With the possibility of a COVID-19 vaccine fast approaching, I have felt compelled to do some research into the ethics of compulsory vaccination. Only yesterday (16th Nov) did the Health Secretary Matt Hancock state that he would not “rule out” making it compulsory to take a coronavirus vaccine if one becomes available.
So, what are the ethics behind compulsory vaccination? In the UK, there is currently no regulation that requires a person to undertake involuntary medical treatment, including vaccination. This is made very clear in the Public Health (Control of Disease) Act 1984, that gives government the power to prevent, control or mitigate the spread of an infection or contamination. This legislation was carried forward in the Coronavirus Act of 2020 that, according to Barrister Louise Hooper, "makes explicitly clear that the power to make such regulations does not include mandatory treatment or vaccination”. This has not always been the case, however. In 1853, for example, a law introduced in England and Wales required universal vaccination against smallpox, with fines levied on people who did not comply. With the World Health Organisation declaring the anti-vaccine movement one of the top 10 global health threats for 2019, perhaps there is reason to introduce compulsory vaccination.
Those that argue for such regulation state that it ensures herd immunity thresholds are met. For most diseases, the level of the population required to be vaccinated is around 95%. As the benefit of the herd outweighs the rights of the individual, supporters argue that compulsory vaccination is a positive initiative for the greater good of a population - linking into the ‘Justice’ aspect of the pillars of medical ethics. On the other hand, critics state that mandatory vaccination is not required to meet these thresholds. According to the NHS, the percentage of children vaccinated by their 5th birthday against diphtheria and polio were 95.6%, well over the 80% threshold needed for herd immunity. MMR was also at 94.9%, hugely exceeding the 83% required. And this is the general trend for all childhood vaccines. Vaccination rates have fluctuated over the past 10 years by fractions of a percent, which is perhaps negligible when it comes to the whole population. Those against compulsory vaccination argue that a better option is to have difficult difficult exemptions for vaccines. As Dr Julie Learsk, professor of medicine argues, it is much better to have “exemptions for vaccines that are harder to get than to fully vaccinate your child". This allows a respect for personal choice, as well as keeping vaccination rates high.
Secondly, it could be said that mandatory vaccination, or indeed any mandatory treatment, opposes patient autonomy - a patient's basic right to have choice over medical treatment. This would arguably bring up difficulties for human rights - The UN Universal Declaration on Bioethics and Human Rights, for example, adopted by the United Kingdom, states the following: “any preventive…medical intervention is only to be carried out with the prior, free and informed consent of the person concerned, based on adequate information.” - but also for the concept of consent. Once a patient is over the age of 16, they are assumed capable of consenting (or not consenting) to medical treatment. For those under 16, if Gillick Competency guidelines are met, the child can also consent to treatment. These guidelines are important for the ethical basis of the NHS, and mandatory vaccination opposes these central values.
In conclusion, it would seem that mandatory vaccination is not an ethical decision. Instead, it would be much better for government to educate the public to the best of their abilities, and to clamp down on the anti-vaccine propaganda that is currently rampant on the internet. This should allow for a higher uptake of vaccinations, such as that for COVID-19, and should ensure that
vaccination continues to be an ethically sound medical initiative.
Bibliography
Goodman, Jack. (2020). Coronavirus: Compulsory vaccines in the UK and other rumours fact-checked. Available: https://www.bbc.co.uk/news/52565764. Last accessed 16th Nov 2020.
Solomon, T. (2019). The pros and cons of compulsory vaccinations. Available: https://www.independent.co.uk/news/health/vaccinations-measles-mumps-antivaxxer-compulsory-a8849671.html. Last accessed 17th Nov 2020
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