Chris Kaposy acknowledges the ethical justification for coercive COVID-19 vaccine policies, while also recognizing the danger of ceasing to view vaccine skeptics as thinking subjects.
The federal Minister of Health recently mused that provinces could implement sweeping mandatory vaccination policies. A few days later, the premier of Quebec announced a plan to tax the unvaccinated. Jurisdictions around the world are adopting increasing levels of coercion in order to get their populations vaccinated against COVID-19. The President of France has explicitly conveyed his intentions to make life uncomfortable for the unvaccinated through stronger vaccine mandates for admission to public places. Austria recently confined unvaccinated people to their homes amidst a dangerous rise in cases.
American intensive care units are filling up with unvaccinated patients. Here in Canada, we may be facing the same problem soon. We may wonder whether those who refuse vaccination are doing something morally wrong. There are a couple lines of argument suggesting that there is a moral duty to get vaccinated.
Over the past year, just after voluntary vaccination plateaued in many countries that had good access to vaccines, public health officials and governments have been implementing strategies for convincing people to get vaccinated. In the beginning, they strove to make vaccines as accessible as possible. Experts took to the airwaves to provide the public with good information and to counter misinformation. Doctors spent a lot of time answering questions in a non-judgmental fashion, addressing the concerns of vaccine skeptics. Some people were convinced by these methods, but many have remained unvaccinated nonetheless. It appears as though no amount of good science-based evidence, and no amount of mass death of the unvaccinated, can persuade many of the people remaining to get vaccinated.
So some political leaders, employers, and public health decision-makers have turned to mandates and vaccine passports of various kinds. In support of these strategies, researchers have determined that coercive measures like employee mandates are effective to some degree with those unreceptive to persuasion or educational approaches. As Anupam B. Jena and Christopher M. Worsham of Harvard have stated, “‘Get vaccinated or get fired’ has shown to be an effective message”.
With the adoption of coercive measures, decision-makers have abandoned a position in which vaccine skeptics are addressed as people with beliefs and values that can be part of a rational discussion. Public health officials and political leaders have moved to a position in which skeptics are viewed behaviouristically, as subject only to incentives and punishments. Due to this shift, it is no longer necessary to care about what vaccine skeptics believe or to understand their thought-processes. Officials have moved from seeing vaccine skeptics as thinking subjects toward seeing them simply as moveable objects.
Vaccine skepticism is now increasingly irrelevant. The thoughts and beliefs that lie behind skepticism no longer matter. With coercive strategies to get people vaccinated, these thoughts and beliefs will not be acknowledged, or addressed. There is also less effort to correct misinformation. The goal is simply to vaccinate as many people as possible, regardless of what people believe about the vaccines.
This is not to claim that coercive policies are wrong. Of course, in public health, it is easier to justify interventions that allow people to make their own choices, such as educational campaigns. There is a stricter standard of ethical justification for coercive measures. But we are living through death rates higher than in living memory, widespread trauma caused to health care workers, and an ongoing collapse of health systems. If these circumstances do not justify the use of coercive measures, none will. Unprecedented public health emergencies are precisely those that meet the high standard of justification for coercion. As the Minister of Health, Jean-Yves Duclos has said, “our health care system in Canada is fragile, our people are tired, and the only way that we know to get through COVID-19, this variant and any future variant, is through vaccination”. The broad safety of COVID-19 vaccines, and their effectiveness in preventing serious illness, support mandatory policies, even though with the omicron variant the vaccines are not highly effective in preventing infection. If high levels of vaccination are required to manage the risks of the pandemic, and coercive policies are the only measure that can get us to this goal, then some mandatory policies are justified.
We know that scientific evidence is not enough to address the roots of vaccine skepticism. Instead, anti-vaccination beliefs of all kinds arise out of mistrust of the institutions that have played a role in the response to the pandemic, such as governments, universities, and pharmaceutical companies. Truly addressing the roots of vaccine skepticism would require building public trust in these institutions among those people or groups who mistrust them. This is an important goal, but it cannot be realized in the short term. Meanwhile, populations urgently need to be vaccinated. Coercion is a short-term strategy with greater likelihood to increase vaccination.
Even though COVID-19 vaccine mandates of various kinds are justifiable, we should recognize the trade-off we are making. Coercion can be dehumanizing. In this moment while we remain in the midst of a pandemic, coercive policies might be acceptable, but we should nonetheless be wary when leaders cease treating some of our fellow human beings as thinking subjects..
Chris Kaposy is an Associate Professor at the Memorial University Centre for Bioethics, and an editor of the Impact Ethics blog. @ChrisKaposy