People who oppose vaccinations are perpetually terrified of being forced to vaccinate. Is this fear justified, and if so, is mandatory vaccination defensible?

The stock libertarian response to the question whether Covid vaccines should be mandatory is: ‘No, of course not. Coercion is evil. That way lies tyranny.’

On a number of occasions, I have responded in a similar vein when asked the question. It is a glib answer, however, which glosses over many nuances.

Let’s start with the idea that coercion is evil. This is, generally speaking but not universally, true.

One might oppose seat belt laws, for example, or helmet laws, on grounds of individual liberty. If you’re stupid enough not to wear a seat belt when driving, or a helmet when riding a motorbike, the consequences are entirely your own.

As John Stuart Mill wrote: ‘The only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others.’

Some might argue that state intervention is justified by the burden irresponsible people place on the healthcare system, but the additional burden of more severe injuries may well be balanced by the additional number of accident victims who would die and need no healthcare at all.

When your actions affect other people, however, coercion is more easily justified. The rules to drive on the left side of the road, not to run red lights, and not to overtake on solid white lines, are all impositions on your liberty, but they are justified because breaking those rules places other people at grave risk of injury or death.

The law against discharging firearms in suburbia limits your freedom to express yourself as a crazed gun nut, but it does so in order to protect society from your recklessness.

Mandatory vaccines

So it is with vaccines. To the extent that they protect you from others, there is little justification for making them mandatory, short of arguing that excessive disease incidence among the unvaccinated could overwhelm healthcare systems.

However, vaccines are also intended to protect others from you. This makes a far stronger case for mandating vaccines in people who do not have good medical grounds for being exempt.

Eight years ago, I wrote about mandatory vaccines, and concluded thus: ‘Preventing reckless actions that cause clear harm to others does not contradict any principles of liberty, as far as I know. This, the scientific evidence that [vaccination] works, and the unusual fact that it can only confer “herd immunity” if as many people as possible are vaccinated, seem like perfectly sound reasons to support mandatory vaccination.’

It isn’t as simple as saying liberal principles oppose coercion, therefore mandatory vaccinations are always unjustified.

Peter Singer, professor of Bioethics at Princeton University, makes a good case for why Covid-19 vaccinations ought to be compulsory.

That said, vaccinations are not mandatory in South Africa. That goes not only for Covid vaccinations, of course, but for all vaccinations. Whether or not you have good medical grounds for doing so, you are free not to get vaccinated, or not to vaccinate your children. You might have to find a school that admits unvaccinated children, but otherwise you’ll be okay.

I would strongly – very strongly – recommend against forgoing vaccinations, however, especially against serious childhood diseases. However, your right to ignore this recommendation is not under any threat in South Africa.

Propaganda

Recently, however, the question has been raised: should Covid vaccines be made mandatory? One of the reasons is that the uptake in South Africa is relatively low, in part due to false or misleading information spreading on social media that suggests vaccines against Covid-19 are ineffective, are not necessary for healthy young people, or are actively harmful.

There’s a whole industry dedicated to spreading anti-vaccination misinformation, some of it linked to countries renowned for their propaganda designed to undermine faith in liberal democracies.

Last year, they attacked Covid testing, and often went as far as claiming that the pandemic wasn’t real, or that fear and anxiety were killing people, not Covid. Of course, fear and anxiety are real, but they are unlikely to reduce your blood oxygen saturation levels enough to require ventilation, nor do they present as ‘Covid lung’ on X-rays.

The propagandists operate by cherry-picking scientific papers that appear to cast doubt on mainstream advice; they point to anomalies in data, or anecdotal evidence, and either present them as representative, or claim that they are fatal to the rationale for vaccination.

One just needs to read the charts to see that Covid vaccinations are effective. These are the daily deaths of Covid in the ten most-vaccinated countries:

The trend since vaccination started at the beginning of the year is sharply downwards, and although the delta variant is clearly a variant of concern, deaths have not risen anywhere near the levels seen at the start of the year.

By contrast, here is a selection of countries with similar vaccination rates to South Africa:

In this case, the trend is clearly not downwards, and the third wave, which is almost entirely absent in the most-vaccinated countries, is taking a heavy toll.

Vaccination works

In the USA, 99.5% of recent deaths of Covid occurred among the unvaccinated, according to Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention.

‘I can tell you for sure that during the last few weeks… [in] my Covid high care ward, I have not seen a single person there who has been vaccinated,’ Dr. Mark Mendelson, head of the Division of Infectious Diseases and HIV Medicine at Groote Schuur told News24.

‘Sadly, the same cannot be said for patients who had been taking Ivermectin,’ he added.

Among the South African healthcare workers vaccinated with the Johnson & Johnson shot in the Sisonke trial, 98% reported no significant side-effects. Only 50 out of almost 300 000 reported serious side-effects.

Contrary to recent claims by anti-vaxxers that Covid infections are common immediately after vaccination, only 12 Sisonke trial participants, or 0.004% were diagnosed with Covid in the first 28 days after vaccination.

Data on breakthrough infections after this period has yet to be released, but researchers do know that only 2% of those involved severe disease.

The Bhekisisa Centre for Health Journalism has a detailed analysis of what we know about breakthrough infections. In short, they happen, especially with the delta variant, but they are rare, and very few of them lead to severe illness.

In the US, out of 163 million Americans who had been fully vaccinated by July, 6 587 people, or 0.0004% had been hospitalised or died as a result of breakthrough infections.

So, it is clear that getting vaccinated is highly advisable. However, the dream of herd immunity is out of reach for South Africa.

Herd immunity

Herd immunity is the threshold of immunity in a population that effectively prevents a virus from circulating further, because any one infected person is too unlikely to come into contact with and transmit it to a vulnerable person.

Prof. Shabir Madhi, dean of the Faculty of Health Sciences at Wits points out that with the highly transmissible delta variant now in circulation, we would need 84% of the population to be immune to reach herd immunity.

That is not going to happen. It was never going to be feasible to vaccinate even the government’s target of 67% of the population. We can perhaps hope to vaccinate between a third and a half of the population.

And we don’t know what future mutations might do. They may be even more transmissible, they may be more deadly, and they may escape pre-existing immunity.

As Madhi says, we’ll have to learn to live with the virus. But that means getting it under some semblance of control.

The World Health Organisation (WHO) does not recommend mandating vaccines. In its ethical guidelines, it points out that if public health goals, such as herd immunity, protecting the most vulnerable, or protecting the capacity of the healthcare system, can be achieved with less coercive or intrusive policy interventions, such as public education, a mandate would not be ethically justified, as achieving public health goals with less restriction of individual liberty and autonomy yields a more favourable risk-benefit ratio.

Given that herd immunity is likely not achievable in South Africa, our vaccination strategy should focus on protecting the most vulnerable and protecting the capacity of the healthcare system, neither of which requires mandatory vaccination.

The WHO also warns that mandating vaccinations is likely to undermine public confidence in the scientific community and public trust in vaccines generally.

So, despite my view that making vaccines compulsory could be justified in principle, in practice, mandatory Covid-19 vaccination cannot be justified in South Africa.

Vaccine passports

What the state requires, and what the private sector does, however, are two entirely different things. Private institutions are perfectly entitled to discriminate on the basis of vaccination status, should they so desire.

I think it unlikely that this will become a widespread reality within South Africa. It’s not like participants in our battered economy can afford to turn people away.

Given South Africa’s poor record with issuing ID cards, it is also unlikely that a reliable means for a third party to establish vaccination status will become available any time soon. Handwritten vaccination cards given to vaccinees are hardly durable or secure.

This will have significant downsides, however, especially if foreign countries start to require proof of vaccination to grant foreign visitors entry. Perhaps we ought to put pressure on the government to rapidly develop a secure means of proving vaccination status.

Those who have medical grounds for not being vaccinated will, of course, be exempt from vaccination requirements, but those who refuse vaccination simply on the basis of scary stories they read on the Internet may have to live with the fact that international travel will not be in their future.

There will likely be other benefits to being vaccinated, such as lower life-insurance rates. That would be entirely justifiable, of course.

So, while vaccination will be voluntary, there will likely be significant disadvantages, beyond the risk of an extremely unpleasant death, to remaining unvaccinated. It would be wise not to fall for the fear-mongering and fringe theories concocted by anti-vaccination propagandists.

Lockdown measures such as closing businesses and imposing curfews impose tremendous economic costs. As I have written many times before, authoritarian lockdown measures are destructive, often arbitrary, and sometimes even counter-productive.

Lockdowns pose a far greater threat to individual liberty than public health interventions such as mask-wearing, social distancing, hand-washing or vaccination, which do not impose an intolerable burden upon individuals.

If we want an end to the lockdown insanity, and get both the local and global economy going again, we need to reduce Covid-19 to the level of a seasonal flu. The most promising way to do this is to get as many people vaccinated as possible.

[Image: Wilfried Pohnke from Pixabay]

* This story has been updated to correct the spelling of Professor Shabir Madhi’s name.

The views of the writer are not necessarily the views of the Daily Friend or the IRR

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