Maxwell J. Smith considers the nature and significance of unintended consequences of vaccine mandates.

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In a recent Impact Ethics commentary, Maya Goldenberg and Chris Kaposy describe two cases where parents insisted “unvaccinated blood” be used in their young children’s surgical care. They go on to speculate there is a “likelihood” these requests are an “unintended consequence of how vaccine mandates and passports have been used during the COVID-19 pandemic.”

This raises two interesting and important questions. First, when should we count something as an “unintended consequence” of a policy? And second, if we think something should count as an unintended consequence of a policy, what implications should this have for the fate of that sort of policy?

Photo Credit: Flickr/Kentucky National Guard. Image Description: An individual receives a COVID-19 vaccination.

No one can deny attitudes and behaviours toward vaccines are multifactorial and complex. As a result, it’s difficult at the best of times to trace a direct line between vaccine policies (such as vaccine mandates), and vaccine attitudes and behaviours (such as requests for “unvaccinated blood”). For instance, characterizing attitudes and behaviours like requests for “unvaccinated blood” as an unintended consequence of vaccine mandates ignores the role of misinformation and disinformation about mRNA vaccines that pre-date COVID-19 vaccine mandates. Beliefs that mRNA vaccines alter your DNA, contain microchips, connect your body to 5G, and so forth, arguably provide a more plausible explanation for why some might worry about “vaccinated blood” in the first place. (To be clear, Goldenberg and Kaposy acknowledge the role of misinformation in this case.)

Moreover, because there are many mediating factors between a policy and its consequences (intended or not), we might ask why we should characterize a phenomenon as an unintended consequence of a policy, rather than characterize that phenomenon as an “intended consequence” of some other force. The request for “unvaccinated blood” might instead be an intended result of efforts by well-funded actors to purposefully and maliciously spread disinformation in order to increase the number of people who consider vaccines to be bad or dangerous.

In turn, this complex relationship between policies and their “unintended consequences” has important implications for how we should think about the fate of such policies. I suspect that when people describe a policy’s unintended (negative) consequences, the implication is that we ought to count those consequences as a “disadvantage” of that sort of policy, a reason we might want to avoid using that sort of policy in the future. But this would be too hasty for two reasons.

First, we may be interested in understanding and describing a policy’s unintended consequences because we’re interested in improving policies of that sort in the future, not scrap them entirely. Instead of being counted as “disadvantages”, such consequences may instead be counted as something to keep in mind when designing, implementing, and communicating about future policies of that sort.

Second, and more importantly, counting unintended consequences as a reason to reconsider a policy is too hasty because it assumes it is the policy that ought to be changed rather than the attitude or behaviour considered to be the unintended consequence. Consider the view that permissive abortion policies may have the “unintended consequence” of violence against those providing and seeking abortions. If we believe certain attitudes or behaviours are unacceptable, as is the case for violence against those providing and seeking abortions or exploiting the tragedy of victims of Nazi experiments in debates about vaccines, we surely shouldn’t allow such behaviours or attitudes to dictate policy.

This may seem straightforward enough, but things are more complicated than they seem. Suppose we were reasonably confident that the handful of bizarre instances where people have requested “unvaccinated blood” should in fact count as an unintended consequence of vaccine mandates. And suppose we are convinced that such erroneous and dangerous views – views so erroneous and dangerous they warranted the removal of Baby W from the care of their parents – shouldn’t play any role whatsoever in dictating policy. At the same time, we might think protests against vaccine mandates count as a more legitimate reason to reconsider the role of vaccine mandates in the future. But, of course, those who request “unvaccinated blood” are likely to participate in such protests. And while only a minority protesting vaccine mandates are likely to have such invalid, ill-founded, or repugnant reasons for doing so, this raises questions about whether we should so straightforwardly count “protests” as an unintended consequence worthy of reconsidering vaccine mandates. The reasons some or many protest vaccine mandates may include erroneous or unacceptable beliefs that we think shouldn’t dictate policy.

A lot needs to be thought through when confronted with the possibility that some negative phenomenon constitutes an “unintended consequence” of vaccine mandates. We’ll likely hear much more about this issue following the use of mandates during the COVID-19 pandemic. When studying and discussing a policy’s unintended consequences, we should question the mediating factors that may in fact be working hard to ensure these consequences happen, and be clear whether a policy’s unintended consequences should count as a reason to reconsider policies of that sort in the future.

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Maxwell J. Smith is an Assistant Professor and Western Research Chair in Public Health Ethics in the School of Health Studies, Faculty of Health Sciences, and Associate Director of the Rotman Institute of Philosophy, at Western University. @maxwellsmith.