Despite the fact that people have been vaccinated on a mandatory basis for a couple of centuries, there is surprisingly little convincing scientific research that clearly proves the effectiveness of this measure. Although the overall experience of past epidemics suggests that mandatory vaccination may be an effective means of controlling the coronavirus pandemic, there are too many additional factors of uncertainty to say this with certainty – or even to make predictions with sufficient confidence.
The history of mandatory vaccination spans more than two centuries. As early as 1809, Massachusetts passed a law requiring residents to be vaccinated against smallpox. The experiment was successful, and outbreaks of infection ceased – and soon neighboring states adopted similar requirements. In parallel with the legislative framework, however, there was growing discontent among ordinary Americans. Many categorically refused to be vaccinated, arguing that mandatory vaccination violated their constitutional “right to life, liberty, and the pursuit of happiness. The legality of the requirement was regularly challenged in court, and the courts often sided with the citizens. As a result, mandatory vaccination had to be repealed in seven states – and the lawsuits seemed to have no end.
In 1905, the final decision on the issue was made by the country’s Supreme Court. The authorities’ demand for compulsory vaccination was considered lawful and fair, since a person’s refusal to be vaccinated posed a risk not only to himself but also to those around him. Therefore, mass vaccination benefits society, and the court ruled that “in the name of the common good, the freedom of each individual may be subject to various restrictions. In this case, the public benefit is obvious: mass vaccination is the cheapest and most effective way to combat any infection. From an infection prevention perspective, it is only less effective than access to safe drinking water. Calculations by Public Health England show that since the mass vaccination of English children against measles began in 1968, the country has prevented approximately 20 million cases of the disease, saving at least 4,500 lives.
However, despite doctors’ deep belief in the efficacy and safety of all duly certified vaccinations, compulsory vaccination is impossible because it contradicts the principles of medical ethics, which require the informed consent of the patient for any medical intervention. Because the proportion of the population vaccinated must remain consistently high to maintain herd immunity, authorities must use both carrots and sticks to persuade people to get vaccinated. In this case, “knut” refers to the restriction of the rights of vaccine opponents (in other words, legalized discrimination), and in some countries – administrative liability. Rewards may include cash payments or other incentives. We explain quickly, simply, and clearly what happened, why it matters, and what happens next. The number of offers should remain: episodes. End of story: Podcast Advertising.
Currently, more than 100 countries require vaccination against at least one disease. In 62 of these countries, the law provides for some form of accountability for failure to comply with this obligation, mainly by prohibiting children from attending school, but in some places, such as the Czech Republic and Italy, refusals are punishable by fines. In addition to measles, vaccinations are required for diphtheria, tetanus, pertussis, hepatitis B, poliomyelitis, Haemophilus influenzae type b infection, varicella, mumps and rubella. The situation is similar (but without fines) in other European countries. At the same time, there are no fewer (and often more) anti-vaccine advocates in wealthy Western countries than in Third World countries. As the percentage of the population vaccinated increased, outbreaks of dangerous diseases gradually decreased – until at some point the pendulum of history swung in the opposite direction. People who had never seen a real epidemic in their lives began to fear the side effects of vaccines more than the diseases they were protecting against.
Not long ago, a group of Czech parents made another attempt to outlaw mandatory vaccinations for preschool children. But just as in the United States more than a century ago, their initiative was unsuccessful. Just a few months ago, the European Court of Human Rights issued a final ruling: in a democratic state, a citizen’s personal interests cannot take precedence over his or her responsibility to society. In the United States itself, all 50 states now require immunization for children over the age of five. It is interesting to note that in 1963 there were only 20 such states. However, the rate of disease in those states dropped so significantly that their example was followed by one neighboring state after another, and by 1980 it had become universal.
To this day, outbreaks of measles and other infectious diseases are less common in states with stricter laws, suggesting that mandatory vaccination is more effective where it is more difficult to circumvent the ban. Australia has long since stopped paying benefits to those who do not vaccinate their children against major diseases or delay vaccinations. And as of January 2016, they have also banned opting out of mandatory vaccinations for any reason other than medical. As a result, nearly 150,000 children were vaccinated within six months, and the country’s vaccination rate increased by three percentage points (from 92% to 95%) by 2020. A year earlier, California had outlawed ideological vaccine refusal in the wake of a widespread measles outbreak that began at the local Disneyland and spread to dozens of US states, as well as Mexico and Canada. The ban was met with resistance and scandal: previously, it was relatively easy to refuse vaccination on religious grounds.
Intuition suggests that forcing people to do something should provoke at least a natural reaction of resistance in some of them – especially in countries where the inhabitants do not particularly trust representatives of authority. Scientific data supports this notion. A survey conducted earlier this year by the London School of Hygiene & Tropical Medicine found that people who feel pressure from their employer – whether it’s direct orders or gentle but persistent recommendations – are much more likely to say they don’t want to be vaccinated (even after controlling for all other factors).
“Discussions with medical personnel and especially social workers show that forcing employees to be vaccinated can paradoxically have the opposite effect, reinforcing negative attitudes toward vaccination,” warns one of the study’s authors, Professor Sandra Munie-Dzhek of the School. The results of several similar studies, such as a survey conducted in the United States in December 2020, show that resistance to mandatory vaccination is not unique to healthcare workers. When asked about the possibility of mandatory vaccination, respondents indicated that they would be unwilling to be vaccinated not only against the coronavirus, but also against unrelated diseases such as chickenpox. This is despite the fact that a review of three dozen studies shows that the overwhelming majority of people in various countries support the idea of mandatory vaccination. However, residents of these same countries are clearly not eager to be vaccinated “under duress.
Several scientific papers argue that the carrot can be significantly more effective than the stick and that, from a societal perspective, it is more beneficial to incentivize those who voluntarily vaccinate than to impose punitive measures for nonvaccination. However, despite the fact that the authorities are currently trying to do this both in Russia and in other countries, this practice has not yet produced any tangible results. The majority of the BBC’s experts are far from certain that mandatory vaccination against coronavirus will necessarily prove effective, and they warn against jumping to conclusions.
“Indeed, research in Europe and the US shows that introducing compulsory vaccination generally improves the situation – meaning that more people are vaccinated,” agrees Professor Arindam Basu of the University of Canterbury. “But it is clear that all these studies were conducted under completely different conditions,” the expert emphasizes, “when there was no Covid-19 pandemic, no coronavirus vaccines, and no mass vaccination directly at the workplace (or at specific locations). Therefore, the results of these studies should not be directly extrapolated”.
There is another significant difference that is immediately apparent. Virtually all of the existing scientific studies on the effectiveness of mandatory vaccination are based on the results of vaccinating children. Mostly preschoolers and younger schoolchildren – that is, those who have not yet begun to be vaccinated against the coronavirus. Now we are talking about adults, and on a global scale – or at least on a somewhat mass scale – they are only vaccinated against influenza (and there is no consensus among experts on the feasibility of this vaccine) and hepatitis A and B viruses. In several countries, some of these vaccines are mandatory for healthcare workers, but the decision to be vaccinated is still ultimately made by the individual, by submitting an application. So it can only be called mandatory with a stretch.
In other words, experts summarize, there are simply no historical precedents for the already announced mandatory vaccination against coronavirus. And so it doesn’t make much sense to make predictions about the effectiveness of this campaign. A whole range of new factors will have to be added to the conclusions of any previous research – from the age range of those to be vaccinated to the risk of catching the virus while waiting in line for an injection in a crowded vaccination center – and it is almost impossible to guess how they will affect the results.
You can see this in a simple example. When the WHO officially declared the United Kingdom a rubella-free zone six years ago, the country confidently promised to eliminate measles by 2020. Over the next five years, however, the incidence of measles not only did not decline, it increased almost tenfold. This is despite the fact that children are vaccinated against both diseases with the same vaccine (MMR). Experts explain this difference by the fact that the threshold for herd immunity for rubella is 68-80%, while for the much more contagious measles, it is as high as 92-95% (epidemiologists compare this virus to a canary in a coal mine: if the percentage of vaccinated individuals drops by just a few percentage points, an outbreak of measles is almost inevitable). Scientists still do not know exactly what the threshold of herd immunity is for Covid-19 (if it exists) – and no expert can predict whether the coronavirus will behave like measles, rubella, or something else. And yet this is just one of the many unknowns that determine the development of an epidemic.
After analyzing nearly forty studies from 36 countries (totaling more than 80,000 respondents), a group of Chinese scientists found that healthcare workers around the world, who are strongly encouraged to be vaccinated, are much less likely to be vaccinated than ordinary citizens who are not burdened with medical training. The head of Care England, the largest union of social care workers in the UK, Professor Martin Green, is urging against a rush to compulsory vaccination. “Social workers are divided on whether the vaccine should be mandatory,” he said. “However, we all unanimously support the vaccine and use every means possible to convince residents and staff [of nursing homes] to get vaccinated [voluntarily].” “We recommend not making a hasty decision on such an important issue where there is no consensus, but rather conducting thorough consultations,” he stresses.
Peter Doshi, professor of pharmacy at the University of Maryland and editor-in-chief of the British Medical Journal (BMJ), is adamant that the question of whether coronavirus vaccination should be mandatory cannot be seriously discussed today, as the very fact of the discussion puts the cart before the horse. Professor Doshi points out that all the drugs used were licensed on an emergency basis and for use in an exceptional situation. In the conditions of a pandemic, time was of the essence, and as a result, none of the coronavirus vaccines underwent the necessary tests to ensure the long-term efficacy and safety of the new drug. According to Doshi, it would be irresponsible to require anyone to be vaccinated under these conditions. It will not be possible to revisit this issue until the developers of at least one vaccine meet all the requirements of the WHO regulations and are able to obtain a full certificate for their vaccine. And this will definitely not happen until at least 2022. According to the rules, it is recommended to follow vaccinated volunteers in clinical trials for at least one or two years. And in general, the longer the better.