Paternalism and Vaccination

Sarah Zhang’s article “A Vaccine Reality Check” discusses the ongoing efforts throughout the world to develop a vaccine for COVID-19. Many hope that a vaccine will allow life to quickly return to as it was before. Zhang warns against this, pointing to the difficulties that will still occur even if a vaccine is successfully developed such as a limited number of available resources needed for mass production and the difficulties that will be faced in distributing a vaccine. However, even if all the difficulties of developing, producing, and distributing a vaccine could be overcome, there is still a glaring concern. Zhang states that “20 percent of Americans already say they will refuse to get a COVID-19 vaccine, and with another 31 percent unsure, reaching herd immunity could be that much more difficult.” The question of how to resolve the issue touches on multiple ethical and moral questions. 

The ethical question that seems most relevant to me is whether paternalism is justified in this context. There is a particular brand of liberalism rising within the United States that has been exemplified throughout quarantine. Many have insisted that requirements to wear a mask or adhere to social distancing guidelines are infringements to their autonomy and freedom. The same argument would most likely be raised if any mandates were imposed requiring vaccinations to return to the workplace, school, or university campus. Similar requirements are already in place for many other vaccines, particularly in school environments, and there has been much debate over the topic. However, such a mandate may be needed if the United States is going to reach levels of immunization necessary for herd immunity. A rebuttal I would raise to the argument against mandatory vaccination is a concept that is fairly common in medicine: paternalism is acceptable if restricting a person’s autonomy is necessary to protect others from harm. Refusing to get a vaccination not only puts yourself at continued risk for exposure to coronavirus but could also put others who are unable to receive the vaccine due to economic or health reasons at undue risk. 

One question this debate leaves me with is why American society is much more sensitive to paternalism in this case than in the many other daily occurrences where paternalism occurs. The requirement that we all drive on a certain side of the road, laws prohibiting stealing, and many other aspects of daily life can all be seen as the government engaging in paternalism because they believe it is in the best interest of their citizens. People rarely argue that such requirements infringe on their autonomy. What can such resistance to paternalism surrounding vaccines be attributed to? Does it result from a rising culture of medical and scientific skepticism, a genuine concern for health, or something else?

2 thoughts on “Paternalism and Vaccination

  1. Iris Wickham

    I had a similar experience reading, “A Vaccine Reality Check,” as Amelia. I, too, believe it is unreasonable and illogical for a certain population of the United States to argue against a Coronavirus vaccine on the basis of paternalism when countless other laws exist which hinder personal autonomy. The discrepancies within this argument, as Zhang describes, will have grave consequences for the health of Americans. As Amelia investigates, I would argue that a substantial part of the motive behind vaccine refusal stems from the contemporary political climate. Science, in itself, is now a partisan issue for most voting Americans and the trust of doctors, such as Anthony Fauci, seems to only be supported by one of the country’s two predominant political parties. Another ethical concern of mine is the fair distribution of vaccines once they are produced. Resource allocation can become tangled when the timeline of production is tremendously crunched. I agree that health-care workers, the elderly, and those with underlying conditions should get priority, and I also see the value in prioritization of vaccination by race. Still, how will we prevent the rich and famous from getting an unfair privilege? And how can the government ensure distributive justice for vaccine dispersal, considering the variation that occurred during the 2009 H1N1 outbreak?

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  2. Harrison Pire

    Amelia makes some very effective points about justifications for paternalism in the case of a Covid vaccine. There are pre-existing laws and regulations that require medical treatment or testing for individuals in certain employments or who take advantage of certain social services. For example, there are vaccination requirements in numerous school districts and for people who serve in the military. Many school districts have allowed families to opt out of vaccination requirements if they can demonstrate sincere religious or ethical objections to vaccination. What burden they have to fulfill to demonstrate a justified objection is not always clear or uniform. Late last year there were outbreaks of measles among school children in certain parts of New York City. These were frequently encountered in Orthodox Jewish communities that had resisted vaccination on religious grounds. Clearly, the refusal to be vaccinated, especially for a virus that is contracted through respiratory pathways, threatens to harm not only to the individual that refuses vaccination but also to others whom they might come into contact with. Harm to others is a possible justification for paternalistic medical policies. Recently, NY has seen upticks in Covid infection rates among certain Orthodox communities who might later express reservations about vaccination. Obviously, the cause of the increased cases now is not the refusal to administer a vaccine because one does not exist. Instead, it is likely due to a failure to practice social distancing and use masks. The case for paternalistic insistence on social distancing and mask wearing might be stronger than that for mandatory vaccination since certain religious injunctions can be reasonably interpreted as prohibiting vaccination while there wouldn’t seem to be a rationale beyond personal preference for not wearing a mask. At the same time, the public threat posed by the virus might be thought to override even certain religious objections especially if and when the objectors make use of public services such as schools.

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