Governments across the world are turning to vaccine mandates as the Delta variant continues to wreak havoc and vaccine uptake in some communities begin to slow down.
New Zealand – which has abandoned its COVID-Zero strategy amid persistent infections – introduced last week a “no jab, no job” policy for doctors and teachers, while neighbouring Fiji says all of its public and private sector workers are liable to lose their jobs if they fail to get fully inoculated by November.
In the United States, where a surge of infections this summer disrupted plans to restore some sense of normality, President Joe Biden in September announced a vaccine mandate for most federal government employees and demanded that large companies require their workers to get fully jabbed or submit to weekly testing.
Nowhere are the vaccine rules more stringent than in Saudi Arabia and Italy.
In the Gulf monarchy, all public and private sector employees must get inoculated to be physically present at work, while anyone wanting to enter government buildings and schools, or wishing to use public transport or travel outside the kingdom must show proof of having received double doses of a COVID-19 vaccine.
And in Italy, a policy that came into effect on Friday stipulates all workers to either show proof of vaccination, immunity or a negative test in the past 48 hours to go to work. Those without the so-called “green pass” could be suspended and may have their pay stopped after five days. The pass is also required to enter museums, gyms and restaurants and to travel by train, bus and plane.
These measures have spurred protests, court challenges and in some cases, counter mandates from local politicians.
In Fiji, which in July had one of the world’s highest rates of coronavirus infections per capita, workers petitioned the nation’s top court to throw out its vaccine mandate, while in Texas, Governor Greg Abbott issued an executive order last week banning “any entity” in the US state from enforcing a vaccine mandate.
Meanwhile, huge crowds have taken to streets in cities across the world to protest against compulsory immunisations. Protesters in New York City earlier this month carried signs that read: “We are not lab rats” and “Without bodily autonomy, freedom is dead”, while demonstrators in Rome last week carried placards that read: “No to Dictatorship” and “Freedom! No Green Pass”.
‘100-percent human rights issue’
Kanstantsin Dzehtsiarou, a professor in human rights law at the University of Liverpool said: “There is a very clear connection” between human rights and mandatory vaccinations.
“It is 100 percent a human rights issue related to the right to privacy and the right to bodily integrity,” he said. “Human rights protect our bodies and our ability to be the masters of our bodies. The consequence of this is our ability to determine our medical treatments.”
But this right is not “absolute”, Dzehtsiarou said, meaning that governments can interfere with it if they can justify such interference as necessary for and proportionate to the achievement of another valuable goal.
In the case of COVID-19, advocates for mandates say compulsory vaccinations – at least for certain groups – are a justifiable intrusion on an individual’s liberty and autonomy.
That is because COVID-19 is serious and lethal. So far, the illness has sickened at least 239 million people across the globe and killed at least 4.9 million people, while measures aimed at curbing its spread – including lockdowns – have upended lives and livelihoods, increasing conflict and leaving hundreds of millions of people to go hungry.
And, as David Cole and Daniel Mach at the American Civil Liberties Union point out, inoculations against COVID-19 have proven to be safe and effective, while there is no other equally effective alternative to protect public health yet.
“Far from compromising civil liberties, vaccine mandates actually further civil liberties,” Cole and Mach wrote in the New York Times newspaper in September. “They protect the most vulnerable among us, including people with disabilities and fragile immune systems, children too young to be vaccinated and communities of color hit hard by the disease.”
The World Health Organization (WHO), however, says it does not support mandates for COVID-19 vaccination. The global health body says it currently believes it is better for governments to work on information campaigns as well as making vaccines more widely accessible.
“Mandatory schemes during a crisis will be counterproductive,” said Dr Dicky Budiman, an Indonesian epidemiologist who advises the WHO on pandemic recovery. “When people have what we call conspiracy theories or they have misbeliefs or misunderstandings, [such schemes] will only strengthen their opinions.”
That is why, the WHO says, a mandate should only be considered when governments have made proactive and sufficient efforts to address concerns of those who refuse to get a shot and if low vaccination rates in the absence of such rules put others at risk of serious harm.
No force or coercion
Even when a vaccine mandate is justified, experts say the policy must provide for clearly defined exemptions, such as in the case of allergies.
They also stress authorities must not use physical force to get people jabbed.
In September, Human Rights Watch accused authorities in China of forcibly restraining people in order to vaccinate them. The rights groups said police in Hunan province forced a man into a car heading to a hospital in August, and several people held him down as he was injected with a vaccine.
“International human rights law allows governments to require people to be vaccinated – but not through physical force or undue coercion,” the group said.
Experts also say any COVID-19 vaccine mandate must also be targeted to people in high-risk locations.
A policy that covers all of society “would really feel like government overreach and will be seen as too heavy-handed”, said Debbie Kaminer, a professor of law at Baruch College, the City University of New York. “It should be targeted to places where there’s greatest risk of spread of disease like hospitals, nursing homes and schools.”
In the US, where vaccine uptake has slowed after about 70 percent of adults received two doses, Kaminer said mandates have become necessary because other interventions – such as incentive programmes like lotteries – are failing to push the rate up.
For instance, the state of Ohio announced in May a set of weekly draws of $1m for residents aged 18 years and older who had received at least one shot of a COVID-19 vaccine. But researchers say they have not found a statistically significant association between the cash-draw announcements and the number of vaccinations before or after the announcement date.
These programmes may not have been effective “simply because the issue has become so politicised in the United States,” said Kaminer. “It’s so tied in with people’s political views that it is much more difficult to change someone’s mind.”
The mandates, however, appear to be working.
In New York state, official figures show that 92 percent of healthcare workers got jabbed before a September 28 deadline while in New York City, 95 percent of public school staff complied with an order to get at least one dose by October 4.
“Mandates do work,” said Kaminer. “I want to emphasise here that nobody’s talking about forced vaccinations. It’s that if you want to be a healthcare provider, you need to get a vaccine. If you want to work in a classroom full of unvaccinated children, you need to get the vaccine.
“The point isn’t to be punitive. It’s about keeping society safe.”