For: Dr. H Sudarshan Ballal
Mandatory vaccinations can be a game-changer in war against Covid
The coronavirus pandemic is like no other pandemic that we have witnessed in the last hundred years. The second wave in particular was catastrophic, snatching lives and livelihoods.
During the first wave, the effort was to control the pandemic by encouraging masking, social distancing, hand washing, avoiding crowds etc. Unfortunately, the utter disregard for Covid-appropriate behaviour by the public led to a lockdown which had a devastating effect on the economy.
Now the advent of vaccines has added another very powerful tool in our fight against Covid-19. While efforts to implement Covid-appropriate behaviour should continue, our best bet of controlling this pandemic is mass vaccinations as soon as possible.
However, even after six months of the vaccination program, only about 5% of the population has been fully vaccinated. Much of the public discussion regarding the slow pace of vaccinations has centered around supply-side barriers like shortage of vaccines, lack of infrastructure, logistics and equitable access to vaccines. Demand-side barriers like vaccine hesitancy, especially in the rural population, are less debated. Even before the emergence of Covid-19, WHO recognised vaccine hesitancy as one of the 10 leading threats to global health.
In India, misguided hesitancy and fake information about vaccines are a substantial threat to the elimination of the pandemic and achieving herd immunity against the infection.
This is counter-productive because it will lead to vulnerable people getting infected. The higher the infections, the greater the chance of mutations and spread of the resistant strain.
So the billion-dollar question is: Should we make vaccinations mandatory universally or at least in a select group of people or leave it as a choice for citizens to decide?
In general when we consider mandatory vaccinations, there are certain caveats that we need to fulfill…
1. Is there a need for the vaccination to achieve an important goal which can be a health or economic goal or both?
In this instance, the goal could be achieving herd immunity, protecting the vulnerable, protecting the capacity of the healthcare system and, of course, preventing the devastation of lockdowns.
2. Safety, efficacy and public interest
Certainly any option which interferes with individual liberty and choice should be considered only if it decreases the risk of morbidity, mortality and spread of the disease with unequivocal public health benefits. Clinical trials and ongoing monitoring show that vaccinated people are much less at risk of developing severe disease than unvaccinated people. Mortality is a rarity in fully vaccinated individuals. We also have enough evidence to show that all the currently available vaccines are by and large quite safe with hardly any serious side-effects.
3. Logistics of supply and public trust In addition to mandating vaccinations, we need to ensure sufficient supply, logistics to maintain the supply chain and have infrastructure to vaccinate all the eligible population. Building public trust through ethical, transparent sharing of scientific data at various fora and engaging the relevant stakeholders to understand their perspectives is also necessary.
Let’s look at some of the specific areas of mandatory vaccinations:
Healthcare and other frontline workers: In addition to preventing healthcare workers from getting the infection, it is very essential that caregivers “do no harm” by spreading their infection to the people they are taking care of.
Schools: Given the lack of data on the safety and efficacy of Covid-19 vaccines for children, we cannot at present recommend vaccination for children as a mandate to attend school. However, all teachers and other adult personnel in the school should be vaccinated both to prevent infections spreading to them or them spreading infections to children.
The Public: Vaccines are extremely powerful tools to fight viruses and we have seen tremendous successes in the past like eradication of smallpox and polio due to effective vaccination and a significant decrease in many childhood illnesses by routine vaccinations. Vaccination mandates for the general adult population are rare but this is an extraordinary situation that requires extraordinary measures. I do believe mandatory vaccination of everyone, subject to availability of vaccines, should be our priority. It will certainly be a game-changer in our war against Covid-19. Our fight against the coronavirus is akin to a warlike emergency. In a war people can be conscripted to serve the country with the risk of death or permanent injury. If people can be sent to war against their wishes with significant risks, I believe some level of coercion for vaccination with hardly any risks is justified in our war against this deadly virus
(The writer is the chairman, Manipal Hospitals)
Against: Parth J Shah
Covid situation does not warrant the sacrifice of individual liberties
Enemy planes were bombing London night after night. A group of Londoners demanded their right to keep the lights on. They argued that personal liberty must always be protected — what’s the use of winning a war at the cost of citizens’ liberties? Some supposed that these people must be civil liberty champions, and some suspected them to be enemy sympathisers. Irrespective of motivation, it was a classic case of personal liberty versus the public good.
Take a different example of the tension between individual rights and public interest. Until recently, the Indian state could acquire land for a public project without consent from any of the landowners. The public good, the eminent domain powers of the state, summarily trumped individual property rights. The reformed land acquisition act now requires that 80% of the landowners must consent. If the 80% voluntarily agree to sell their land at the offered price, then the remaining 20% could be compelled to sell their land.
Today, the media and the drawing rooms are abuzz with the debate over whether the Covid vaccine should be made compulsory — a new case of personal liberty versus public good. Is the Covid vaccine situation similar to the aerial night bombing of London or the new land acquisition scenario?
In the case of the night bombing, even a few lights could help guide enemy planes to their right target. Nothing sort of full compliance is necessary. And even the staunchest libertarians would find it difficult to defend the right to keep the lights on. However, the success of the Covid vaccine does not require each and everyone to be vaccinated, just enough numbers to achieve herd immunity. The vaccine situation is less like the night bombing, and more like the land acquisition scenario.
The key difference between night bombing and land acquisition is to whom we entrust the power to define the public good. In the night bombing case, it seems reasonable to let the state define the public good. The citizens abide by the state’s assessment of what constitutes the public good and follow its instructions—all of you/ us keep the lights off.
In the land acquisition case, the old law did give the full authority to the state to define the public good and compelled the public to follow its orders. The history and the experience of the old law, coupled with the changes in our democratic and social values, led to the realisation that in these situations, the public should have the right to define the public good. At least 80% of the affected individuals should agree that the government’s proposed project is in the public interest. This shift in power from the state to the people is indeed revolutionary.
An even bigger revolution is that the power is given to specific individuals and not to the general public. It is not the will of the people a la Rousseau but the flesh-and-blood individuals who get to determine the public good. This is real-life individual liberty.
Now let’s complete the triangle with the Covid vaccine. In the land acquisition case, we do compel the 20% of the affected individuals to follow the decision of the 80%. Do we need to follow this logic for the Covid vaccine also?
The answer is rather straightforward. No vaccine has been made compulsory — not polio, not hepatitis, not diphtheria (DTP). In real life, we need herd immunity, and that is achieved with less than 80%.
This nuanced understanding of the trade-off between individual liberty and the public good, along with who should have the power to define the public good, also explains the overall public response to the government’s handling of the pandemic.
In the first stage, when we did not understand the nature of the Wuhan virus and ways to deal with it, the government view prevailed and the people followed the national lockdown. As our scientific and global experiential understanding improved, we began to challenge the unilateral demands of the government and forced a more differentiated view of the situation, geographically and socio-economically. And later, even the ardent supporters began to criticise the government. If only the government had understood this nuance and genuinely consulted the affected people.
The position that liberty always trumps public good or that public good must always override individual agency is just a longing for simplicity and purity at best. It is probably more for sloganeering and tribal belonging. In real-life situations, individual liberty and public good are far more compatible than what the political and medical elite believe.
(The writer is the founder of Centre for Civil Society and co-founder of Indian School of Public Policy)