The Economist explains
Why don’t governments make covid-19 vaccines mandatory?

Even when vaccines are fully approved, countries will hesitate to force people to get jabbed

IN 1853 THE British government passed the world’s first mandatory-vaccination law. By the age of three months (or four for orphans), all children “whose health permits” were required to be inoculated against smallpox. Failure to do so could result in a fine of £1, equivalent to around £130 ($179) today. On the face of it, covid-19 vaccines look like they might warrant similar treatment. Most governments recognise inoculation is the fastest way out of the pandemic, and in many places, especially where cases have been low, hesitancy is hindering the roll-out. Even so, few governments are keen to make vaccines against covid-19 mandatory for all. Why not?

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Vaccination mandates for general adult populations are rare, for good reason. The benefits for communities have to be weighed against the rights of individuals to make their own decisions. The World Health Organisation (WHO) says that mandatory vaccination must be “necessary and proportionate” in the achievement of “important public-health goals”. But it is not uncommon for laws to insist that children, certain workers or travellers arriving in a country must be vaccinated. A study by researchers at McGill University found that in 2018, 105 out of 193 countries had at least one mandatory vaccine of this sort. Of those, 62 countries imposed penalties for non-compliance. Australia, for example, links childhood vaccinations to pre-school admission (“no jab, no play”) and family-assistance payments (“no jab, no pay”). All allow exemptions on medical grounds and many also in accordance with religious beliefs.

Covid-19 vaccines are different from other jabs, however. Their rapid development and roll-out means that the quantity of data usually produced by clinical trials is not yet available. Calculating the threshold of herd immunity for a country is hard because covid-19 is still a young, rapidly evolving virus subject to many imponderables. It is still unclear how effectively vaccines cut transmission or how long immunity will last (although evidence from the real world is quickly stacking up). Serious side-effects, although extremely rare, are recognised.

The deficit of safety and efficacy data means that covid-19 vaccines have so far been approved only for “emergency use”. This makes mandating them legally and ethically tricky. The WHO does not support mandatory covid-19 vaccines even for international travel. In February Indonesia, which is currently facing a surge in cases, gave local governments the power to fine people who refuse a jab. But most governments have left the decision up to citizens. Even in authoritarian states, like China, a vaccine mandate is not official policy. Some countries do require vaccines for particular groups of workers, such as carers in Australia and Britain and medical staff in Italy. The risk, however, is that some people would rather refuse the vaccine and not work—an especially dangerous prospect if those people are health-care workers during a pandemic. The American army is planning to make vaccinations mandatory as soon as the shots are fully authorised, according to a report in Army Times, a newspaper for personnel.

Even when covid-19 vaccines have been fully authorised, governments will hesitate to make them mandatory. Compulsion risks fuelling “anti-vax” sentiment, undermining other inoculation programmes. Punishing non-compliance usually hits poorer and migrant families hardest. Although opinion varies greatly—a survey in January by Ipsos, a pollster, found that 77% of Mexicans and 68% of Brazilians supported mandatory vaccinations for covid-19, compared with 37% of French people and 39% of Germans—democracies would struggle to force needles into arms. The hope is that enough people will get jabbed to render the question of whether to mandate jabs academic. The fear is that widespread hesitancy will make it ever more pointed.

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