The Ethics of Compulsory Vaccines
The advent of vaccines is one of the most momentous inventions of humankind. With its high efficiency against viruses and bacteria, vaccines have alleviated many diseases, including once-dreaded ones such as polio, smallpox, and measles. Mortality rate due to ailments has plummeted, saving roughly 154 million lives since 1974.1 Vaccines are thus foundational to humanity's long-term health and safety.
As efficient as vaccines are, mandating them in public health policy, especially during a health crisis, faces criticism and controversy. In times of public health emergencies, such as the recent COVID-19 pandemic, policymakers need to act promptly to minimize the spread of disease. Hence, making vaccination compulsory is one possible solution to enhance its efficiency and facilitate rapid development in response to the disease. However, this raises doubts about the safety of this rapidly developed vaccine. Opposition to mandates takes several forms: People may be reluctant to receive a rapidly developed one for the lack of guarantee; for some, the act of vaccinating someone is a breach of body autonomy and their rights.
Policymakers are left to approach the ever-present dilemma: ‘Should vaccines be mandatory in a public health emergency?’ This essay posits that vaccine mandates should not be compulsory unless they satisfy a strict guideline. Using what is outlined in the WHO guidelines, the paper states that policy during public health crises is under the influence of three main tenets: the principle of proportionality, evidence, and least infringement.2 Non-pharmaceutical interventions should be initially prioritised as less intrusive alternatives; escalation to legal penalty mandates, not on the physical level, is justifiable only when they satisfy strict conditions of proportionality, evidential necessity, and least infringement upon individual autonomy.
The essay will cover the rationale supporting and opposing mandatory vaccination in public health crises, lay the moral and philosophical groundwork beneath this issue, and establish a definite criterion to assess whether the vaccine mandate is justifiable.
Within the scope of this essay, a public health emergency is “(1) an infectious disease outbreak that (2) causes a large number of deaths, illness, or injury in the affected population.” (The New Jersey Health Emergency Health Powers Act, 2005)3 Among the benefits of vaccines is herd immunity, “the indirect protection from an infectious disease that happens when a population is immune either through vaccination or immunity developed through previous vaccination.” (WHO, 2020)4
Vaccine mandate is also categorized into levels from least to most intrusive, mainly four levels: nudges and defaults - vaccination as a default option and reminder uptakes; conditional access mandates - using vaccination status to access certain spaces and services; employment mandate - vaccination as a prerequisite for employment, especially in healthcare, education, the public; to physical compulsion - forceful vaccine administration against an individual’s resistance.5 Although almost no democratic authority imposes a Level 4 mandate, Level 2 and 3 mandates may become coercive enough that they also strip meaningful voluntariness like Level 4 - the point that this essay argues against.
To begin, mandating the masses to be vaccinated fosters herd immunity to counteract the spread of diseases. The more people are vaccinated, the wider the community becomes immunized against infection. Hence, vaccination reduces transmission, severity, and mortality. This is crucial during a public health emergency, when the disease transmission is exponential and uncontrollable. With vaccination mandated for most people, policymakers can ensure a rapidly increased rate of herd immunity to obstruct the growth of viruses and bacteria. Not only is this obstruction beneficial in allocating more time for vaccine research and development, but it is also vital in allowing countries to take measured steps in tackling the epidemic without being rushed.
Implementing vaccination as compulsory is a preventive measure against public health crises. During a public health emergency, the overwhelming number of admitted cases to the hospital overloads the manpower, equipment, and services. Medical workers face heightened risks of burnout and infection. However, with vaccination in circulation, individuals are immunized against infections or experience less critical conditions from being infected, lowering the number of hospitalized cases. A study from Kosovo, analysing data in three years, found that “an up-to-date COVID-19 vaccine received in the past 6 months was 72% effective at preventing hospitalization related to COVID-19 and 67% effective in preventing more severe outcomes related to COVID-19, including admission to the ICU and death.” (WHO, 2025)6
These benefits notwithstanding, the hasty implementation of vaccination on utilitarian grounds infringes human rights and autonomy on various levels. It is noted that to be autonomous is one of humanity’s rights, and also is “to govern oneself, to be directed by considerations, desires, conditions, and characteristics that are not simply imposed externally upon one.” (John Christman, 2025)7If vaccination is made compulsory, especially through access and employment limits, this deprives individuals of their autonomy to decide whether they should take the vaccination or not. This also violates the tenet of least infringement of the WHO public health policy guidelines.
In view of the unpredictability and volatility of pandemics, prompt actions must be taken to maximize counteraction against disease spread. The development of vaccines, a long and painstaking process that demands months or year-long trials, is thus accelerated to generate a temporary panacea for public health emergencies. When a government mandates a vaccine whose long-term effects are genuinely uncertain, it is asking citizens to bear an unknown personal risk for a known collective benefit. This asymmetry is ethically significant. The collective benefit is distributed across millions of people, but if an individual experiences a rare adverse effect, that harm is concentrated entirely on them. During COVID-19, this concern was not entirely hypothetical. There were rare yet harmful aftereffects of deploying vaccines: myocarditis associated with mRNA vaccines in young males,8thrombosis with thrombocytopenia syndrome associated with some adenoviral vaccines.9 Without much prior trials, such a lack of guarantee of safety further exposes individuals to greater harm beyond complications from viral infections alone.
To understand this matter in depth, some philosophical groundwork needs to be investigated. Underlying the belief that defying herd immunity is inflicting harm on the community is the harm principle, first proposed by John Stuart Mill. It establishes that “people should be free to act however they wish unless their actions cause harm to somebody else.”10 Theoretically, the autonomy to choose not to be vaccinated is harming other people, as this increases infection risks. However, one question that needs to be addressed is the precise definition of ‘harm’ in this principle. While the harm principle was designed around deliberate or negligent acts (e.g, punching, assaulting), viral transmission is categorically different because this transmission act may happen unknowingly, asymptomatically. Besides, refusing vaccination may be risky, but it does not cause harm.11It is the illness spreader that causes actual harm, not individuals’ refusal to be vaccinated.12 Therefore, the vaccine mandate needs to be considered carefully.
Additionally, the reasoning for mandating vaccines must also be weighed against the foundational principles of patient autonomy and informed consent. To define, informed consent is “voluntary authorisation by a competent patient for a medical intervention based on the knowledge necessary to make an appropriate choice.” (T Thirumoorthy, 2023)13 The implication is that the patient is informed of the various medically possible options and the potential side effects to choose one that best caters to his or her preferences and conditions.14If this process is glossed over and medical intervention is conducted, this is an assault or battery,15 going against the foundation of health care and infringing human autonomy. Importantly, one of the important principles is that no form of coercion or rushing should be imposed on patients during their decision-making process. It is important to ensure that there is sufficient time, privacy, and opportunity to consult others for patients to reach their decision.16 Therefore, mandates such as restricting work returns and access to public facilities are imposing
on this right to make decisions that best suit one’s needs instead of being controlled by external factors. One example is that during COVID-19, many countries, such as Singapore and Austria, demanded that workers be vaccinated against the disease fully to return to work. Considering the economic recession and unemployment rate that COVID-19 had caused, employees had little choice and time but to abide by the law if they wanted to return to work as soon as possible. Indeed, while medical practitioners are not directly enforcing such restrictions to compel patients, mandates that deprive patients of their rights to work and freedom undermine the voluntariness and time allowance that patients are undeniably granted.
Once again, the priorities of public health policy are to ensure communal health safety by safeguarding against viruses and employing means to minimize the threats posed to the community. In the context of the pandemic, this priority is further emphasized as communal interests take precedence over individuals’.
From the points above, proportionality rises and becomes central to public health ethics. As an ethical principle, proportionality requires that restrictions to individual rights and freedoms should be adopted only to the extent to which they are necessary and effective in promoting a public health policy goal. Indeed, the requirement of proportionality is that “restrictions on individual freedoms and rights are based on the best available evidence.”17 However, immediate actions may be justifiable even without the lack of substantial evidence when public health faces serious threats, as it protects the safety and interests of society.18
Despite this argument, this does not mean that vaccination is the ultimate, proportional solution should the situation turn grim. Indeed, proportionality only requires an equivalent solution to an equivalent problem, but it does not restrict the methods to achieve the goal. During a public health emergency, there are Non-Pharmaceutical Interventions (NPI) to vaccination, which entail quarantine, mask wearing, etc., while substantially reducing transmission and upholding greater autonomy. A systematic review of 172 observational studies from 16 countries and 6 continents that researched the risk of infection with beta-coronaviruses (e.g., SARS, SARS-CoV-2, MERS-CoV) found that physical distancing of greater than or equal to 1 meter, bolstered by face masks and eye protection, could substantially reduce infection (Chu et al., 2020).19 Meanwhile, mask mandates have been associated with decreases in daily COVID-19 case and mortality rates throughout 20 days (Guy et al., 2021).20 Simultaneously, these medical interventions minimize infringement on individuals’ autonomy and are escalated according to the current situation, i.e, from face masks to physical distancing to quarantines.
However, should the situation overstep a threshold, such as when the healthcare system is at risk of collapse, and the disease becomes highly transmissible through the air, vaccination can beconsidered. In the case of viruses with mass transmission, outbreaks are even probable in well-vaccinated populations due to stochastic introductions that result in superspreading events that eventually die out (Garske and Rhodes, 2008). Nonetheless, the fact that such introductions die out over time and that pathogen growth rate slows as a result of immunity emphasizes the relevance of population immunity.21 However, mandates should only extend to employment mandates for healthcare and public service workers, at most, for safety reasons. Physical, legal, and financial coercion should be avoided as much as possible so as not to violate individuals’ voluntariness and decision-making - two of the cornerstones of public health. Meanwhile, nudges and defaults are justifiable because they merely suggest potential courses of action and allow individuals to decide for themselves.
To conclude, vaccine mandates, except for nudging, should not be enforced during public health emergencies. Rather, NPIs must be prioritised and exhausted first to ensure the least infringement. Should the situation turn dire, however, vaccination may be mandated through the least intrusion, and shall escalate according to the circumstances and evidence gathered.
References
1. “Facts About Vaccines: Why Vaccines Matter for Children.” UNICEF. September 19, 2025. https://www.unicef.org/stories/why-vaccines-matter-children.
2. “COVID-19 and mandatory vaccination: Ethical considerations.” WHO. May 30, 2022. https://iris.who.int/server/api/core/bitstreams/4630bf27-23ad-4278-95e0-3e32957f7079/content. 3. “Public Health Emergency,” Gale eBooks, The Law of Emergencies, 2nd ed., 2018. https://www.sciencedirect.com/topics/computer-science/public-health-emergency.
4. World Health Organization. “Coronavirus disease (COVID-19: Herd immunity, lockdowns, and COVID-19”. December 31, 2020.
https://www.who.int/news-room/questions-and-answers/item/herd-immunity-lockdowns-and-covid-19. 5. Alberto Giubilini.“Vaccination Policies and the Principle of Least Restrictive Alternative: An Intervention Ladder.” In The Ethics of Vaccination, Palgrave Pivot Cham, 2019, 59–93:
6. World Health Organization. “COVID-19 still causes severe disease, but up-to-date vaccines are effective, new research shows.” December 31, 2025.
https://www.who.int/europe/news/item/31-12-2025-covid-19-still-causes-severe-disease--but-up-to-date-vaccine s-are-effective--new-research-shows.
7. John Christman. “Autonomy in Moral and Political Philosophy.” Stanford Encyclopedia of Philosophy. Substantive revision August 22, 2025. https://plato.stanford.edu/entries/autonomy-moral/. 8. “Clinical Considerations: Myocarditis After COVID-19 Vaccines | CDC.” n.d.
9. Nicolson, Phillip Lr, et al. “Understanding Mechanisms of Thrombosis and Thrombocytopenia With Adenoviral SARS-CoV-2 Vaccines: A Comprehensive Synopsis.” Ef icacy and Mechanism Evaluation. February. 1–36. https://doi.org/10.3310/ffss9010.
10. The Ethics Centre. “Ethics Explainer: The Harm Principle.” October 27, 2016.
11. Tim Hsiao. “Why Vaccine Mandates That Fail to Respect the Right of Conscience Are Immoral.” Foundation for Economic Education. February 6, 2024.
13. T Thirumoorthy. “Core Concepts of Consent in Medical Practice.” Singapore Medical Journal. May 30, 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC10335635/.
14. Ibid.
15. Ibid.
16. Ibid.
17. H D Gunnarsdóttir, M S Sinha, S Gerke, T Minssen. “Applying the proportionality principle to COVID-19 antibody testing”. Journal of Law and the Biosciences 7, no.1. August 04, 2020.
18. Ibid.
19. Derek K Chu, Elie A Akl, Stephanie Duda, Karla Solo, Sally Yaacoub, Holger J Schunemann. “Physical Distancing, Face Masks, and Eye Protection to Prevent Person-to-Person Transmission of SARS-COV-2 and COVID-19: A Systematic Review and Meta-Analysis.” U.S. National Library of Medicine. June 27, 2020. https://pubmed.ncbi.nlm.nih.gov/32497510/.
20. Guy GP Jr., Lee FC, Sunshine G, et al. “Association of State-Issued Mask Mandates and Allowing On-Premises Restaurant Dining with County-Level COVID-19 Case and Death Growth Rates.” MMWR Morbidity and Mortality Weekly Report 70 (2021): 350–354. http://dx.doi.org/10.15585/mmwr.mm7010e3. 21. Ibid.
BIBLIOGRAPHY
Chu, Derek K., Elie A. Akl, Stephanie Duda, Karla Solo, Sally Yaacoub, and Holger J. Schünemann. "Physical Distancing, Face Masks, and Eye Protection to Prevent Person-to-Person Transmission of SARS-CoV-2 and COVID-19: A Systematic Review and Meta-Analysis." PubMed, June 27, 2020. https://pubmed.ncbi.nlm.nih.gov/32497510/.
Christman, John. "Autonomy in Moral and Political Philosophy." Stanford Encyclopedia of Philosophy. Last modified August 22, 2025.
"Clinical Considerations: Myocarditis After COVID-19 Vaccines." CDC. n.d. https://www.cdc.gov/vaccines/covid-19/clinical-considerations/myocarditis.html.
"COVID-19 and Mandatory Vaccination: Ethical Considerations." WHO, May 30, 2022. https://iris.who.int/server/api/core/bitstreams/4630bf27-23ad-4278-95e0-3e32957f7079/cont ent.
The Ethics Centre. "Ethics Explainer: The Harm Principle." October 27, 2016. https://ethics.org.au/ethics-explainer-the-harm-principle/.
"Facts About Vaccines: Why Vaccines Matter for Children." UNICEF, September 19, 2025. https://www.unicef.org/stories/why-vaccines-matter-children.
Giubilini, Alberto. "Vaccination Policies and the Principle of Least Restrictive Alternative: An Intervention Ladder." In The Ethics of Vaccination, 59–93. Palgrave Pivot Cham, 2019. https://doi.org/10.1007/978-3-030-02068-2_3.
Gunnarsdóttir, H.D., M.S. Sinha, S. Gerke, and T. Minssen. "Applying the Proportionality Principle to COVID-19 Antibody Testing." Journal of Law and the Biosciences 7, no. 1, August 4, 2020. https://academic.oup.com/jlb/article/7/1/lsaa058/5878809.
Guy, G.P. Jr., F.C. Lee, G. Sunshine, et al. "Association of State-Issued Mask Mandates and Allowing On-Premises Restaurant Dining with County-Level COVID-19 Case and Death Growth Rates — United States, March 1–December 31, 2020." MMWR Morbidity and Mortality Weekly Report 70 (2021): 350–354. https://doi.org/10.15585/mmwr.mm7010e3.
Hsiao, Tim. "Why Vaccine Mandates That Fail to Respect the Right of Conscience Are Immoral." Foundation for Economic Education, February 6, 2024.
https://fee.org/articles/why-vaccine-mandates-that-fail-to-respect-the-right-of-conscience-are-i mmoral/.
Nicolson, Phillip LR, Simon T. Abrams, Gayatri Amirthalingam, Kevin Brown, Richard J. Buka, Mark J. Caulfield, Joshua Gardner, et al. "Understanding Mechanisms of Thrombosis and Thrombocytopenia With Adenoviral SARS-CoV-2 Vaccines: A Comprehensive Synopsis." Efficacy and Mechanism Evaluation, February 2025, 1–36. https://doi.org/10.3310/ffss9010.
Schaeffer, Beau, Bradford Taylor, Mary Bushman, and William P. Hanage. "The Devil in the Details: Herd Immunity and Pandemic Response." Cell Host & Microbe 29, no. 7, June 17, 2021: 1048–1051. https://www.sciencedirect.com/science/article/pii/S1931312821002997.
Thirumoorthy, T. "Core Concepts of Consent in Medical Practice." Singapore Medical Journal, May 30, 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC10335635/.
World Health Organization. "Coronavirus Disease (COVID-19): Herd Immunity, Lockdowns, and COVID-19." December 31, 2020.
World Health Organization. "COVID-19 Still Causes Severe Disease, but Up-to-Date Vaccines Are Effective, New Research Shows." December 31, 2025.
https://www.who.int/europe/news/item/31-12-2025-covid-19-still-causes-severe-disease--but-u p-to-date-vaccines-are-effective--new-research-shows.
Comments