Vaccines are designed to protect the body against diseases and achieve this by stimulating the production of antibodies through injecting the patient with a weakened or inactive form of the disease’s microorganisms. The term was coined by Edward Jenner, the first person to experiment with vaccines at the end of the 18th century. Throughout history, there has been very little resistance to the administering of vaccines due to the high chances of mortality and the lack of explicit information regarding the science behind them – however, in recent years a substantial rejection of vaccines, labelled the ‘anti-vax movement’, was catalysed by the publishing of a paper by scientist Andrew Wakefield in 1998, linking the measles vaccine with autism and inflammation of the stomach. Though this research has now been disproven, and Wakefield stripped of his medical license, the public concern pertains to this day. As a result, and due to the inherent danger presented by this rejection of arguably vital vaccines, a case could be made for a government mandate ordering vaccines to be made compulsory. It is evident that a state has a duty to protect its citizens, but equally it is debatable as to whether a parent’s duty of protection over their child’s health overcomes that of the state’s. However, a mandate of such a kind could only be justifiably enforced if it could be proved to result in more good than harm, both through scientific proof of the overall-positive effects of vaccines, and through the prevention of social uprising through public rejection of such a law. Though questions of liberty may be of concern, it could be suggested that the most important factor to be considered here is the safety and integration of children into society, which perhaps should be not put at risk through the miseducation and predispositions (whether that is religious or moral) of their parents. Having said this, coercion as a legal principle may not be the most effective measure to take, nor necessary – in fact, coercion itself as a solution may cause more problems than it would solve, such as rejection of the healthcare system as a whole and general distrust of the state. From our current situation, there are certain steps that need to be made before a mandate can be justifiably imposed; these steps include solving issues such as the lack of information, failures in delivering vaccines and engaging with those who are uncertain. After having maximised the efficacy of all of these areas, the necessity of a mandate must then be reviewed, particularly being measured against the immunity threshold needed for herd immunity. However, currently, it can be justifiably argued that vaccines ought not be made compulsory as the potential negative effects of this decision may not be proportional to the action, as the step to enforcing a mandate is not currently needed.
It has been estimated that around 1 in 1000 children will die from measles (Solomon, 2019), a figure that, for some, may seem surprisingly high. As a result, to some it may also seem counterproductive that some parents choose not to vaccinate their children to defend them against diseases such as this, particularly when their overriding motive is to ‘protect their children’. This objection to vaccines becomes even more outrageous when the previous statistic – that around 1 in 1000 children will die from measles – is compared with that of the effects of the measles vaccine itself: only 1 in 1,000,000 children are estimated to get side effects (Solomon, 2019). In comparing these statistics, it seems contradictory that parents would choose not to vaccinate their children if their true motive were to protect them from harm. Furthermore, due to the high rate of infection, the herd immunity percentage (the amount of people in a community that need to be vaccinate for the disease not to pose a significant threat) needed for measles is around 55% more than the Ebola virus, which has caused the deaths of around 15,000 people in 2014 alone (Ross, 2014). Due to the wealth of scientific evidence available which clearly shows the dangers of abstaining from vaccinations, and the odds being evidently in the favour of those who are vaccinated in terms of one’s health, it seems that vaccines are, unequivocally, the correct measure to take in order to promote wellbeing. Hence, as a result, does this suggest that the government ought to enforce a mandate, therefore making vaccines compulsory? If the state is expected to promote the wellbeing of its citizens, and vaccines can achieve this, then it does seem to be the case that part of the government’s responsibility in this duty of protection would be to deem vaccines as compulsory.
In an ideal world, citizens would have faith in their government and put trust in its decisions, so long as the decision was properly advised by the correct authorities (here, scientists). However, this does not seem to be the case. Since the aforementioned Andrew Wakefield case of 1998, distrust has permeated the country, causing an incremental decrease in the amount of people getting vaccinated (Williams, et al., 2019); this trend has perhaps been promoted by online communities, which are accustomed to spread both misinformation and fear, therefore ‘amplifying the anti-vax sentiment’ (Williams, et al., 2019). Though the evidence Wakefield published has now been rejected, it is not a coincidence that his messages are still being heard today – his paper, published in 1998, happened to coincide with the launching of Google, currently the world’s most-used search engine. Due to this new wealth of information at the population’s fingertips, advice from experts now left to public’s discretion, and the country gained a new self-confidence of self-sufficiency, particularly in medical matters. However, despite the irrationality of these objections to vaccines, it cannot be denied that they exist and are held by a significant number of people, and therefore imposing a mandate would directly conflict with their values and preferences, hence enforcing coercion. Though Matt Hancock, the Secretary of State for Health and Social Care, says that he is not going to completely rule out a mandate, it is evident that coercion is very rarely an effective policy in the long-term, particularly when concerning a mandate which would have such aggressive opposition. In this way, therefore, it could be argued that this is not so much a scientific issue, as it is a social one.
In 2019 it was estimated that only around 87% of children were completely vaccinated against measles (leaving around half a million at risk), a figure 8% below the herd immunity rate needed to protect the UK from a significant threat of the disease spreading (Bodkin, 2019). If the government were to impose a mandate, this figure would undoubtedly rise, and the herd immunity goal would be reached. However, the social consequences of imposing a mandate must be considered. If vaccines were to be made compulsory, and parents were therefore coerced into getting their children vaccinated, it could be viewed as an infringement on human rights – specifically, the right to self-determination. In John Stuart Mill’s ‘On Liberty’ he writes that people in a society ought to have maximum personal liberty, in addition to discussing the importance of civil liberty in the context of limiting the state’s power over the individual (Mill, 1859). However, if we were to apply Mill’s Principle of Liberty to the question at hand, I doubt that it could successfully be used to argue against the imposition of a mandate on vaccines. Specifically, Mill’s Principle of Liberty states that ‘the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others.’, meaning that one can do as one pleases up until the point that one’s actions negatively and disproportionately cause harm to others. Could it not be argued, therefore, that the liberty of the parents regarding the vaccination of their children ought to be overruled by the state, as their actions cause harm to their children? Furthermore, if the herd immunity level continues to be missed, it could even be argued that the actions of these parents are causing harm to the whole country. In this way, the government could potentially justify initially imposing a mandate. However, the consequences of this may cause more harm than good. Firstly, if the state were to intervene and take away the parent’s responsibility for their child, tension between the public and the state could be instigated (or increased, depending on one’s view of the current political climate). Some may even adopt a ‘slippery slope’ argument, suggesting that if the state were to be allowed to take away a parent’s responsibility of the health of their child, would they then be able justify taking away a parent’s right to, for example, choose their child’s place of education? Or the clothes they put their child in? Although this is unlikely, by breaching this trust in the parent to know what is best for their child, fears such as these could be heightened. Not only could the imposition of a mandate create tension between the public and the state, but also potentially a general disconnect with health services, therefore perhaps leading to an even greater public health risk. Hence, perhaps imposing a mandate would not be the most effective solution to solve the ‘global health threat’ of the anti-vaccination movement the world is currently facing, as it was deemed by the World Health Organisation in 2019 (Solomon, 2019).
Of course, there are other objections to vaccinations that are not due to health concerns, such as those for religious or moral reasons (these are more common in countries such as the USA but are present here in the UK too). For example, those who don’t eat meat, either for religious or moral reasons, may object to getting vaccines which contain porcine gelatine, such as those that protect against flu, measles and shingles (Public Health England, 2015). These objections are perhaps harder to dismiss, as they do not rely on fear and misinformation but on deeply held, valid beliefs. By enforcing vaccinations on Muslims who abstain from eating (and here, being injected with) pork, it could be argued that we are impinging on their religious liberty, something which is protected in Article 9 of the 1998 Human Rights Act. However, much like the aforementioned Principle of Liberty as proposed by John Stuart Mill, ‘the right to manifest your beliefs is qualified. This means it can be interfered with in certain situations - for example, to protect the rights of others.’ (citizens advice). If one were to take an extreme stance, it could be argued that this freedom to manifest one’s beliefs in the form of objecting from a vaccine because it contains gelatine, could be interfered as it impinges on a fundamental right of others: the right to life. However, this would only become an issue to be addressed if a mandate were to be imposed. Currently it seems that imposing a mandate regarding vaccines, though it may help the country’s overall welfare, may cause more problems than it would solve – for example, tension between the public and the state, a general divergence from health care services in general (and therefore creating more health problems, not just to do with vaccines) and a need to impinge on individuals’ religious and moral freedom of belief. Hence, a satisfactory solution could perhaps be partly achieved that would ensure both an increase of wellbeing for the public, but without necessarily causing these negative effects which would certainly not be ideal.
Currently in the UK, another main reason for the decline in vaccine administration is due to faults in medical services themselves. In 2018, a report by the Royal Society of Public Health found that the most common barriers to getting vaccinated were not the parents’ objections, but the timing and availability of appointments, alongside childcare duties (Public Health England, 2019). If the UK is to achieve the herd immunity percentage of diseases such as measles (which stands at 95%), perhaps the most effective way to do it is not to tackle those who voluntarily abstain from vaccinations, but those who physically cannot get them due to faults in the system. Things that can easily be done to increase vaccine uptake, according to Dr George Kassianos, National Immunisation Lead at the Royal College of General Practitioners, include sending invites and reminders to patients, updating IT systems so that they tell GPs when their patients have missed appointments and offering additional and more flexible appointments to aid those with busy schedules (Public Health England, 2019). Finally, one area that arguably needs the most attention is the spreading of simple, scientifically verified information to dispel myths that are often perpetuated by the media regarding the dangers of vaccines. This could easily be done through the use of pamphlets, leaflets, online sources and, critically, by fostering dialogue. The ‘vaccine debate’ seems to be dangerously polarised: one either is completely in favour, or a strict ‘anti-vaxxer’ – there is no room for uncertainty. The concerns of those unsure where they stand regarding vaccines can be easily remedied with transparency, and arguably, these are the people that we should be most focused on targeting with information, as they will be most easily persuaded.
Historically, coercion has never been an effective policy for change – however, with regards to making vaccines compulsory, coercion is not only going to be ineffective, but is unnecessary as well. Due to plethora of alternate reasons behind the falling uptake of vaccines nationally, it can be concluded that, before even considering a mandate, the UK must first overcome the pre-existing weaknesses in its healthcare services such as the inflexibility of appointments, the lack of essential, easily-accessible information and its systems in place for tracking vaccinations. Even with a disease as contagious as measles, the herd community threshold still allows for 5% of the population to be unvaccinated, which could potentially still allow for uncontested objections from some religious groups, and from those who simply refuse. Perhaps when these steps have been taken, the imposition of a mandate could be considered; however, currently, a measure of making vaccines compulsory is not only unnecessary but would be detrimental to the social wellbeing of the country, and should therefore not be implemented.
Bibliography
Mill, J. S., 1859. On Liberty. s.l.:s.n.
Pym, H., 2019. Should vaccines be compulsory?. [Online] Available at: https://www.bbc.co.uk/news/uk-scotland-49881317
Solomon, T., 2019. The pros and cons of compulsory vaccinations. [Online] Available at: https://www.independent.co.uk/news/health/vaccinations-measles-mumps-antivaxxer-compulsory-a8849671.html
Vatican, J., 2020. Should Vaccines Be Mandatory?. [Online] Available at: https://www.medicaldaily.com/should-vaccines-be-mandatory-448729
Williams, G., Larson, H., Whittal, H. & John, S., 2019. Should vaccines be compulsory? [Interview] (9 May 2019).