The Equitability of Universal Vaccine Mandates – A Bioethical Analysis of COVID-19 Vaccine

Abstract

In public health emergencies that warrant mass vaccination, vaccine mandates are sometimes imposed. There is historical evidence of the effectiveness of vaccination mandates, but varying strategies in policy implementation. The COVID-19 vaccine mandate presents an ethical imbroglio that poses these bioethical questions, “Is there ethical justification for a vaccine mandate?”, and “Whose responsibility is it to ensure the equitability of a vaccine mandate in a pandemic?” Using ethical principles and theories, this paper focuses on the health equity of vaccine mandates, considering both the global and local implications. Vaccination mandate, in a pandemic, is driven by the need to accelerate the achievement of public health goals of herd immunity, protecting the most vulnerable in terms of case fatality and hospitalization rates, protecting the capacity of the acute health care system, as well as circumventing the economic impact. These mandates must still be guided by appropriate stakeholder involvement and bioethical considerations, to assess their validity and equitability, as vaccine mandates may impose restrictions on the freedoms and rights of an individual. Using COVID-19 as a case study, we argued the equitability of vaccine mandates based on the WHO framework of ethical considerations and caveats for mandatory vaccination. Necessity and proportionality of the vaccine, sufficient evidence of safety, efficacy, and effectiveness, sufficient supply, and public trust are key during ethical processes of decision-making. We conclude that vaccine mandates are more equitable as population-specific mandates, as opposed to global or universal mandates, even in pandemics. This is due to varying geographic, socio-cultural, and economic characteristics. Bioethicists should be actively engaged in discussions on the vaccine mandate, as its equitability is a function of critically analyzing the proposed mandate based on ethical recommendations prior to being issued. Retrospective bioethical analysis is warranted to identify shortfalls and make recommendations for future decision-making.