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Should the Covid-19 vaccine be mandatory? We asked the experts

It’s already clear that large sections of the South African public are reluctant to have the Covid-19 vaccine – but, in order to achieve herd immunity, around 40 million will need to be injected. (Photo: National Cancer Institute on Unsplash)

Health Minister Zweli Mkhize has said that having the Covid-19 vaccination will not be compulsory in South Africa. But with just 53% of respondents to a recent poll saying they are willing to have the jab, some are asking whether it might be necessary to make the vaccination mandatory.

It’s already clear that large sections of the South African public are reluctant to have the Covid-19 vaccine – but, in order to achieve herd immunity, around 40 million will need to be injected.

Is there a case for making the Covid-19 vaccine mandatory? The World Health Organisation has indicated that it’s not in favour of the notion. But it’s a question which has been debated in countries all over the world, as vaccine-hesitancy is by no means limited to South Africa.

Brazil’s Supreme Court ruled in December 2020 that local governments could introduce measures for compulsory Covid-19 vaccination. What this means in practice is not that citizens can be held down and forcibly injected, but that they may be stripped of certain rights – like entering certain places, or receiving certain funds – if they do not comply with vaccination.

In most countries it is a basic medical precept that consent should be given for all procedures. In addition, South Africa’s Constitution enshrines the right to “bodily and psychological integrity, which includes the right to security in and control over their body”.

But there are collective rights as well as individual rights, and vaccinating one person may stop others from becoming infected. Lockdown is mandatory; individuals may not “opt out” of it even if they have decided that they are willing to take the risk to their personal health. This is the case even though lockdown arguably comes at a far greater individual and social cost than vaccination.

The lockdown argument is one advanced by Oxford ethicist Alberto Giubilini, who writes that the vaccination should be compulsory because “the less burdensome it is for an individual to do something that prevents harm to others, and the greater the harm prevented, the stronger the ethical reason for mandating it”.

Being injected comes at a minimal personal cost, Giubilini argues, and can stop one from killing others. He also contends that reaching herd immunity benefits the whole of society, so it is “only fair” that the burden of getting there is shared equally by individuals.

Giubulini suggests that we see Covid-19 vaccinations as the equivalent of wearing seatbelts: some people find them uncomfortable, but we recognise that society as a whole is safer if road travellers are strapped in.

The major counter-argument against making vaccinations compulsory is that it may not work. University College London’s Vageesh Jain cites a 2014 study which found that countries where vaccines are mandatory “do not usually reach better coverage” than countries where no such obligation exists.

A more effective strategy, it’s suggested, is educating people on the purpose of vaccination – although, weirdly, this can backfire. There has been at least one study which has concluded that giving the public information about vaccines “may actually increase misperceptions or reduce vaccination intention”. The study was in the context of the wildly polarising debate about vaccines and autism, however, which may have skewed matters.

Another argument against compulsory vaccination is that Covid-19 is not deadly enough to justify it. The Nuffield Council for Bioethics has previously concluded that mandatory vaccination may be warranted in just two cases: “for highly contagious and serious diseases and secondly, for disease eradication if the disease is serious and eradication is in reach”.

But the latter point may be significant. A just-published paper in Nature by Marc Veldhoen and J Pedro Simas states:

“Although a recently emerged virus, the development of SARS-CoV-2 vaccines is based on decades of knowledge, and we predict that these vaccines will be successful to end the Covid-19 pandemic.”

One thing is virtually certain: even if governments do not make Covid-19 vaccinations mandatory for citizens, they will almost certainly be required for travel to certain countries. It is also possible that some South African employers may make vaccination compulsory in the workplace, which law firm Cliffe Dekker Hofmeyr indicates might be legally acceptable.

Daily Maverick canvassed local experts on whether they believed the Covid-19 vaccination should be mandatory in South Africa:

Medical Research Council president Glenda Gray:

“I think there should be opt-out [options], but I am sure it will become a requirement for travel or for certain jobs.”

Professor Francois Venter, director of Ezintsha:

“My public health side wants to say yes, but lots of studies show it doesn’t work making them mandatory. Also, I think it’s unnecessary: education and careful explanation is enough. Interestingly though, it may de facto become compulsory to travel (like the yellow fever vaccine), or for certain work (the Hepatitis B vaccine is compulsory to get into medical school).”

UCT ethics lecturer Jacques Rousseau:

“Personal liberty shouldn’t automatically trump public health. For Covid-19 vaccines, I’d certainly support their being mandatory in limited cases at least, for example those who benefit from public schooling or state grants, though not universally, as I’d expect that sufficient numbers of people would accept a vaccine voluntarily to make herd immunity probable without making them mandatory for all.”

Dr Jeremy Nel, head of infectious diseases at Helen Joseph Hospital:

“No, I don’t. It’s not that I don’t support vaccination 100% (I absolutely do) but the blowback from making it mandatory would probably be counterproductive. I’d much rather we try to aggressively and proactively win over anyone who is hesitant to take a vaccine instead.”

Wits vaccinology professor Shabir Madhi:

“No – I think it would create more scepticism and would not improve uptake. We could, however, create ‘enablers’ to encourage vaccination.”

Maverick Citizen editor Mark Heywood:

“It’s important to understand that vaccination is not just about your health, but also about the risk you pose to other people’s health if you don’t get vaccinated. It’s about social solidarity as much as it’s about individual autonomy. Ubuntu in action. Having said that, I don’t think vaccines should be made mandatory, or that we can criminalise not having a vaccine, because that will in all likelihood encourage vaccine resistance and conspiracy theories. It’s a shortcut. Instead, it’s up to government to invest in meaningful health education and vaccine literacy, supported by other health-seeking strategies.” DM

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"Information pertaining to Covid-19, vaccines, how to control the spread of the virus and potential treatments is ever-changing. Under the South African Disaster Management Act Regulation 11(5)(c) it is prohibited to publish information through any medium with the intention to deceive people on government measures to address COVID-19. We are therefore disabling the comment section on this article in order to protect both the commenting member and ourselves from potential liability. Should you have additional information that you think we should know, please email [email protected]"

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All Comments 13

  • My hesitancy is based on the fact that the virus is constantly mutating, so whats the point. Will we need to be vaccinated against all future mutations as well forever? I did contract covid in early December, it was very tiring and I was out of action for a week and isolated for another total about 18 days. I don’t know which strain I caught, but I could get a different strain tomorrow. How is a vaccine going to help with that?

    • Quite right, viruses are intrepid survivors. They mutate constantly. Look at how many variants there are of flu viruses. New vaccine needed every season. The best and only sure solution is to make sure your own immune system is in good shape and of course take reasonable sanitary precautions.

    • Do you think it is easier to get people to wear a mask or physically distance for the next how many years or just get a vaccination? Just looking out my window early this morning: 14 people walked past; 6 sans mask; and of the eight with a mask, four had it around their neck or under the nose. Only four were wearing a mask correctly out of 14 people. Just vaccinate. If others hold your life in their hands, vaccinate.

  • An intensive education program is required. I heard a school teacher on 702 giving his reason for refusing the vaccine to be: “polio was caused by the vaccine during the epidemic in the 50’s”, whereas :
    1. There was no vaccine when the polio epidemic struck in the 50’s
    2. Polio has been eradicated by the vaccine.

  • I would vote that we wait and see – the supply of the vaccine will be the limiting factor rather than the reluctance of the recipients. So as the vaccine proves itself over time, the reluctant ones might change their minds. It good to have the debate now though and to start the education.

    • As a reluctant one – my stance is that I want to wait and see what side effects occur with others as time goes by – if none – then I am happy to vaccinate. I have an auto immune condition – so in other words my body is attacking itself – what research has been done to identify possible issues when the vaccine is introduced into the blood streams of people whose anti bodies are already in over drive? I have had all the childhood vaccinations – but then at that point I was not in a position to object. I am not an anti – vaxer – its just that this is new and I have concerns.

  • At some stage most people’s vaccine hesitancy will be overcome by the common sense implicit in the data. As of the 11th January, Our World in Data reported over 28 million vaccinations. To date there have been no deaths attributable to Covid vaccination. In South Africa we had over 30 000 Covid deaths for just over 1 million infections. That meas vaccination is at least 28 x 30 000 = 840 000 times safer than catching Covid. Private schools will be in an invidious position. If they allow pupils in that have not been vaccinated and another pupil gets Covid from an unvaccinated pupil (vaccination is not 100% effective) then in all probability they could be sued. Most schools will thus make Covid vaccination compulsory in the same way that they make measles vaccination compulsory.

    • Wow Bruce!! That is some fancy maths there. (I do not even understand the logic) You do realise that of the 28 Million people that have been vaccinated around 280 000 will die in the next year based on crude mortality rate. How does that factor into your calculations? And another thought – considering that vaccination is not 100% effective, what if a vaccinated student gets infected from another vaccinated student? Who sues who? Wonderful thought experiments, but not really useful in any context, I would think.

    • Well, I’m coming a bit late to the party, but there HAVE now been deaths reputedly attributable to the CV19 vaccine, or at least common side effects thereof. This is in Norway, and as far as I can make out it’s not fake news or scaremongering. Yesterday reports gave the figure as 23 deaths, today I saw one which quoted 29. Here’s the thing, though; the deaths were of reportedly aged, frail people. Some are possibly attributable to allergic reactions. The conclusion is that there needs to be more careful consideration given as to who receives the virus. However, as over 30000 people in Norway have been vaccinated, it’s really an insignificant percentage.

  • There is of course a precedent. If you enter South Africa from a region where yellow fever is endemic, you don’t come in without proof of vaccination. If you’ve forgotten to take your yellow card (or allowed it to expire) you either go back to where you came from or you are vaccinated at the airport.

    The same will happen with COVID – it will be a requirement for international travel so, not compulsory but you decide if you want to travel or not.

    It would also be reasonable for service providers in health care and education to make it a requirement for entry to facilities. But let the the individuals concerned make that – and surely, there will be education and health case providers who won’t insist on vaccination, although that might be a good reason not to use them ….

  • The comments are just so scary !
    Nothing to do with mutations !
    Get a grip, prevention is better than any cure !
    Any one out here having unprotected sex with a known HIV carrier ?
    Sure , why else the 20 k deaths each year ?
    All about choice , expose yourself and you might die !
    I am a smoker , I know the risks and how I might die !
    My personal choice , does not affect others .
    You choose to expose yourself !
    Why should I care ?
    You have a death wish , not me !
    It is an avoidable disease , follow the rules and the virus dies , herd immunity is BS . Let it in can start all over , China is back to lockdown . And they ‘cured ‘ it !

  • Vaccination should absolutely not be mandatory. Especially now, in the early stages, when the available vaccines have been in use for such a short period of time. Not only that, it’s already questionable as to whether any of them, even the expensive Moderna vaccine, will be effective against the new strains. If government attempts to push mandatory vaccination, expect a horde of Concourt cases which, IMHO, the State will lose.