Vaccine Mandate Ethics Through A Historical Lens

By Emma Kaplan

We once lived in a world where the most daunting part of going out to dinner in New York City was finessing a reservation or managing insanely high prices. However, since the outbreak of COVID-19 and subsequent imposition of vaccine mandates, one must now display proof of vaccination before entering indoor NYC establishments. A “new normal” has sparked intense debate around whether this hindrance to everyday life is ethical. Since the first vaccination was administered by Edward Jenner in 1796 against smallpox, mandates have been enacted all around the world in order to protect communities against infectious diseases. The widespread usage of vaccines throughout the 20th century has dramatically limited the danger of infectious diseases, which has been declared one of the 10 great public health achievements of the twentieth century by the CDC. Because of vaccine mandates’ historical prevalence and demonstrated effectiveness within the US, implementing a COVID-19 vaccine mandate at the state level is both ethical and eminently reasonable.

The history of vaccines and vaccine mandates in the US has shown that they are both effective and enforceable. Diseases like smallpox and poliovirus, whose vaccination rates have enabled herd immunity, have nearly been eradicated from the modern world. In this sense, it can be argued that it is actually unethical to prioritize the individual at great risk to the community by refusing vaccination, thus muddling the foundation of herd immunity. The Pfizer-BioNTech COVID-19 vaccine has the highest efficacy rate of almost any infectious disease vaccine, at a whopping 95%. The cost-benefit analysis therefore shows that the risk of adverse effects is less than the risk of getting sick without vaccination. This subjective analysis is not agreed upon by all, as anti-vaxxers with an opposing perspective question why a healthy person should participate in something that has any risk of getting them sick at all. This is especially pertinent with COVID-19 because for a great portion of the population, the “risk” imposed by not getting vaccinated and being more likely to contract COVID-19 is extremely minor, as symptoms mirror the common cold. This tragedy of the commons benefits the individual while conferring on the rest of the community the great cost of not reaching herd immunity, therefore allowing the COVID-19 to continue to spread indefinitely.

If there has been little issue with vaccines for other diseases being mandated in the past, why is there now such a sudden protest? Vaccine mandates date all the way back to the 19th century, with compulsory vaccination acts in 1862 England against smallpox. In the US, all infants and children are required to be vaccinated against 11 different diseases in order to attend public schools. Despite these precedents, “freedom, not force” has become the battle cry of anti-vaccination protests, with arguments stemming from the idea that mandates are not Constitutional. This is simply untrue, as the US Supreme Court has concluded that a private right to refuse mandatory vaccination will not be recognized as long as a public health need for widespread vaccination exists, and that the power of states to implement and enforce these mandates does not violate the Fourteenth Amendment. Another argument against mandatory COVID-19 vaccines stems from suggestions that the vaccine, which was developed in record-breaking time, has not been sufficiently tested, thus calling into question it’s safety. While it is true that no other vaccine has been released so quickly, this speed represents the collective efforts of much of the medical and scientific communities and the benefits of technological advancement, and does not indicate that the vaccine is unsafe. Normally, time and funds are split between many different research projects, so it does make sense that such a great increase in manpower would allow the vaccine to be developed in record time.

Thanks to increased polarization in the US, the fight against vaccine mandates has turned into a political debate rather than a conversation about public health focusing on science and ethics. COVID-19 was officially classified as a pandemic during the leadup to a presidential election, and this unfortunate timing may have altered the government’s response and the view of the disease in the eye’s of the general public. With two opposing parties desperately grappling for the presidency, the narrative surrounding COVID-19 was manipulated to advance numerous agendas. Suspicion of such foul play can be seen with President Trump downplaying the pandemic’s severity despite being told otherwise by the CDC. The politicalization of what should have been completely left up to the scientific community and public health officials has bred dangerous mistrust of the vaccine. People listen to doctors when it comes to prescriptions or treatments for illness without having a comprehensive understanding of ingredients or mechanisms occurring, trusting them to make the right decision. However, when it came to the COVID-19 vaccine, people were suddenly worried about what exactly they were putting into their bodies. In reality, this talking point is a bad-faith concern brought up to support certain political alignments. This can be seen readily with many Republican leaders who fight against vaccine mandates while getting vaccinated themselves. This contradictory behavior shows that hesitations about the vaccine have absolutely nothing to do with the science behind it and everything to do with defending political stances.

COVID-19 vaccine mandates are shown to be ethical through precedents set by previous public health matters. It is indisputable that vaccines are effective at minimizing a disease’s damage, as seen with the virtual eradication of smallpox and polio virus following strong vaccination campaigns. In addition, mandates similar to the ones in place today have cropped up throughout history with little to no opposition from the general public. For these reasons, it is really inarguable that COVID-19 vaccine mandates are ethical. What is truly being argued are political ideologies with very little consideration for science or public health.