COVID vaccine mandates need to be justified and fair to succeed
In an article published in the Medical Journal of Australia, Professor Julie Leask from the University of Sydney Susan Wakil School of Nursing and Midwifery and colleagues from the , write that a range of issues must be considered before COVID-19 vaccine mandates are introduced.
鈥淏ecause they are more coercive than other interventions to increase vaccination coverage, mandates demand stronger ethical justification,鈥� writes Professor Leask and colleagues. 聽
鈥淧olicy makers should balance rights of individuals and the promotion of public good whilst carefully considering the epidemiological, programmatic, and legal issues.鈥�
The authors outlined the following prerequisites for a successful and fair mandate:
- 聽The mandate should be legal 鈥� in most settings it must have legislative support. Fair Work Australia provides general guidance in workplace settings;
- The burden of disease should be high enough to justify a mandate;
- The mandated vaccines must be safe 鈥� 鈥淕overnments need to operate a no-fault vaccine injury compensation scheme to compensate those required to vaccinate in the rare occurrence of a serious adverse event鈥�;
- The vaccines should reduce transmission 鈥� 鈥渕andates are only justifiable when vaccinating one person helps protect others around them鈥�;
- Vaccine supply should be sufficient and access easy 鈥� 鈥淎 penalty for not vaccinating when the government has failed to meet its service delivery obligations is unjust鈥�;
- 聽Less restrictive and trust-promoting measures should come first;
- 聽The type of mandate should not penalise the poor unfairly 鈥� 鈥淢andates should not compound disadvantage鈥�;
- Those mandating need to plan and support implementation 鈥� 鈥渟ystems for documenting and retrieving evidence of vaccination are essential鈥�; and,
- Affected populations should be considered in planning 鈥� 鈥淎ll mandates must include exemptions for those with a valid medical reason to not vaccinate鈥�. In community settings it may be sufficient to require proof of vaccination (or medical exemption), evidence of past infection, or evidence of recent negative test.
鈥淎ddressing these considerations in ways that consult with affected populations and keep the process fair means the outcomes are more likely to be trusted. Trust in governments remains crucial while we need people to keep up the other public health actions like testing and wearing masks,鈥� Professor Leask and colleagues concluded.
鈥淢andates that are careful and responsive to context are more likely to avoid social harms while, ideally, helping to achieve a public good.鈥�
Disclosure: Julie Leask and Kerrie Wiley have received a grant from NHMRC to study policy aspects of childhood vaccine refusal. Julie Leask sits on the Expert Advisory Group for the Victorian Department of Health and Human Services and was a temporary unpaid advisor to the Vaxzevria (previously COVID-19 Vaccine AstraZeneca) Advisory Board.
Please refer to the paper for additional disclosures involving co-authors.