While most of the world continues to be in dire need of COVID-19 vaccines, a few
rich countries are experiencing another crisis, one that seems to be trivial when
compared with the world at large but is integral to ensuring a possible end to the
pandemic at large. One such region is Hong Kong. While a free and easy-to-access service that has been available to everyone above the age of 18 since April, only about 10% of the 7.5 million-strong population has received both vaccinations, with poor rates even among the elderly. Hesitancy is so strong that only half of the people claim that they are even considering getting vaccinated.
Hong Kong is a rare, perhaps serious, example of hesitation, as seen in analyses of attitudes toward other control mechanisms, relative to Singapore and Malaysia and this can be attributed to political upheaval, mistrust of government, and ironically, the government’s performance in holding caseloads down.
However, Hong Kong is far from alone as the developed world moves towards a
worrying trend that has shifted governments agendas from scarcity to
indifference, long before enough populations have been inoculated to warrant a
stable reopening.
So when the question pops as to how policies can encourage people to take
the vaccines, or rather take the vaccines quickly, the answer screams currency,
free biriyanis and alcohol, and even the possibility of foreign travel bans to
achieve herd immunity - the vaccination rate of approximately 70% or higher that is needed to protect everybody. Particularly in the face of a pandemic that has wreaked havoc on communities around the world, it's difficult to call for mandatory vaccinations. However, if we don't improve our vaccination rates until vaccinations are widely available, some kind of coercion could be essential.
The profit is far too high, and the cost and effort demanded of the people are
more or less insignificant, to disregard. Taking the example of England alone,
Authorities report that by the end of April, vaccination had averted at least 11,700
deaths for those aged 60 or older. And it doesn’t take a genius to figure out that
this number increases exponentially on a global scale.
In most cases, state participation in public health is on a sliding scale. It's
referred to as an action ladder by the Nuffield Council on Bioethics and it ranges
from "do nothing" (which many people prefer) to "eliminate preference." When it
comes to COVID-19 vaccines, which are still being distributed, we are still on the
lower rungs. Information is being disseminated, people are being persuaded, and
access is being made easier. However, we're quickly approaching the stage when policymakers have begun to use monetary and in-kind resources to influence these decisions. The state of Ohio in the United States has launched a lottery of $1 million cash prizes. New Jersey has sold free beer in exchange for a shot, and West Virginia is offering $100 savings bonds to young people. Hong Kong has discussed providing vaccines at workplaces to make life easy for workers in recent days. Governor J.B. Pritzker praised Six Flags Great America for donating 50,000 free tickets to Illinois' newly vaccinated. Serbia, for example, pledged vaccinated people 3,000 dinars ($31), making it one of the first countries to offer straight-up cash with no strings, although I am sure more countries may have to follow suit.
The good news is that such policies that aim to nudge people along rather
than force them still have plenty of scope for operation. Hong Kong, for example,
could definitely continue to use more of its cash reserves. If all of its citizens
crossing the age of 16 are counted, a lucrative bonus of HK$5,000 ($640) (the
same amount provided in a scheme to stimulate demand) would cost a little more than $4 billion — a little more than merely 1% of the GDP which in my opinion is a worthwhile investment, given the harm caused by COVID-19 closures and
limitations. Unfortunately, motivation and incentivizing won't carry us all the way
to herd immunity, or at least not in sufficient areas. But, what occurs next? Is it
appropriate for a government to suggest disincentives, such as mandating
vaccinations for things such as dining out or even going to kindergarten, as it does for childhood shots in certain places? After clean water, vaccines are the greatest gift to public health. Can we take a more stringent stance? Should we take a more stringent stance?
Full-scale compulsion, which entails fines or even incarceration as opposed
to merely not receiving a reward or doing public service, is a difficult concept to
accept. For me, it's not so much about questions about personal liberty as it is
about the extreme polarisation that exists in many nations, like the United States,
and which would only escalate if such an approach were taken. More specifically, any of the factors that prevent citizens from getting vaccines — mistrust of health or political authority, or more urgent medical or shelter issues — should be addressed and tackled rather than papered over and essentially ignored. The harm theory, on the other hand, tells us that action is required where there is actual or possible harm to others, and the harm, in this case, is significant — 3.4 million lives have been lost to date. Vaccines that could have essentially
prevented a vast majority of these deaths are now being widely accessible, and
time is running out.
Jessica Flanigan, a philosopher at the University of Richmond, compares
vaccination refuseniks to anyone who fires a missile or bullet into the air.
Bystanders could be injured or killed, so we'd try to deter the gunman.
Vaccinations are no different, she claims. The essential question here remains as
to what takes precedence in this case? A refusenik’s right to deny, or an average
citizen's right to not be infected — particularly for those that can't be vaccinated,
such as little children, the immunocompromised, or those with serious allergies.
That doesn't necessarily have to imply compulsion or coercion, but it certainly can. Around a century earlier, the U.S. Supreme Court supported a Massachusetts
bill that authorised towns to demand people be vaccinated against smallpox. So a community, maybe not at a national level but a local level can certainly demand to protect itself, so why not stretch this to an international scale?
Alberto Giubilini of Oxford University makes yet another compelling case for going up the public health ladder, claiming that vaccinations are similar to taxes. COVID-19 security is a mutual privilege that imposes commitments that the state will obtain from us. We don't have the right to be free of that commitment. Vaccines, like taxes, have a low cost, mitigate damages, and are a roughly equitable way of sharing the burden of communal duty. While the comparison isn't ideal (vaccines require our bodies, not just money), the equity factor is convincing.
Obviously, this implies that the state has responsibilities. Shots must be
free and readily available if they are to be made obligatory. People should be
given the option to choose between vaccines and even the most prosperous
nations will take time to get there. Importantly, states will require appropriate
payout mechanisms to offset unanticipated negative consequences, something
many does not provide.
In conclusion, at least in my opinion, We’re not at the point of compulsion
yet and hopefully won’t get there. Implementation would be messy and pushback likely. But if we accept that COVID-19 is something we should aim to control before more new and dangerous variants emerge, there are ethical debates that need to be had. Especially as we watch the stomach-churning spectacle of some countries desperately asking for shots while others allow them to go to waste.
Twisting people' arms works; we know this from vaccine programmes imposed on children all around the world. However, there is another valid reason: equality.
Selective mandates for certain workplaces or access to certain government
services would adversely affect various groups, often at the lower end of the
income spectrum, such as migrant domestic workers in India. The rich have an
easier time avoiding minor stumbling blocks and this is evident in a 2016
California survey that tells us that exemptions from the mandatory school vaccination exemptions are more common in the White, affluent districts in the
United States.
If there is a burden, if there is an inconvenience, if there is a life-
threatening virus killing people all over the globe, handicapping global economies and societies, the least we can do is carry that burden equally.
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