeds 97% for those over 60. Also, it is estimated that over 90% of the adult population in the UK have COVID antibodies, suggesting a high level of immunity, either natural or from vaccination.

Compared with Austria, the UK also has a lower number of cases per capita – 457 per 100,000 at the time of writing, so it is harder to argue that a vaccine mandate would be necessary or proportionate.

If any mandate can be justified, its justification will depend on facts about the level of immunity in the population, predicted pressure on the healthcare system at a given time (given levels of infection and critical-care capacity), and the likely effectiveness of a mandate. Such assessments must be made on a country-by-country basis.

What if things get worse? For example, if omicron does lead to “vaccine escape” (where the vaccine no longer works effectively against the variant), and the number of COVID hospitalisations do start increasing, the UK could rapidly find itself in a very difficult situation. If this were to transpire, one option to consider would be imposing a selective rather than a general vaccine mandate.

If policymakers must limit people’s freedom, they should do it to the least extent and affect the smallest number of people necessary. The Greek approach of making vaccination mandatory for over-60s and allowing exemptions for natural immunity is more ethically defensible than the Austrian or German proposals to make it mandatory for all adults. It is the over-60s who are most likely to need hospitalisation and ICU if they get ill, putting pressure on healthcare systems.

Vaccinations are vital and save many lives. And those who haven’t been vaccinated should strongly be urged to do so. But the UK should only mandate vaccines if it absolutely has to, and to the least extent necessary.

Julian Savulescu, Visiting Professor in Biomedical Ethics, Murdoch Children’s Research Institute; Distinguished Visiting Professor in Law, University of Melbourne; Uehiro Chair in Practical Ethics, University of Oxford; Dominic Wilkinson, Consultant Neonatologist and Professor of Ethics, University of Oxford, and Jonathan Pugh, Research Fellow in Applied Moral Philosophy, University of Oxford

This article is republished from The Conversation under a Creative Commons license. Read the original article.
The Conversation

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12 Comment on this post

    1. utter bollocks !! mandatory vaccination should become law in the uk. then we can all start living normally again

      1. Only if living normally means being vaccinated every 3 months. In which case nobody is going to get any vaccinations ever. Saying this as somebody who has already had 3. Omicron is less virulent and actually I do want to catch it do want a nature immune response to it as well as the vaccines because I am not having a 4th in the spring and there is nothing the retards like you can do to make me give up my medical autonomy. Sick of both anti vaccers and pro vaccers knowing jack shit on both ethics and science.

  1. Today I was not allowed to enter a hotel because I had no vaccination passport with me… I had a test with me. But in Munich it’s not accepted…

  2. This is not a vaccine in the true meaning of the word. It is novel technology. It has also been responsible for numerous deaths caused by adverse reactions to it. As such, it would be unethical to mandate anything knowing it could result in deaths. Where there is risk there must be choice.

  3. In fact, the idea of applying a vaccine mandate only to people over 60 doesn’t make sense. I would argue that in the context of this pandemic vaccine mandates for every person two or older who can medically get one, is not only defensible but in the context of this pandemic is very much the pro-freedom choice. With appropriate medical exemptions, I see it as reasonable to apply vaccine mandates starting at age 5, and when a covid-19 shot becomes available for younger children it could be justifiable to go as a young as two or younger if the child attends nursery school.

    The thing about vaccination is that it has always only partially been a question of individual risk. As long as a vaccine at least somewhat lowered one’s change of passing the virus to other people, it has been a matter of protecting the whole community. In the context, of the Covid-19 epidemic we have seen lockdowns, mask mandates, and school closures. People have lost their jobs, been forced separated from friends and family. People with high medical risks and low vaccine response have called off marriages because their fiancé had other obligations (kids from a prior marriage, elderly parents, certain jobs) because the couple decided the medically vulnerable one’s safety and a proper marriage were incompatible. People have had to give up their hobbies 100% and some retirees have had to give up volunteering gigs that they loved, and their lives revolved around. Kids have been forced to go to online-learning or homeschooling and parents (mostly Moms) have given up jobs for it. Most kids even under the best of situations for this aren’t doing very well educationally or socially.

    The bottom line is that not only have people given up a tremendous amount of freedom, options and the lives they enjoyed over this pandemic.

    The realities of masks mandates, lockdowns, social distancing, school closures are radically greater constraints on people’s freedoms and lives than requiring a vaccine of some people who don’t want it. Unless a person has unique medical risk factors associated with the vaccine, Covid-19 represents a greater risk than the vaccine.

    Therefore, having to get a few injections-even if this becomes three boosters a year- is a much lesser impingement on people’s freedoms than being required to live socially distanced and socially isolated lives behind a mask, often deprived of work, school, and in some cases relationships or other things that make life meaningful.

    It is true that it’s most likely the over 60’s who mostly need hospitalization. However not only is it the case that all age groups have a worse risk from covid-19 than the vaccine, but that over 60’s have on average a weaker response to the vaccine and younger people can protect the elderly with their more robust immune responses. By mandating vaccines not just on personal risk to but stem the spread of the virus entirely, the vulnerable are better protected and society’s prospects for returning to normal improve.

    The language often used by those who say mandatory vaccines are such a huge imposition on personal freedom, show a real lack of proportionality. Especially in the context of this pandemic.

    Will vaccine mandates for Covid-19 be less effective than the mandates that have long existed in the US, Italy or Australia? Certainly possible. However, that is different from saying they are overly burdensome to personal freedom-unless calibrated for age-based risk. Also “less effective than school mandates in Italy or the US” doesn’t seem a very good reason to dismiss them, seeing how much vaccine hestitancy keeps the world slogging through this pandemic.

    1. The only way to end this pandemic is for everyone to lose weight. We know losing weight is a long hard process and most won’t do it, so, to save lives, the government should mandate all overweight people get their stomachs stapled.

      For free, of course. And we need to ensure that only those with low BMI’s or proof of staples can enter restaurants, theaters and even keep their jobs. Traveling also should be limited to those thin or those stapled to become thin.

      1. You and everyone who likely reads this can see the false equivalence there.

        Vaccination is a quick and only slightly painful process that doesn’t carry anything close to the risks associated with bariatric surgery-to say nothing of the cost.

        Besides we know that while overweight and obese people are higher risk for severe covid-19 than others their age and at risk for other comorbidities, BMI as a risk factor is nowhere within 500 miles of being equivalent to a safe and effective vaccine.

        Also lockdowns and social distancing seems to have caused weight gain in some people by being home all the time, walking around less, and having fewer chances to exercise. So, if you are concerned about obesity and overweight it makes all the more sense to have mandatory vaccines, because the sooner people can get out of a lifestyle that seems to promote weight gain and safely hit the gym again, the better!!! Since the pandemic has seen the commercial launch of one new non-invasive weight loss device (the oral hydrogel Gelesis100/Plenity) and one once-weekly shot for weight management (Wegovy) let’s start this improved era on the best possible foot!!!

  4. This argument borders on fanatic libertarianism. The argument about drinking alcohol as analogous is ridiculous unless the consumer is driving a car. Not being vaccinated and mingling with the public is like refusing to stop at a red light and claiming ‘freedom’. No one has the liberty to endanger others in this way. If the vaccine carried significant risks, it would be a different story. But the vaccine is one of the safest ever developed.

    Those individuals who were born with compromised immune systems or who are recovering from cancer must be protected from those with a choice. It is completely immoral to snuff out a vulnerable segment of the population simply because you claim ‘freedom’. The health system is on the brink of collapse as it is.

    1. I have been reading today that Israel is about to roll out the fourth dose to its population. Really? If you need four doses it’s clearly useless! It’s like the Emperor’s new clothes, nobody dare admit it doesn’t work. How many doses do you think the human body can withstand before everybody ends up with a compromised immune system? You’ll be on the 15th booster by the time the Zachary variant arrives on the scene. Crack on!!

      1. If you have concerns about a kidney problem, you should consult a nephrologist. In the same way, if you have concerns about the safety and efficacy of the vaccines and boosters, you should address those concerns to a specialist in immunology, virology, or epidemiology. They can tell you why the vaccines and boosters are being recommended.

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