Literature Review: Ethics of Mandatory Vaccination

Ethics of Mandatory Vaccination

Giubilini (2021) uses his invited review to examine ethical issues surrounding behaviour and policies pertaining to vaccines. The variables within Giubilini’s study are vaccination and public health ethics (p. 4). Since Giubilini wrote this article while most vaccines were still in development, some of his phrasing around the topic is hypothetical. Giubilini states that “when we do have a vaccine that is widely available, COVID-19 will stop being a threat only if enough people are willing and given the opportunity to be vaccinated” (p. 5). He elaborates on this point by saying: “Vaccination decisions affect not only (or even not primarily) the individuals who get vaccinated, but also people around them and the community more broadly, vaccination decisions and policies are also ethical decisions” (p. 5). These quotes enunciate the fact that while getting a vaccine is a personal decision, it creates a butterfly effect on the surrounding community of each individual. Getting an immunization is not always something one does to protect themself. Receiving a vaccine for a disease can be a gesture of care for one’s community because it prevents the further spread of infection. However, as Giubilini points out, it is not always a matter of choice but sometimes an issue of access. He elaborates, by naming a few sample populations, that it is typically individuals of lower-middle-income nations who do not have access to vaccines and individuals of higher-income nations who choose not to immunize (p. 5).

As part of the review, Giubilini (2021) defines herd immunity as a public good, the principle of least restrictive alternative and vaccination policies, harm prevention, and fairness as points of ethical argument (pp. 6-10).

Herd immunity is when enough people in a particular population are immunized against a disease to effectively halt infection rates. In turn, this protects the smaller percentage of people unable to be vaccinated due to a medical exemption or because they may not be old enough. In the example of the current Covid-19 vaccines available in Canada, children aged five and under and immunocompromised individuals would depend upon herd immunity to protect them from infection (Government of Canada, 2021, paras. 1-7).

Giubilini (2021) states that, ethically, the prevalent perception of herd immunity is as a public good because it benefits the whole of the community directly and indirectly. But, herd immunity raises issues when brought against the principle of fairness and equal contribution to a cause (pp. 6-7). Essentially, the people who do vaccinate may find it unethical that those who did not receive a vaccine, even though they are medically able to, reap the same benefit as they, the contributors, do. Herd immunity works on a collective where each able person contributes.

Giubilini (2021) describes the principle of the least restrictive alternative and vaccination policies relating to achieving herd immunity and how a government can implement a plan without infringing upon individual liberties. Giubilini states that the following rights and freedoms are at stake with mandatory vaccination—bodily autonomy and choice regarding one’s health and the health of their offspring (p. 7). The following quotation adequately describes the central ethical conundrum within the least restrictive alternative principle: “It aims at promoting the collective good but also at preserving as much freedom as possible” (p. 8). However, this does not account for individuals who value their perceived freedoms much more than they care for the collective good. Giubilini concludes a similar point before opening his argument on harm prevention (p. 9).

Harm prevention is closely related to the principle of the least restrictive alternative based upon the least possible intrusion on an individual’s autonomy in promotion of a greater good, in this instance, the greater good of slowing/stopping further infections through vaccination (Giubilini, 2021, p. 9). ‘Do no harm’ is a fundamental principle in healthcare, so its correlation to public health crisis’ responses is not out of character. Individuals should scale the potential risks within vaccines against the harms, or risk of harms, in the spread of a disease among the population. (pp. 9-10). Overall, the debate stands on which side has less risk.

Ethical fairness rests at the core of each argument detailed above: fairness in herd immunity when not all contribute, and fairness in the least restrictive alternative and harm prevention where personal choice and community obligation meet to debate risk mitigation for either. Giubilini (2021) lists two requirements for fairness: “not to free-ride on a public good like herd immunity, when the public good exists; and (2) a requirement to make one’s contribution to a public good like herd immunity, regardless of whether the individual contribution ‘makes a difference’” (p. 10). Overall, fairness depends on equal contribution to collective benefit. Taxes to build public services exemplify the fairness principle; everyone who pays taxes funds something contributing to the betterment of their community.

Giubilini (2021) concludes his review by connecting the interdependence of individual, collective, and institutional responsibilities to vaccination ethics (p. 10). The most effective way to solve a problem is working with the parties around oneself and prioritizing a universal solution. His final line emphasizes the importance of maintaining the collective, individual, and institutional responsibilities at the forefront “with regard to vaccination decisions and policies […] at the centre of future philosophical, sociological and legal work on vaccination” (p. 11). Giubilini’s review was included within the current research study because it highlights arguments both for and against mandatory vaccination. Giubilini’s study also emphasizes how, ethically, major decisions such as implementing a mandatory vaccination regulation need to be made with considerations of the effects on all parties.