Why mandatory vaccination is nothing new

‘Mandatory vaccinations have been with us for centuries, quietly saving lives – and they're often largely unopposed until something changes.

‘When chosen carefully, there's no question that mandatory vaccinations can save lives. For example, one study found that patients were substantially less likely to die (with mortality rates of around 13.6% mortality verses 22.4%) in hospitals where healthcare workers had higher rates of flu vaccination compared to those with low rates, though patients were equally as likely to be infected with the virus.

Another European study also found that in countries with mandatory measles vaccinations, and without non-medical exemptions, the disease incidence was 86% lower than in countries without the mandates.   
‘One common tension is between obligation, which can increase hostility, and voluntary vaccination, which can increase transmission. Some health experts are nervous about mandatory vaccination because these policies may diminish trust in medical authorities over the long term. Vaccine mandates have led to violent riots in Brazil and may have contributed to vociferous anti-vaccine movements all over Europe, for instance.

‘In France, one of the world's hotspots of vaccine hesitancy, the Ministry of Health has attempted to reduce the polarising effects of vaccine mandates by embedding mandates within a broader effort to build trust. This has led to improved vaccine coverage, although a significant minority are still vaccine-hesitant – suggesting the importance of continuing to monitor attitudes and strengthening relationships between the medical establishment and the public.’

Read here (BBC, Nov 1, 2021)

Frustration with those who refuse Covid-19 vaccination but making it compulsory is tricky: Infectious diseases experts

Ramping up communications to convince those on the fence, along with differentiated measures nudging more to take the shot can help get vaccination rates up, say infectious diseases experts on CNA’s Heart of the Matter podcast...

‘As someone who treats COVID-19 patients, Dr David Lye, Director of the Infectious Disease Research and Training Office at the National Centre for Infectious Diseases (NCID), says he has spoken to “thousands of people”, and he always has one message for them: Get vaccinated. As a researcher and a scientist, he admits he gets frustrated when he encounters people medically able to get a vaccine but choose not to. But would he go so far as to recommend that vaccines be made compulsory?

“To be honest, I am in favour of a vaccine mandate, but I'm also aware that the impact on individuals in these times can be devastating,” Dr Lye added, pointing to the possibility of the unvaccinated getting shut out of jobs if COVID-19 vaccination was made compulsory nationally.

‘He was speaking to Supervising Editor Lin Suling, host of Heart of the Matter podcast on Thursday (Sep 16).

‘Dr Ashley St John, Associate Professor at Duke-NUS Medical School’s Programme in Emerging Infectious Diseases, who was also on the podcast, agreed. "If you're asking me personally, it would be nice to have compulsory COVID-19 vaccines, but I also understand there are other policy considerations … beyond just the scientific aspects.”

Read here (Channel News Asia, Sept 18, 2021)

Vaccine mandates have worked in the past. Can they overcome modern hurdles?

‘While some politicians have touted the new mandates as “un-American,” vaccine mandates are older than the United States itself. “General [George] Washington mandated smallpox inoculation—the precursor to the vaccine, and a more dangerous procedure—for the Revolutionary Army,” says Dorit Reiss, a law professor who specializes in vaccine policy at the University of California, Hastings College of the Law. “And I don't think it’s fair to describe Washington as un-American.”

Read here (National Geographic, Sept 16, 2021)

What’s the law on vaccine exemptions? A religious liberty expert explains

‘Many schools, businesses and governments requiring vaccination have offered religious exemptions. Some are loath to challenge people’s claims that getting the shot goes against their beliefs for fear of being sued, but organizations have come up with a variety of ways to assess claimants’ sincerity. But the legal basis of Americans’ supposed right to a religious exemption to vaccination is less clear than such policies’ popularity would suggest.

‘As a lawyer and scholar who focuses on religious liberties, I have supported religious exemptions for a baker who refused to create a cake for a same-sex wedding, a family-owned business that refused to provide emergency contraception to its employees, a Muslim prisoner who was obligated to grow a beard and many others.

‘Even so, I believe that under the general law of religious liberty – including the Constitution and state and federal religious freedom laws – the government has an easy case to refuse religious exemptions from vaccines against infectious disease.’

Read here (Religious News Service, Sept 15, 2021)

Ethical dilemma of mandatory vaccination

‘In the absence of a mandatory vaccine policy, the government can consider other lesser restrictive options. They are as follows:

1. The government can emphasise the educational approach on the vaccine-hesitant population by informing them of the risk-benefit analysis of the vaccine and the importance of taking the vaccine while also addressing their concerns.
2. The government can use behaviour nudge techniques, such as providing incentives or gift cards as the cost incurred will be minimal in comparison to them contracting Covid-19.
3. The government should actively ensure they clamp down on disinformation on social media that further reinforces the false belief of people who hold such extreme views.
4. The health ministry should release data and statistics that are available to bring
5. transparency to help the vaccine-hesitant population make an informed decision.
6. Teachers should not be allowed to teach in schools if they are not vaccinated and continue teaching from home until they get vaccinated.
7. Those who are fully vaccinated can play their role by sharing their experiences as studies have shown people tend to believe their own peers. Social media influencers can use their star power to influence the fence-sitters.
8. The education ministry should consider setting up vaccination centres at schools and provide counselling for school children who refuse vaccines.

‘In a nutshell, the government should navigate through this ethical dilemma cautiously. The government should consider other less restrictive alternatives that will protect the individual’s self-determination which is also in the state’s interest.’

Read here (Free Malaysia Today, Sept 12, 2021)

If you’re going to mandate Covid vaccination at your workplace, here’s how to do it ethically

‘Maintaining and promoting trust is important when it comes to vaccine mandates. It matters to people subject to mandates and it matters to the public more broadly because mutual trust is a cornerstone of effective public health engagement. People should feel supported in their health decision making and they should trust and feel respected by their employers. We’re seeing increasing politicisation about COVID public health measures, in Australia and internationally. This is a social harm we should avoid.’

Read here (The Conversation, August 18, 2021)

Covid-19 and mandatory vaccination: Ethical considerations and caveats

‘Vaccines are one of the most effective tools for protecting people against COVID-19. Consequently, with COVID-19 vaccination under way or on the horizon in many countries, some may be considering whether to make COVID-19 vaccination mandatory in order to increase vaccination rates and achieve public health goals and, if so, under what conditions, for whom and in what contexts.

‘It is not uncommon for governments and institutions to mandate certain actions or types of behaviour in order to protect the wellbeing of individuals or communities. Such policies can be ethically justified, as they may be crucial to protect the health and wellbeing of the public. Nevertheless, because policies that mandate an action or behaviour interfere with individual liberty and autonomy, they should seek to balance communal well-being with individual liberties (1). While interfering with individual liberty does not in itself make a policy intervention unjustified, such policies raise a number of ethical considerations and concerns and should be justified by advancing another valuable social goal, like protecting public health.

‘This document does not provide a position that endorses or opposes mandatory COVID-19 vaccination. Rather, it identifies important ethical considerations and caveats that should be explicitly evaluated and discussed through ethical analysis by governments and/or institutional policy-makers who may be considering mandates for COVID-19 vaccination.’

Download here (WHO Policy Brief, April 13, 2021)

No jab, no job? Ethical issues in mandatory Covid-19 vaccination of healthcare personnel

‘Mandating COVID-19 vaccination of healthcare personnel (HCP) could maximise vaccine uptake, but risks exacerbating breakdowns in trust between HCP and their institutions.

‘Ethical arguments for mandating COVID-19 vaccination of HCP appeal to their duties to ‘do no harm’ and to care for patients, but the fulfilment of these duties requires a safe working environment.

‘We argue for policies aimed at strengthening HCP’s trust in healthcare systems by addressing HCP concerns, including the institutional factors that have put them at risk of infection throughout the COVID-19 pandemic, before considering a COVID-19 vaccine mandate.’

Read here (BJM, February 17, 2021)