Frequently Asked Questions about Mandatory Vaccination

1. What does “mandatory vaccination” entail?

Modern versions of "mandated vaccination" coerce immunization by threatening (direct and indirect) to impose limitations if non-compliance is observed. Typically, mandated vaccination rules provide for a limited number of exceptions that are approved by legitimate authorities (e.g., medical contraindications). Despite its term, "mandated vaccination" is not genuinely required, in the sense that no force or fear of criminal consequence is employed to compel compliance. "Mandatory vaccination" regulations restrict human choice in non-trivial ways, such as making vaccination a requirement for attending school or working in certain professions or environments, such as health care. Such policies are not prevalent, however it should be emphasized that the World Health Organization (WHO) does not currently support the implementation of COVID-19 vaccination requirements, arguing that it is preferable to focus on public awareness campaigns and making vaccinations more available. Furthermore, the World Health Organization has released a policy statement stating that COVID-19 vaccination should not be required as a condition of international travel by national authorities or conveyance operators. Mandatory vaccination laws and legal grounds vary by jurisdiction. A legal obligation to get vaccinated differs from an ethical commitment in that the latter is not enforced by threats of restrictions if non-compliance is not met.

2. What are the ethical caveats regarding the mandatory COVID-19 vaccination?

Necessity and Proportionality

Mandatory vaccination should be considered only if it is necessary for, and proportionate to, the achievement of an important public health goal (including socioeconomic goals) identified by a legitimate public health authority. If such a public health goal (e.g., herd immunity, protecting the most vulnerable, protecting the capacity of the acute health care system) can be achieved with less coercive or intrusive policy interventions (e.g., public education), a mandate would not be ethically justified, as achieving public health goals with less restriction of individual liberty and autonomy yields a more favorable risk-benefit ratio.

Sufficient evidence of vaccine safety

Data should be available that demonstrate the vaccine being mandated has been found to be safe in the populations for whom the vaccine is to be made mandatory. When safety data are lacking or when they suggest the risks associated with vaccination outweigh the risks of harm without the vaccine, the mandate would not be ethically justified, particularly without allowing for reasonable exceptions (e.g., medical contraindications). Policymakers should consider specifically whether vaccines authorized for emergency or conditional use meet an evidentiary threshold for safety sufficient for a mandate. In the absence of sufficient evidence of safety, there would be no guarantee that mandating vaccination would achieve the goal of protecting public health. Furthermore, coercive exposure of populations to a potentially harmful product would violate the ethical obligation to protect the public from unnecessary harm when the harm the product might cause outweighs the degree of harm that might exist without the product.

Sufficient evidence of vaccine efficacy and effectiveness

Data on efficacy and effectiveness should be available that show the vaccine is efficacious in the population for whom vaccination is to be mandated and that the vaccine is an effective means of achieving an important public health goal. For instance, if mandatory vaccination is considered necessary to interrupt transmission chains and prevent harm to others, there should be sufficient evidence that the vaccine is efficacious in preventing serious infection and/or transmission. Alternatively, if a mandate is considered necessary to prevent hospitalization and protect the capacity of the acute health care system, there should be sufficient evidence that the vaccine is efficacious in reducing hospitalization. Policymakers should carefully consider whether vaccines authorized for emergency or conditional use meets evidentiary thresholds for efficacy and effectiveness sufficient for a mandate.

Public Trust

Policymakers have a duty to carefully consider the effect that mandating vaccination could have on public confidence and public trust, and particularly on confidence in the scientific community and public trust in vaccination generally. If such a policy threatens to undermine confidence and public trust, it might affect both vaccine uptake and adherence to other important public health measures, which can have an enduring effect. High priority should therefore be given to threats to public trust and confidence amongst historically disadvantaged minority populations, ensuring that cultural considerations are taken into account. Vaccine hesitancy may be stronger in such populations and may not be restricted to concerns of safety and efficacy, as mistrust in authorities may be rooted in histories of unethical medical and public health policies and practices as well as structural inequity. Such populations may regard mandatory vaccination as another form of inequity or oppression, making it more difficult for them to access jobs and essential services.

Ethical processes of decision-making

Transparency and stepwise decision-making by legitimate public health authorities should be fundamental elements of ethical analysis and decision-making about mandatory vaccination. Reasonable effort should be made to engage affected parties and relevant stakeholders, and particularly those who are vulnerable or marginalized, to elicit and understand their perspectives. Steps should be taken in good faith to respect human rights obligations not to discriminate or disproportionately disadvantage vulnerable populations. Legitimate public health authorities that are contemplating mandatory vaccination policies should use transparent, deliberative procedures to consider the ethical issues outlined in this document in an explicit ethical analysis, including the threshold of evidence necessary for vaccine safety and efficacy to justify a mandate.

3. What is the importance of stopping mandatory vaccination to people?

COVID-19 vaccines are successful in protecting people. Before considering forced vaccination against COVID 19, governments and/or institutional policymakers should employ arguments to support voluntary vaccination. Efforts should be made to demonstrate the benefits and safety of vaccinations in order to achieve the highest level of vaccination acceptability. Only if these methods fail should stricter regulatory actions be considered. When deciding if mandatory COVID-19 vaccination is an ethically justifiable policy choice, a variety of ethical issues and cautions should be openly acknowledged and addressed via ethical analysis.