Thread by @mathesonrussell

Teacher vaccine mandates are on the cards in NZ.

Should the NZ govt introduce vaccine mandates? A mega thread covering some basic ethical (not legal) considerations. 🧵

BTW, by a 'vaccine mandate', I mean a legal requirement that a person be vaccinated in order to be in some setting (e.g. bars and restaurants) or in some role (e.g. worker in MIQ). /1

First, this question is not the same as the question of whether individuals have an ethical obligation to get vaccinated. That is the easy question. For those who can safely get vaccinated, I believe the answer is yes. /2

Vaccination is a win/win: self-interest and obligations to others align. At relatively low risk and cost to yourself, you can protect yourself and help protect others from a potentially life-threatening virus. /3

What’s more, being vaccinated significantly lowers one’s chances of requiring intensive medical care and thereby taking up costly medical resources that might be needed by others. Everyone who can get vaccinated should get vaccinated. /4

But some people won’t be able to get vaccinated so will remain vulnerable (incl. children). And others won’t voluntarily get vaccinated, even though they should. /5

Equity in availability of vaccine availability is essential. The blame for underserved communities lies with the health providers, not the individuals! /6

I don’t want to minimise the fact that people have reasonable questions about the vaccine and about the trustworthiness of govt as a provider of vaccines. But I take it that there are good answers to these questions, and so I’m going to leave this aside here. /7

As a general rule, when individuals are reluctant to do what they should do to contribute towards securing the basic needs of the group (in this case health), it is justifiable to enforce cooperation. /8

In fact, the NZ govt, like all govts, compels costly pro-social cooperation in lots of ways: requiring taxes be paid, requiring employers to implement health and safety measures, etc. /9

But the obvious difference in the case of vaccination is that we highly value autonomy over our own bodies. Being forced to have a medical procedure that we absolutely do not want violates basic norms of bodily autonomy, and is generally bad. /10

For example, we intuitively think it would be wrong to force someone to donate their kidney to someone else, even if it would save their life. But Covid vaccine mandates are unlike the kidney case in two ways. /11

First, the costs and risks of getting vaccinated, while not zero, are considerably outweighed by the benefits TO ONESELF (even before considering the benefits to others). Second, it is quick, easy (and free) to get vaccinated, even if it is unpleasant for a moment. /12

Even so, one would be hard pressed to justify forcing people to get vaccinated who have a strong principled objection. In a society that shows respect for people, this kind of overruling of an individual’s bodily autonomy should be used as an absolute last resort. /13

But this still leaves still scope for mandates. For example, MIQ workers are already required to be vaccinated. Such specific mandates don’t force any individual to be vaccinated, since there are other employment opportunities open for objectors. /14

But it does ensure that the risk to vulnerable others is minimised. It is vital, however, that if mandates are used, they are (1) equitable and (2) proportionate to demonstrable public health needs. /15

First, it needs to be clear that no one group is being forced to bear a disproportionate share of the burdens and risks in the common effort to protect the public’s health; mandates should not unfairly target particular social groups. /16

Second, the use of mandates should have a clear public health rationale. For example, there are good reasons to exclude unvaccinated MIQ workers from frontline roles since this plays an important role in minimising the risk of spread across the border. /17

By contrast, docking the pay of unvaccinated MIQ workers in order to incentive getting vaccinated, say, has no intrinsic justification. It is just a tactic to apply pressure on individuals to force them to comply. /18

I suspect that the majority of people who have not been vaccinated in NZ are not hardcore anti-vaxxers. The majority will simply have failed to get jabbed out of inertia, obstacles, or an aversion to needles(!) /19

Sensible rules, including vaccine mandates for settings where there is a public health justification for them, will have a salutary effect in motivating foot-draggers to get vaccinated. This isn't a violation of their autonomy, since they don't have a moral objection. /20

Again, govt is responsible to ensure equitable and easy access. Every effort must be made to remove obstacles must be made, especially for vulnerable and underserved groups. /21

For genuine objectors, it is true, mandates will make life more restrictive. Can't do this, can't do that. And, as the govt has rightly said, even objectors have a right to access basic services such as supermarkets, hospitals, and pharmacies. /22

Provision will have to be made for genuine objectors, even though it will place costs and burdens on others.

BUT that doesn't mean we can or should guarantee that the life of the objector is the same and as good as all others. /23

If one’s principled stand entails being excluded from certain activities in life, sometimes that's just the cost of sticking to one’s principles. /24

In short, well-designed vaccine mandates can help ensure that all but the diehard anti-vaxxers will get the jab. No one’s basic rights of bodily autonomy need to be violated, and the public health benefits will be worth it. /END

Addendum: We still have to make balanced judgments about the merit of mandates in specific cases (e.g. teachers), and that requires weighing lots of considerations beyond the ones mentioned here. The main point is that mandates can and should be considered. /END END