I will receive my second shot of AstraZeneca next week. Vaccination is our pathway to living more freely so I have been encouraging everyone to get vaccinated.
But something about vaccination makes it a lightning rod for controversy.
Make vaccines “mandatory” and you have just hitched your lightning rod to a powder keg.
That’s unfortunate, because vaccination is the key to getting back to a life that resembles “normal”.
Collectively, we don’t really have a choice. Neither “letting it rip” nor indefinite lockdowns are acceptable.
Herd immunity through vaccination is the only viable option, but we have to achieve that goal without steamrolling people’s basic rights.
My purpose is to set out principles that help define the circumstances in which we might reasonably make vaccination mandatory.
Firstly, general principles of respect for bodily integrity, and the inherent right of individuals to refuse any medical treatment, apply to the administration of a vaccine. There are no circumstances under which any person ought to be vaccinated without their informed consent (or the consent of parents or guardians).
Secondly, there is our common duty to protect those most at risk from Covid-19: the elderly, the disabled, remote indigenous communities, the seriously ill and so on.
Thirdly, democratic governments have an obligation to keep the community safe from material threats to life and health while refraining from gratuitous intervention in people’s lives.
How does mandatory vaccination fit in the context of these competing principles, rights and obligations?
In some circumstances, mandatory vaccination will be not only acceptable, but necessary.
For example, the obligation to protect the elderly and other at-risk populations means it is reasonable to minimise the risk of transmission of Covid-19 in certain facilities or communities by limiting access to people who are vaccinated.
This is analogous to the requirement that nurses and doctors undertake proper surgical hand preparation before entering an operating theatre.
Similarly, for workers at the frontline — in the quarantine system, testing clinics, and vaccination hubs — mandatory vaccination is a justifiable measure to substantially lower the risk of the virus escaping into the community.
In these cases, vaccination can be an inherent requirement of the job. If someone is unable or unwilling to be vaccinated, they probably shouldn’t be doing that job. (If you’re a vegetarian, you oughtn’t expect sympathy when you complain about the nature of your job in an abattoir.)
The more challenging side of mandatory vaccination is when it is linked to reopening.
In these cases, vaccination is not an inherent requirement of the job but a public health measure to prevent a spike in Covid-19 cases and deaths while getting as many people back to work as possible. The choice is between mandatory vaccination and prolonged, stricter lockdowns.
This corresponds with the government’s obligations to keep people safe, while keeping restrictions to a minimum, but it also brings into play our shared obligation to keep the most vulnerable people safe, by contributing to the push towards herd immunity. Anyone who can get the vaccine should do so now, because we won’t achieve herd immunity by relying on others to do the heavy lifting.
Still, for those who cannot or will not freely consent to vaccination, coercion by any means is not justifiable. Termination of employment for vaccine refusal should be a last resort.
Where possible employers should negotiate alternative, safe working arrangements for unvaccinated workers. In some cases, temporary “stand downs” and access to disaster payments may be the only option. Making vaccination a condition of returning to work is not intended to be a penalty, but a means by which we can incrementally and safely get back to life as we knew it.
These general principles will apply differently in different settings, depending on the risk of a Covid-19 outbreak developing; the danger to vulnerable populations; the burden on individuals who have chosen not to be vaccinated; and the likely effectiveness of other protective measures.
It may be justifiable to require vaccination for fans at a footy match – an optional recreational activity. It is not justifiable to mandate it for entry to the local supermarket – a necessary task for daily life.
The New South Wales government will continue to make the hard decisions – aiming at the right combination of a robust public health response and support for a vigorous economy.
Together with the community, we should seek the common good, and never forget that the aim is to save lives while getting our state open again as quickly as possible.