COVID vaccine mandates need to be justified and fair to succeed

13 September 2021
What is needed for a successful and fair mandate?
Mandatory vaccination proposals must be backed by "strong justification", and less restrictive avenues to increase uptake must be "meaningfully attempted" first, write Professor Julie Leask and co-authors in the MJA.

In an article published in the Medical Journal of Australia, Professor Julie Leask from the University of Sydney Susan Wakil School of Nursing and Midwifery and colleagues from the Collaboration on Social Science in Immunisation, write that a range of issues must be considered before COVID-19 vaccine mandates are introduced.

“Because they are more coercive than other interventions to increase vaccination coverage, mandates demand stronger ethical justification,” writes Professor Leask and colleagues.  

“Policy makers should balance rights of individuals and the promotion of public good whilst carefully considering the epidemiological, programmatic, and legal issues.”

The authors outlined the following prerequisites for a successful and fair mandate:

  •  The mandate should be legal – in most settings it must have legislative support. Fair Work Australia provides general guidance in workplace settings;
  • The burden of disease should be high enough to justify a mandate;
  • The mandated vaccines must be safe – “Governments need to operate a no-fault vaccine injury compensation scheme to compensate those required to vaccinate in the rare occurrence of a serious adverse event”;
  • The vaccines should reduce transmission – “mandates are only justifiable when vaccinating one person helps protect others around them”;
  • Vaccine supply should be sufficient and access easy – “A penalty for not vaccinating when the government has failed to meet its service delivery obligations is unjust”;
  •  Less restrictive and trust-promoting measures should come first;
  •  The type of mandate should not penalise the poor unfairly – “Mandates should not compound disadvantage”;
  • Those mandating need to plan and support implementation – “systems for documenting and retrieving evidence of vaccination are essential”; and,
  • Affected populations should be considered in planning – “All mandates must include exemptions for those with a valid medical reason to not vaccinate”. In community settings it may be sufficient to require proof of vaccination (or medical exemption), evidence of past infection, or evidence of recent negative test.

“Addressing these considerations in ways that consult with affected populations and keep the process fair means the outcomes are more likely to be trusted. Trust in governments remains crucial while we need people to keep up the other public health actions like testing and wearing masks,” Professor Leask and colleagues concluded.

“Mandates that are careful and responsive to context are more likely to avoid social harms while, ideally, helping to achieve a public good.”

Disclosure: Julie Leask and Kerrie Wiley have received a grant from NHMRC to study policy aspects of childhood vaccine refusal. Julie Leask sits on the Expert Advisory Group for the Victorian Department of Health and Human Services and was a temporary unpaid advisor to the Vaxzevria (previously COVID-19 Vaccine AstraZeneca) Advisory Board.

Please refer to the paper for additional disclosures involving co-authors.

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