Vaccines - between Freewill & Coercion

"The needs of the many eclipse the needs of the few".

Vaccines are only effective when enough people receive them within a given population. Yet vaccine refusal remains a serious issue. For example, in Hong Kong, less than 30 per cent of the over 70s have had the jab.

Given the resistance level, should we be moving towards mandatory vaccinations enforced by the law? Of course, any such move opens up an incalculable number of issues, but it is worth pondering a few to get some clarity. 

For the record, I am vehemently pro-vaccination because of the role vaccination has played and continues to play in converting the pandemic into an epidemic. Nonetheless, I'm agnostic on mandating vaccines because this sets an uncomfortable precedent. 

Also, let's be clear that mandating people get vaccinated is coercion. And yet other factors are at play, including moral responsibility, body autonomy, the context of the coercion, the consequences of the coerced action and the greater good.

While it is true that some forms of coercion are more unpalatable than others, it isn't easy to see that there can be a proper distinction drawn in this way. This is because all pressure relies on overcoming an individual's withholding of consent by applying some form of restrictions on their private life or ability to take part in public life. 

Untangling these issues isn't straightforward. As a start point, we often hear that the un-vaccinated impinge on the rights of the vaccinated because they expose all of us to greater risk. This debate is nothing new. It arose with other vaccines and in the issue of smoking.

On the citizenship front, despite claims of being individuals, in truth, we are all part of a larger entity. We couldn't exist without the people around us. They drive the buses that get us to work, man the supermarkets, bring our food to town and clean up our waste. Thus the responsible-citizen argument holds that we owe it to those around us, who make our life possible, to comply for the greater good. 

Often we are silently compelled to comply. When in Tokyo, I'd never jaywalk because nobody does, and I don't want the shame of being the uncouth foreigner. A hidden hand holds me back from dashing over an empty road. Then back in Hong Kong, the hand is lifted, so I'll take my chances and cross that road on red. 

Legal approaches to increasing vaccination rates range from the most coercive—actual physical force, e.g., police coming to people's houses to vaccinate them—to least coercive, such as sanctions on access to places. 

The WHO acknowledges that mandating vaccines restricts individual choice in 'non-trivial' ways and advises that they should not be the first resort. 

The United States is one of many countries with a long history of using school mandates to increase vaccination rates. No vaccine, no school. US courts have consistently upheld these mandates against claims that rights are violated. 

Then, again, this week, the US Supreme Court struck down a Covid vaccination-or-testing mandate for large businesses. The Court's conservative justices claimed the order is "a significant encroachment into lives." 

The European Court of Human Rights suggests compulsory vaccination is permissible to protect the vulnerable. They concluded that such mandates are a justifiable interference.

Hence, Italy and France impose fines on parents who do not vaccinate their children. In France, jail time is a potential consequence, although rarely happens.

In the UK, estimates are that 73,000 NHS staff are declining the vaccine and could lose their jobs under mandatory provisions. This reluctance is against a background of staff shortages, including 36,000 nursing vacancies. Add poor staff morale atop that, and any vaccine mandate will cause a collapse in services. 

But why are so many NHS staff reluctant? For starters, medical staff are taught that body autonomy is a cornerstone of their profession; they can't do anything to a patient without permission. So to then demand they act under a mandate flies in the face of everything they stand for. 

Others express concern about the mandate's impact on employment terms and conditions. However, the view is that if the government can force this on NHS staff, then what next? 

Given the staff shortages, it appears unlikely the UK government can force through any mandate. So it has quietly dropped the idea. Hong Kong faces similar challenges with medical staff, which will constrain the government's options.

What do our friends, the philosophers, say on the topic? Can we get any guidance from them? While it is impossible to take in the full breadth of their opinion, let us dip a toe in the water.

Aristotle (384BC) identified that we need to live with each other and find balance by interacting well with those around us in a well-ordered political state. He opined that we need to fit in with our society, just like me in Tokyo. 

Thomas Aquinas (1225-74) advocated coercion/compulsion by state and private entities when it served a greater good. Later thinkers such as Thomas Hobbes (1588-1679), in basic agreement with Aquinas, argued that coercion plays a central, justified and necessary part in the functioning of the state. 

Although hating what he called " the tyranny of the majority ", the great Victorian philosopher John Stuart Mill (1806-73) refines matters for us. He opines state coercion is justified as it conforms to the "harm principle." Thus, pressure is warranted when it prevents harm; similarly, force is justified if it punishes those who cause harm. 

Not all are in agreement with these positions. For example, in Kant's view (1724-1804), coercion is wrong because the person coerced could not consent. In that sense, he is an absolutist. 

In this discussion, I've ignored the postmodern philosophers because they've rejected science and all its exemplary deeds as subjective. Instead, they place feelings at the root of all values, devaluing logic and seeking to seed discontent. As a result, they've implanted much of the cultural malaise gripping western societies in many ways.

Chinese philosophers take the consensus view that citizens must act for the greater good; "the needs of the many eclipse the needs of the few". Although, Confucius held that "Never impose on others what you would not choose for yourself." 己所不欲，勿施於人.

Underpinning Chinese thinking is the concept of lǐ (禮); doing the proper thing at the appropriate time; balancing between maintaining existing norms to develop an ethical social fabric, and violating the rules to do moral good.

We can see that the Western philosophers and their Chinese counterparts broadly agree that if coercion benefits the majority without undue harm to the few, it is justified. 

Now, where does all this leave us? Well, there is undoubtedly a legal precedent for mandating vaccinations. In addition, we have support from the great men of philosophy if we cherry-pick our advice. 

I suppose it comes back on the adage that rights confer responsibilities. These responsibilities are to yourself, your immediate family, friends and the wider community. When you make your choices, you must accept the consequences. 

In the end, I tend to favour vaccine coverage achieved by rational persuasion, not compulsion. But, equally, those who resist reasonable influence and have no legitimate reason not to be vaccinated must accept restrictions, such as access to venues and workplaces. 

After all, the majority have acknowledged and respected the right to opt-out, now be ready to accept the wider community's interest to protect itself.