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Are the mandates of Covid vaccines ethical?  Here’s what medical experts think

Protesters rally against vaccination warrants on November 20, 2021 in New York City.

Stephanie Keith | Getty Images

Ethical justification

Julian Savulescu, director of the Uehiro Center for Practical Ethics at the University of Oxford, said the main motive for implementing enforcement measures during a pandemic is to prevent harm to other people.

“You are not allowed to shoot a gun in the air at the risk of injuring other people and likewise, you cannot shoot Covid which could kill other people in a crowd”, he said on a phone call.

But according to Savulescu, four ethical conditions must be met to justify coercive policies like vaccines or masks.

“First, the problem must be significant, so you must have a serious emergency or a real risk of injuring people. Second, you must have a safe and effective response,” he told CNBC. “Thirdly, [the outcome] must be better than less freedoms and more restrictive measures. And finally, the level of coercion must be commensurate with the level of risk and the safety and effectiveness of the intervention. “

Savulescu said that in his opinion the obligation of Covid vaccines for an entire population does not meet these requirements. Since vaccinations are not 100% effective in reducing transmission, he said they do not offer an extra level of protection to others that justifies such an extreme level of coercion.

“But there is a second way to justify coercion, which is less common, and that is when you have a health care system that will collapse if you don’t prevent people from getting sick,” he said. he declares. “Then you can use coercion to keep people from getting sick, not to keep them from infecting other people, but to keep them from using this limited health resource in an emergency.”

This could be used to justify making Covid vaccines mandatory, he said, but only when the policy is applied to people most likely to require hospitalization or intensive care if they contract the virus.

Vivek Cherian, physician at Amita Health, agreed that to be ethically justified, the overall benefit of a vaccination warrant must outweigh the risk.

“The ethical dilemma, especially in the United States, is the inherent conflict between an individual’s autonomy and freedom and public health value,” he said. “Since if more people are vaccinated [it would] lead to fewer deaths, there is an ethical justification for the general good. “

But in the United States, Cherian said, there was “virtually no chance that we would see universally required vaccine warrants.”

“This is because we currently don’t have it for any vaccine,” he said. “What we’ll most likely see are some communities that need it, like federal workers, the military, or individual businesses. States will likely end up requiring that Covid vaccines be educated in public schools, in addition to the many other vaccines currently required. “

While countries introducing nationwide vaccination mandates are in the minority, several countries – including the UK, US and France – have made Covid vaccination mandatory for healthcare workers.

UK Health Minister Sajid Javid has explicitly ruled out extending the vaccine’s mandate to the entire population of the country.

Al Dowie, professor of medical ethics and law at the University of Glasgow, said compulsory vaccination was not inherently controversial “depending on the context”, noting that British doctors should already be vaccinated against common communicable diseases .

“Coercion is ethically justifiable when the risk to public health is great enough,” he said in an email. “Healthcare is a risk-laden phenomenon, and there must always be some residual risk. The question is what level of risk is deemed acceptable.”

Coercion vs inducement

While some governments have opted for aggressive mandates, others have instead attempted to boost vaccination uptake by offering individuals incentives to get vaccinated.

For example, the Ohio State’s “Vax-a-Million” lottery program, which involved people in a raffle for $ 1 million after getting their chance, was hailed as a winner. “Resounding success” by Governor Mike DeWine. New York and Maryland then started their own lottery programs to incentivize vaccination, but a study by doctors at Boston University School of Medicine later found no evidence that the lottery incentive of Ohio had boosted vaccination.

Alternative research has shown that financial incentives could be useful to encourage vaccination. A Swedish study published last month found that paying people the equivalent of $ 24 increased the vaccination rate by 4%. The researchers told CNBC, however, that it was “a little extra motivation to get the vaccine,” rather than a tool to change the minds of ardent skeptics.

During the pandemic, several governments, including those of the United States, Japan and Hong Kong, issued millions of citizens with checks valued between $ 930 and $ 1,280 in an attempt to keep their savings at bay. flow. Savulescu said he suspected that offering people one-time payments of the same value would increase vaccination rates and protect economies by preventing further lockdowns.

“The effectiveness of these interventions is poorly understood and will likely depend on the culture, the level of incentive or coercion, the ability to enforce them, etc.,” he said. “I think in general it’s better to start with incentives rather than go straight to coercion.”

Cherian said while offering incentives to boost vaccination was not an unethical strategy, he was skeptical of the effectiveness of coercion and incitement tactics.

“Those who support public health will be ready to get the vaccine regardless of the consequences or the incentives,” he told CNBC. “Those who are on the fence can be incentivized. However, for people who for whatever reason are extremely opposed to vaccination, coercive policies can actually have the opposite effect and make these people even more suspicious of them. vaccines that someone is forcibly trying on them. “

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