Immunisation should be legally AND morally compulsory
The debate around vaccination in modern times is most significantly about whether or not the government has the right and duty to compel people to be immunised, or whether this compulsion is the duty of individuals and society. The applied ethical scenario of challenge to individual preferences is part of a much larger philosophical conversation around the right of individuals to autonomy under a protective state. Political philosophers such as Mill and Hobbes are significant in arguing for and against whether liberal democratic regimes, which largely make up the Western world, have the right to impose certain duties on their citizens. This essay will examine historical examples of challenges to public autonomy and, ultimately, use these examples to argue that the best way to ensure the greatest public good is to enforce vaccination nationwide.
As a society over time, we have valued it as beneficial to live under a government. Relying on an authority to maintain common benefits and to keep us safe from dangerous individuals has been crucial; those less able to defend themselves are protected. This worthwhile moral ideal seems well-established throughout many civilisations, demonstrating, perhaps, its evolutionary benefit. In a modern context, the state-led protection has allowed humans to concentrate on their individual careers and “happiness,” as Rule utilitarians would argue, while national and international affairs are overseen by an elected body. The etymological derivation of “govern” from the Greek “kybernan,” or “steering a ship,” reflects the ship of castaway humans being steered by their chosen captain away from danger and towards the same destination. Mill’s argument that “everyone who receives the protection of society owes a return for the benefit” describes this chipping in by those on board the “ship” in order to ensure plain sailing. Many people simply argue that vaccination is an example of citizens’ necessary contribution. We receive herd immunity through the coordination and “steering” of the government; in turn, arguably, we must buy into this reward by paying our dues in vaccination.
Applying these principles to the real-life issue of vaccination is less clear-cut, however. Due to the nature of herd immunity and its requirement of a majority rather than an entirety of vaccinated citizens, there is a lack of legal compulsion behind it from authoritative sources. Only nineteen out of twenty people need to be vaccinated in order to create the benefit; five percent of healthy citizens can safely forgo the immunisation. While at face value a bonus, this situation can create an issue of social justice. If there is not clear regulation as to who fits into that five percent, more people will opt out than herd immunity can afford. Legally, any healthy member of the public can ‘comply’ with herd immunity by simply cruising along, reasoning that if herd immunity levels were to go down, they themselves could be vaccinated. Either way, individually, they do not face much risk of death from the particular disease in question. However, others in the herd ‘comply’ in the eyes of the law with higher stakes: by being unable to be vaccinated and so living in fear of infection, or by risking potential discomfort and ill health by vaccinating themselves for the good of everyone. This potential for discrepancy in what our duty is as citizens is dangerous for the balance of society. Although British politicians influenced by Mill in government positions may argue that “the inconvenience is one that society can bear,” without equal sacrifice, the benefit cannot be shared equally; some will need and covet herd immunity more than others given the risks involved. Any utilitarian calculations of “happiness” therefore will have to be readjusted. The greater good, or security for those unable to be immunised, becomes more conditional upon the diligence of others.
Having to rely on societal pressure rather than top-down enforcement is naturally less certain. Hobbesian analysis of humanity without government as “solitary, poor, nasty, brutish and short” is worryingly applicable in the context of vaccination. Without common rules, the “state of nature” dictates that those physically unable to be vaccinated will be left behind by others, and most people will be more at risk without mass vaccination; they are all simply trying to survive on their own. The organised benefit will be no more, and the population will slowly dwindle to a negligible number of those completely unaffected. Without a common benefit, we lose a duty of solidarity, and vice versa. This argument against giving individuals autonomy is commonly disputed, but vaccination is not necessarily dangerous enough to become a moral choice; it is a statistically successful method of helping society weather storms of disease. The reasons behind people’s choices not to vaccinate are therefore less linked to morality than to personal preference. To refute the scruples and qualms of individuals is not a particularly useful way to argue for mass vaccination. What is more important is discussing the logical implications for the common benefit and social justice if allowing vaccination to be an opt-in process remains the status quo. Just because the public may, individually, hold different stake values in the success of herd immunity, it does not mean that they should be allowed by authority to act in a way that reflects this self-interest.
Historically, governments have entered periods of war in the (often misguided, but theoretical) pursuance of a common benefit. In the face of inevitable desertion and pleas for exemption, conscription or a fixed amount of duty is distributed among the citizens. In theory, this system would allow for all to continue to live in their ordered society and with its benefits, as long as they serve the authority in turn. Without the harsh but necessary conscription, in the eyes of the contemporary leaders, the common benefit would be lost for all, and the people would lose faith in the government in turn. Conscription must trump trust in the citizens’ moral integrity, given our natural evasion of danger which would influence whether or not they did their duty. However, there are problems with the analogy of conscription as validation for compulsory vaccination. In practice, soldiers fighting for governments are not all being expected to carry out the same degree of duty; there is and always has been a hierarchy. Foot soldiers are, historically, treated expendably by the high-ranking officers who recline in luxury, miles from the front. Some of the conscripts, therefore, end up sacrificing more than others for the same ‘good.’ Thus, objections to conscription could be made logically as well as morally. The analogy can therefore be used as a counter argument to mass vaccination as much as an argument for it. One method of refuting the criticism is to argue that conscription in practice is, perhaps, a better analogy for our current, non-compulsory vaccination in practice. Those refusing vaccination are able to enjoy the benefit of herd immunity in relative comfort, while those choosing to be vaccinated and those unable to are being ‘sent over the top.’ The natural hierarchy that this gives rise to creates new problems of social justice whereby the difference of duty being carried out makes society revolt or distrust all figures of authority due to the lack of intervention which is needed to maintain the ratio between duty and benefit and make it worth each citizen’s while to muck in.
Many deserters and objectors are and have been justified in choosing not to bear the unequal burden for a common good. As Mill argues in the utilitarian style, if people do not wish to buy into the benefit, then their duty can be similarly rescinded. Without an enforced and fair maximum and minimum duty, it seems that the common good cannot be fair either; those doing the least are getting the largest relative benefit. Indeed, in the cases of war, public figures away from the fray are often making sure that the terms of the war are the most profitable to themselves. The moral philosopher, David Levy, uses an example of one soldier jumping in front of a bomb to save other lives as an example of this point of unjust distribution of duty. The other soldiers are not condemned for letting the soldier sacrifice himself in what is a supererogation of his conscripted duty. Thus, a hierarchy is created in terms of duty; while some undertake more of the duty in self-sacrifice, others are able to cruise along without lifting a finger and not be condemned or barred from enjoying the ‘benefit’ that the war will bring. In a similar way, without government legislation dictating a compulsory level of duty for all in terms of vaccination, there is a compromised benefit for all. Even if there were a danger in having the vaccine, if a government has decided that herd immunity to a particular disease is more important, then, morally, there is no reason why some should be allowed to stay passive while others stumbled into clinical trials in a supererogation of their duty as citizens. Without compulsion by legal means, however, we cannot fairly condemn those opting out, as we cannot condemn the passive soldiers.
This distinction over whether we can fairly condemn selfishness or a perceived lack of moral integrity is epitomised in the example of Franz Stangl, a notorious collaborator in Nazi extermination camps. Gita Sereny, his interviewer, and the rest of the world morally condemned his refusal to risk his life in order to halt his rise to becoming a Treblinka kommandant. Unlike supererogation, the act of risking his life to stop genocide seems implicit in his duty as a citizen, regardless of the immoral government of the time. However, this judgement made by society is unfair in a number of ways. Had Stangl sacrificed his life, he would have been seen as a hero. In the circumstance, he was instead seen as a villain. Without a moral common denominator, given the circumstances, there is not a reference point from which to rank different collaborators unless they were extremely moral or extremely immoral. In high pressure situations such as that which Stagl lived through, human nature is proven through research such as the Milgram experiment to act in a way that ensures individual survival. When given the slightest nod to act selfishly or violently, humanity seems to lose all moral inhibitions and become destructive. In many ways, the reality is akin to Hobbes’ thesis of the ‘State of Nature.’ This argument citing our tendency, in the face of faulty or minimal authority, to be destructive was responsible for getting various figures from the Nuremberg trials off the hook. If people are put into a situation where they are not prevented from sacrificing ‘moral duty’ in favour of technically legal though morally tainted practice, then it is not just to deny them the right to be accepted into the new, bettered society. Thus, without clear government compulsion for vaccination, those who aren’t vaccinating (for selfish reasons) are justified in legal terms.
Despite public disdain for those who do not ‘do the right thing,’ with no penalty for not ‘doing the right thing,’ people’s preferences as compared to reasons for being unfit for vaccination are put on par with one another. Social criticism of the unvaccinated inevitably leads to prejudice against those who physically cannot be vaccinated; it is not up to the public to make the decision about imposing moral duty upon people; in the Nuremberg trials, it was nearly impossible to know who could actually have helped but collaborate. The problem in charging people was the difficulty of proving that somebody was actively selfish rather than having no choice. Due to society’s limitations and inevitable self interest, Mill similarly argues that “the public” is prone to “interfere wrongly.” It is the law and the government’s duty to clearly state a common denominator regarding the duty of vaccination instead. This system would be better able to hold people accountable for failing one another morally, and allow those who genuinely cannot vaccinate to avoid wrongful labels.
One may, nevertheless, argue that the government is there to “steer” the society rather than to compel it. They may conclude, therefore, that mass vaccination will naturally come about through processes of this harsh public pressure; increased efficacy and societal acceptance of immunisation as necessary will make it a tacit rule. There are two logical problems with this approach given our current situation in regards to herd immunity. The first is that the figures for herd immunity and the average do not take into account the density of immunity in different areas. Some areas are much more likely to have been vaccinated than others. Thus, the societal pressure to make vaccination the status quo would not be consistent everywhere. Additionally, there may be reasons for these areas failing to vaccinate. If British society treats these particular suburbs or villages with contempt in an attempt to bring about greater herd immunity, they may be acting discriminatorily. For example, if vaccination were to encompass factors such as cost, freedom of time and ability to travel to a GP, then those in less well-off areas would be at a disadvantage. As well as this population being seen as immoral by society, they would not be receiving subsidised transport and immunisation fees which a legal mandate could have brought. If there were a law in place to make vaccination mandatory, however, these discriminatory considerations would not have to be navigated by society; the question of whether a fellow citizen was fulfilling their duty would be more black and white.
In conclusion, by withdrawing from making vaccination compulsory, the government gives it the ability to become a subject of debate, and, in turn, the means of societal divisions. It is not enough to promote vaccination as a moral duty. There are many moral duties that we as human beings choose to ignore when there are no consequences for abandoning them. If charity were a law with government direction, it would be much more effective and consistent across different causes. In a similar vein, if vaccination were a government-led exercise, all areas would have the same proportion of herd immunity. The law, not society, would have the final say in who was shirking their duty as a citizen. Thus, when somebody had no medical defence for opting out of vaccination, it would be less likely that the public were simply “getting it wrong” in calling them selfish.