By Charalampos Karouzos,
Vaccines, often taken for granted or underappreciated for their immense importance, certainly stand as one of the most remarkable achievements in medicine; profoundly shaping human existence and public health irreversibly. It is well known that vaccination has substantially reduced the morbidity and mortality associated with infectious disease, with the pivotal moment being the eradication of smallpox, an unprecedented feat until 1980, but equally crucial are their roles in managing polio and controlling influenza. However, despite their proven efficacy in minimizing disease and death, especially among populations who lack adequate healthcare, the question of whether vaccines should be mandatory remains complex and multifaceted, involving important areas of of public health benefits, ethical principles and societal responsibilities.
Vaccination, as a medical procedure, predominantly functions by stimulating the immune system to recognize and combat pathogens in a controlled manner, thereby minimizing severe symptoms and full-scale disease development upon exposure to the real pathogen. Their success in preventing illness, disability and death is unparalleled; no other medical advancement has had such cumulative benefits for humanity. To highlight their benefits for humanity, the eradication of smallpox must be stressed again, as once a deadly scourge, after 1980, it remains only a part of history. Similarly, polio cases have decreased by over 99% since 1988 due to extensive vaccination campaigns.
Beyond their potential for eradication of pathogens, vaccines currently play a critical role in controlling outbreaks. Diseases like measles and mumps, once widespread, have seen dramatic declines in incidence due to vaccination efforts, and thus, complication of the associated diseases such as hearing loss has been on a constant decline. Moreover, the recent COVID-19 pandemic highlighted the crucial role of vaccination in preventing a global catastrophe, showcasing the success of novel vaccines despite challenges in distribution equity among nations.
Mandatory vaccination policies, although highly controversial, can significantly enhance public health by ensuring high vaccination coverage, thereby establishing herd immunity. Herd immunity occurs when a sufficient proportion of the population is immune to an infectious disease, indirectly protecting those who are not immune, such as newborns or individuals with compromised immune systems. Countries like Italy and France have observed improvements in vaccination rates and reductions in disease incidence following the implementation of stricter vaccine mandates.
Ethically, the debate of “forceful” vaccination revolves around balancing individual autonomy with the collective good, a dilemma that has been greatly debated in humanity; where does the right of liberty of the individual cross the line of the public benefit? While individuals have the right to make health decisions, a right that must be strongly withheld, in the context of highly contagious diseases, personal choices can profoundly impact the broader community. From an ethical standpoint, mandatory vaccination can be justified by the principle of beneficence, acting for the benefit of others, and by principles of justice, ensuring equitable access to protection irrespective of socioeconomic status. However, practices as vaccination, that require the interference with one’s health, must remain under the power of the conscious individual.
Addressing concerns about vaccine safety, efficacy, personal freedom and trust in institutions, all phenomena exacerbated in recent years, as well as the idea of the person’s emancipation against strict governmental control, which has escalated further after the recent pandemic, requires transparent communication and evidence-based education. Vaccines undergo rigorous testing to ensure safety and efficacy before approval, with ongoing surveillance for adverse events, a crucial process which the public has limited information about, thus allowing misinformation to be spread by propagandists. Indeed, scientific consensuses overwhelmingly support the safety and efficacy of vaccines, emphasizing that their benefits outweigh risks, which, although existing, are minimal compared to the established good for individuals and societies.
On a global scale, equal access to vaccination could have profound implications, particularly in low –and middle– income countries, where infectious diseases remain major causes of illness and death, and vaccine availability is still inadequate. Programs like the Global Vaccine Action Plan aim to extend immunization benefits universally, making vaccination a powerful tool in achieving global health goals. In fact, ensuring vaccines availability, under fair and equal circumstances to low-income countries is essential, not only for their health but also for the global community’s well-being. Access to vaccines in these regions can significantly reduce the burden of infectious diseases, improve public health, and enhance quality of life.
As history has repeatedly shown, a society cannot thrive unless its health is maintained; its progress will be hindered until the disease-causing agents are eliminated or significantly reduced. Moreover, health as other important aspects of humanity, is not limited by borders and remains interconnected among all nations. Indeed, more than ever in the 21st century, controlling infectious diseases globally helps prevent the spread of pathogens across all countries, reducing the risk of outbreaks that can affect anyone, anywhere. For example, the Omicron variant of SARS-COV2, the only still circulating one, was first detected in Batswana, and then spread in all 7 continents. It is equitable vaccine distribution that allows global stability and economic growth, creating a healthier, more resilient world. By prioritizing vaccine access for all and supporting in practice Human rights and the work of WHO, we can ensure a collective defense against preventable diseases, benefiting everyone.
In conclusion, the debate over mandatory vaccination involves complex considerations of public health, individual rights and ethical principles, making the effects of potential policies unpredictable to their full extent. Undoubtedly, overwhelming evidence supports vaccines’ role in preventing infectious diseases and promoting public health, however, as every multifaceted decision, although scientifically sound, since such policies can bolster vaccine coverage, establish herd immunity, and protect vulnerable populations, it cannot achieve a harmonious state based on one sole factor. Ethically, these policies align with principles of beneficence and justice, reflecting our collective responsibility to safeguard against preventable diseases. However, humanity must approach these issues meticulously, as a misstep could potentially unleash unforeseen consequences, jeopardizing global health efforts. Vaccines have reshaped human history, saving millions of lives and enhancing global quality of life, however, ensuring universal access and educating the public about their benefits are crucial steps that must be taken, thus, steering towards a universal trajectory of global, inclusive, sustainable health across borders and continents.
References
- Ethical Issues and Vaccines. History of Vaccines. Available here
- Ethical considerations of the vaccine development process and vaccination: a scoping review. BMC Health Services Research. Available here
