As of writing, Covid-19 has taken about 5,35 million lives worldwide, 800,000 lives in the USA alone. When the pandemic first broke out, the Economist newspaper predicted that between 1 to 2 million lives would be lost to Covid-19 in the USA. I remember being shocked by this number, and for a while those predictions seemed to be way off the mark. Almost two years later, we are almost reaching their lower boundary.
Despite all efforts, the US continues to have a relatively low percentage of fully vaccinated people. Overall, the number stands at 61%, far from what is required to attain herd immunity. Moreover, this number hides differences between states. Some like Ohio, Tennessee, Indiana and Georgia are in the low 50s, whilst Mississippi, Idaho and Wyoming in the 40s. Half or more of the people in these states refuse to get vaccinated.
In Europe, the situation is slightly better, though again it varies between countries. Even in those where people have been more hesitant about the vaccine – Germany, Austria, the UK and the Netherlands nearly 70% of people are fully vaccinated. At a time where a new variant has appeared on the scene, and the deaths are soaring once again, governments are increasingly turning to partial or full vaccination mandates.
Earlier this month, Austria took a step once unthinkable for a Western democracy: it announced that Covid-19 vaccinations would become compulsory for its entire eligible population. Austria’s extraordinary move came just days after it introduced a lockdown for the unvaccinated — a restriction that went farther than other European nations in singling out the people who have been driving a worrying surge in hospitalisations.
In other countries, compulsory vaccination has already been partially introduced for certain age groups or professions. France was the first to introduce partial compulsory vaccination last September. Not only do health-care personnel have to be vaccinated, but so do professions such as police and fire workers. In Greece, where infections are rising, Prime Minister Kyriakos Mitsotakis recently announced that Covid-19 vaccinations would be made mandatory for all citizens over the age of 60. Even the president of the European Commission, Ursula von der Lyen, has suggested that every member state should do likewise and force vaccination upon its citizens. The fact that the EU has no mandate over how member states organise their health sectors, seems now to be of little importance.
Needless to say, this has created a huge outcry. In recent weeks we have seen a wave of protests all over Europe against compulsory vaccinations. The question as whether or not to pull the trigger on mandates, and how to weigh up the risk to civil liberties against a serious threat to overstretched healthcare systems, has caused a lot of hand-wringing across the world — especially in Europe, a proud bastion of liberal democracy. Austria has paved the way, and other countries are likely to follow suit. Some have welcomed this stance; others believe that we have opened Pandora’s box. How far should we go to achieve herd immunity?
At the root of our disagreements on these issues lies our stance on morality. These questions involve considerations of the rights of individuals, obligations individuals may or may not have to one another, what the role of the state should be, and, ultimately, how society should be organised.
As individuals and societies, we face moral dilemmas every day. Whenever we ask ourselves “what is the right thing to do?” citizens and those who govern them pose moral questions. Some of these are easier to answer than others. If the decision is between binge watching another episode of the series “The Office” and completing your professional or parental obligations, we all pretty much know what should be done. We may still choose to watch another episode of that feel good comedy, but at the end of the day we all know what the right thing to do is.
However, not all issues are of such easy resolution. Life in democratic societies is rife with disagreement about right and wrong, justice and injustice. Take the recent discussions over compulsory vaccination, euthanasia, or abortion: all these are thorny issues. So too are biogenetics, surrogate mothers, affirmative action, the torture of terror suspects, conscription and so forth.
Political and moral philosophers cannot resolve these disagreements once and for all. They themselves disagree over the right thing to do. Some believe that we should aim to maximise welfare, others we need to safeguard individual rights and still others to promote civic virtue. Each of these ideas’ points to a different way of thinking about what ought to be done, and in turn, a different position on knotty moral issues. For the sake of simplicity, I shall only discuss here the first two approaches: welfare maximisation vs. individual rights.
The fact that moral philosophers themselves disagree, does not make considerations of morality or justice irrelevant. In a rapidly changing world, with disruptive and potentially lethal technologies, and where Man faces several existential threats, moral discussions have never been as important. They may not provide us with one, indisputable answer, yet they give shape to the arguments we have, and bring moral clarity to the alternatives we confront as democratic citizens.
Consider the case of the anti-vaxxer camp. It’s important to know what moral beliefs underlie their stance in order to best frame arguments to combat it. Identifying these ethical codes could help shape persuasion strategies more successfully and help answer just how far we should go to combat this pandemic.
Until recently, governments around the world had rejected the idea of a universal coronavirus vaccine mandate, opting instead for incentives and other “nudges” to motivate people to get shots. Unvaccinated people suffer severe restrictions of movement. In Greece, Italy and France employers cannot fire people who do not have the vaccine but it is possible to suspend workers without pay – a “friendly” nudge. The USA mandated that federal contractors demonstrate that their workforces are vaccinated. It also conditioned federal student loans on proof of vaccination. Those measures might or might not be wise policy: inducements are usually more effective at changing individual behaviour than penalties. But they spread the message about what people ought to do, in the same way as sanctions against drunk driving, cheating on taxes, and unjust discrimination in the workplace do.
Broadly speaking, there are two ways to think about mandatory vaccinations. The first approach, known as the utilitarian school of thought, says that the morality of an action depends solely on its consequences: the right thing to do is whatever will produce the best state of affairs, all things considered. The second approach says that consequences are irrelevant, morally speaking: certain duties and rights should command our respect, for reasons independent of their social consequences. Put differently, certain rights are fundamental – be they natural, sacred, inalienable or categorical.
Some of our debates reflect profound disagreements about what should take precedence: maximising social welfare or respect for individual rights. Others involve disagreements about what to do when these ideals conflict, namely the right I have to guarantee my health (and life) and avoid future lockdowns vs. the right of others to choose what to do with their own bodies.
The main idea behind welfare maximisers is simple: the highest principle of morality is whatever will maximise utility, or in this case whatever produces the least pain and the most happiness. Jeremy Bentham, the father of utilitarianism, heaped scorn on the idea of natural rights, calling them “nonsense on stilts”, a phrase that most liberal democrats would flinch at.
Anti-vaxxers put lives at risk, prevent a society from reaching herd immunity and therefore prolong restrictions like mask waring, working from home, children being sent home from school, businesses being closed – entailing a cost to the majority of the population that has been vaccinated. Moreover, when they get sick, they are likely to be a greater drain on the public health system since they have no immunity, forcing the state to devote more resources to keeping them alive, resources that could be used to combat other diseases.
Covid-19 has become a pandemic of the unvaccinated. Most people that are hospitalised today have not been vaccinated. But the costs of being vaccinated are miniscule. Very few people have adverse or even fatal reactions, vaccinations are free, and vaccinations work. There is no doubt that the benefits of vaccination far outweigh the costs and therefore it follows, in this view, that the right course of action for any government is to make Covid-19 vaccinations mandatory.
People who refuse to be vaccinated are unethical because they risk causing serious harm to other people for no valid reason; irresponsible because they run counter to individual and collective responsibilities to contribute to important public health goals. Achieving herd immunity—the point at which a population is sufficiently vaccinated where a virus can’t find enough new hosts and new mutations are avoided—would now require close to 90% of people to take the vaccines. With most adults immunised, new and more infectious coronavirus variants would have nowhere to spread. Life could return to normal much sooner and less variants (some of which could land up being resistant to the vaccines that have been developed) are likely to arise. Other harmful effects that prolonging this pandemic has on the economy, effective education and mental health would be minimised.
Mitigating strategies – masking, social distancing, hand washing and regular testing– are effective in slowing the spread of Covid-19. However, these measures are not as effective and are much less appealing as long-term strategies. As more variants arise, states are forced to go back to requiring mask wearing and social distancing, practices that inhibit personal freedom and have significant socioeconomic repercussions. Allowing some people, the choice to remain unvaccinated severely limits the mobility and threatens the safety of other people, which makes the availability of that choice both unfair and dangerous for those who are especially vulnerable and who may not have other options to protect themselves.
In an ideal world, we would be able to convince all people to freely choose to take vaccines. Although people should generally be left free to behave as they want, sometimes constraining their behaviour is justified when their actions cause harm to others. John Stuart Mill, another utilitarian, proposed the Least harm principle. In general, it’s best to use the least intrusive means necessary to encourage desirable behaviour. The best approach would be to achieve herd immunity through education, persuasion, incentives and a belief in science. If those don’t work, bans and restrictions. Should the next step be making vaccines mandatory?
In the highly polarised society we live in, prone to politicising most issues, and where common sense or even any sense at all is sometimes in short supply, governments have had to turn to more drastic measures. Unvaccinated people are subject to discriminatory measures such as being barred from restaurants and sports arenas unless they provide a negative PCR test. However, the number of unvaccinated people in some countries remains persistently high. Bans and restrictions have not had the desired outcomes we thought they would
Defenders of individual rights argue that this is just one step away from pinning people down and forcibly vaccinating them – the slippery slope argument. If we allow vaccine mandates today, what guarantees do we have that the State won’t physically compel people tomorrow to undergo unwanted immunisations? Mandatory vaccines, in this line of argument, is opening the door for Holocaust type policies tomorrow – the reason why many anti-vaxxers wear the yellow star of David.
The most glaring weakness of utilitarianism, is that it fails to respect individual rights. By caring only about the sum of satisfactions, it can run roughshod over individual people. Anti-vaxxers say that mandates fail to respect their intrinsic dignity as human beings, that are sovereign, autonomous and have agency. Who better than themselves to decide if they want to be vaccinated? In some ways, being anti-vaccine is a deeply American sentiment: it’s the stubborn belief that individuals know better than the government what is best. Moreover, the right of patients to control their bodies is a bedrock principle in medical communities around the world.
Liberal rights activists believe that we are living through a chilling overhaul of the entire relationship between the state and the individual, with the state empowered to such an extraordinary degree that it can now instruct its citizens on what to inject in their bodies, and the individual so politically emaciated, so denuded of rights, that he no longer enjoys sovereignty over himself, over that tiny part of the world that is his own body and mind. They believe that we are witnessing the violent death of European liberalism and the birth pangs of a new and deeply authoritarian era.
Mandatory vaccines, they believe, spell the end of freedom as we know it. Bodily autonomy is the foundation stone of self-government and self-government is the thing that gives freedom meaning. If we do not enjoy sovereignty over our minds and our flesh, then we are not free in any meaningful way. The state diktat determining that only those who receive a certain form of medical treatment will get to enjoy freedom will make freedom itself contingent upon doing what the state wants you to do.
Two liberties seem to collide: the liberty of the anti-vaxxers vs. the liberty of the rest of society (the majority) that are vaccinated. However, what if they are right? What if these vaccines turn out to have bad long-term consequences that scientists and virologists couldn’t possibly know now? This argument carries special weight when we discuss vaccinating young children from the age of five. If this age group is less likely to get seriously ill from Covid-19, why should they be vaccinated in order to protect the older population? Aren’t they being used as means to attain an end (protecting the elderly and the infirm) instead of being treated as ends in themselves?
Do governments have the right to lawfully require more public-health cooperation from their populations? In the end, the unvaccinated person has decided to inflict a preventable and unjustifiable harm upon family, friends, neighbours, community, country, and planet, so infringing on the rights of others to their own health and to not endure future lockdowns which restrict their movements and could cost them their livelihood. Even if we believe that individuals may know better than governments what is best for themselves, is this enough of a question when considering society as a whole in a pandemic?
When one person’s choice might harm others, it can arguably be ethical for that choice to be limited. That is why we have speed limits and stop signs; both limit your right to drive as you might wish, but they are necessary for public safety. Other examples include laws about smoking in aeroplanes, firing a gun in an urban area and so forth. It is the risk of harm to others – impinging on their liberty to be safe whilst driving, to breathe clean air, or not be shot – that makes it ethical to place limits on personal choices. Moreover, this would not be the first time that vaccines have been mandatory. Most public schools do not admit children unless they have been fully vaccinated. It was due to this that we managed to eradicate measles, smallpox and other equally disagreeable illnesses. What makes mandatory Covid-19 vaccines polemic and do anti-vaxxers have a case?
Anti-vaxxers argue that the state has no right to dictate what risks people take with their bodies and lives. However, it turns out that humans are not always terribly good at calculating risk. Whereas there is an eight in 10,000 chance of contracting facial paralysis with the vaccine, one out every 100 Portuguese was killed by COVID-19 since the beginning of the pandemic. The mortal arithmetic here is easy to do—and argues strongly in favour of getting the shots, yet many anti-vaxxers will still prefer to fixate on the facial paralysis argument and completely ignore that they have a much higher probability of dying if they do not get vaccinated.
Other vaccine hesitaters distrust the pharmaceutical industry, which they argue is corrupt, and attempting to spin up a coronavirus vaccine too quickly. Some suspect that it is in cahoots with doctors and the government, in a dark cycle of profit and secrecy. This fear of nefarious medicine is perhaps understandable in a world where drug companies’ lies and greed sparked an opioid epidemic that has killed nearly half a million people. Understandable yes, but not completely rational. Are we to lose complete faith in all scientists, virologists and doctors because mistakes were made in the past?
Still others point to the question of effectiveness. Vaccines do not prevent you from getting the virus. True. But those who are vaccinated are less likely to get the virus and if infected, will not have severe symptoms which require hospitalisations and may lead to long term Covid or in some circumstances death. Vaccines work.
Those of us who are pro-vaccination and liberals, like myself, should shudder and remain vigilant at the thought of state power encroaching into areas once considered inviolable. However, life in society requires limits. My freedom ends where yours begins. I am not free to run naked in the public square, drive under the influence of alcohol or endanger other people’s lives. Though mandatory vaccines leave me feeling uncomfortable, I believe they have become a necessary evil to secure both social welfare and the inalienable rights to life, liberty and the pursuit of happiness.
