Exploratory Essay: Pros And Cons Of Vaccine Mandate 2022

For millennia, viruses have plagued humans and have caused millions of deaths1 It was only in 1796 when vaccines were invented, and we finally had a defense against viruses.2 However, from the start vaccines have been controversial. There were many reasons behind vaccine hesitancy from religious reasons to beliefs vaccines were unhygienic. Recently, disinformation such as Andrew Wakefield's, infamous study, which stated that the MMR vaccine causes autism,3 has sparked a new wave of vaccine skepticism. This has led to decreasing vaccine uptake, causing some to ask “Should vaccines for all diseases be mandatory?”

One of the most well - known and compelling arguments for a vaccine mandate is herd immunity.  Herd immunity means that people who are not vaccinated are protected from infection due to the fact that others in their community are immune.4 In fact, Dr Alberto Giubilini, a senior research fellow in the university of Oxford states that “mandatory vaccination ensures that the risks and burdens of reaching herd immunity are distributed evenly across the population.” 5 An example of the effects of a loss in herd immunity can be seen in late 2014 to early 2015, when a fall in children receiving the MMR vaccine led to a measles outbreak in the USA.6

Moreover, widespread community immunity is what leads to disease eradication. In 1977 smallpox was eradicated, this feat was accomplished by mass vaccination programmes and focused surveillance.7

Furthermore, pathogens such as measles induce immunosuppression, and can deplete T – cell repertoires and shrink antibody cell repertoires by up to 70%.8This leaves a person vulnerable to other pathogens and secondary infections. Another example of this can be found in the coronavirus pandemic where a study by the CDC found that over 70% of those who had COVID-19 had complications due to pneumonia.

However, there are caveats to mandatory vaccination, if a financial penalty for vaccine refusal is enforced, people from lower socio-economic backgrounds would be disproportionately affected and a financial penalty could “turn vaccine refusal in a purchasable commodity for the wealthy” 10. This leads to a varied impact of mandatory vaccination across different backgrounds.

Furthermore, for a vaccine mandate to be implemented vaccines would have to be free and readily available so that those from all backgrounds could have access to it.  However, this is easier said than done, when you consider that a huge proportion of the world’s population live in rural areas (around 3.4 billion in 2017).11 People living in these areas may not have hospitals close to them, nor access to the modes of transport necessary to reach vaccination centres/hospitals. So, it may not be feasible to implement a vaccine mandate, especially in developing countries.

One of the key principles of bioethics is patient autonomy. It is the notion that patients have a “moral claim to direct their own care”.12 Mandatory vaccination infringes upon this right, and by doing so could build more distrust between the authorities and the vaccine hesitant.

While the benefits of vaccination are undeniable, whether a mandate is the answer to increase vaccination rates is debatable. To my mind, strategies to educate the public and eliminate misinformation and disinformation (regarding vaccines) on the internet and other platforms should be considered first. However, regardless of the strategy used, efforts should be made to increase vaccine uptake.