COMMENTARY

Should COVID-19 Vaccinations Be Mandatory? Some Think So

Arthur L. Caplan, PhD

Disclosures

January 20, 2021

This transcript has been edited for clarity.

Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at the NYU Grossman School of Medicine in New York City. There's been a lot of enthusiasm about the appearance of vaccines; Moderna's is out there and Pfizer's is out there.

Different medical centers are vaccinating their healthcare workers and staff that support them in cleaning and laundry. Nursing homes are starting to vaccinate pretty aggressively. The discussion has started to take place around vaccinating meatpacking workers, truck drivers, and other essential workers.

There's going to be debate about who's an essential worker. Many people want these vaccines and hope to get them quickly. That raises a separate issue, which is whether we can mandate or compel someone to take a vaccine, and whether we are going to see vaccine mandates soon.

Different hospitals have some mandates for vaccination in place. For example, flu vaccine is mandated in many hospitals in the United States and Canada. We also have mandates for children for school admission. There are many states in the US that permit exemptions for religious, philosophical, or health reasons. Nonetheless, the expectation is that if you go to public school as a child, you're going to have to get a series of mandatory vaccinations.

There are other groups that have mandates, too, including the military. They definitely have strong mandates in the active armed forces about taking vaccines. Some businesses — say, if you work in the oil industry and you're out on one of those derricks out in the ocean, and are going to be out there for a while — do require mandates. Some daycare centers in certain states mandate vaccination of their staff.

We've seen mandates for vaccination and they've stood up to court challenges and objections. What will happen with COVID-19 vaccines? Well, the answer comes in two parts. Right now, COVID-19 vaccines are being made available under what's called emergency use authorization. That means partial data that look very impressive in terms of efficacy and safety were used to allow people to prescribe these vaccines, but it's with incomplete information.

The vaccines are not yet licensed. The FDA hasn't said that they're approved for sale. What they've said is that it's an emergency — and it's hard to argue that — and that given the fact that we need something, because the virus is out of control all over the United States, then we've got to make these vaccines available as fast as possible. I agree with that, but it's emergency use.

It would be almost impossible, in my opinion, to mandate any vaccine under emergency use authorization. It's based on incomplete data, these are not final data, and it's not a license. You can offer it, you can urge it, and you could hope that your workforce takes it, but I don't think you can mandate it. I think people will be free to refuse it for any reason they want.

In some parts of the country with vaccines already available, there are refusals going on. Some people are saying, "I don't want to be first. I want to wait a little bit, see what happens to people who take the vaccine, and then maybe I'll come back and get it." We are seeing refusals and I don't think you're going to be able to overcome that in a health system, in a private business, or through government requirements.

That means that the second stage, when the vaccines start to get approved — maybe that will happen in the summer or the fall — I will predict that we'll see vaccine mandates. Interestingly enough, I suspect that the first mandates may not come from government. It may not be the county or the state that says you must get vaccinated, as we see with childhood vaccinations for school admission.

I think it's actually going to be private businesses that lead the way. Cruise lines desperate to get people back on those boats where they've had terrible outbreaks, I think they're going to start to say, "You can come on, but only if you're vaccinated." I think airlines will also demand proof of vaccination as a way to assure their customers who want to return that it's safe. I think the same will be true with trains, such as Amtrak and passenger trains. I think you're going to have to show proof of vaccination.

I think some businesses are going to say that if you want to come back to work, you need to show proof of vaccination before returning to the office. They're not going to say it's your choice. They're going to try to require it. I predict that there'll be some fighting because even with a mandate from a business, you still could say no for health reasons.

The Americans with Disabilities Act of 1990 protects people who think they might have a health issue from having to get a vaccination, I think. You may even see religious objections stand up to private businesses that try to mandate vaccinations. I think people will be able to say that they have religious grounds for not wanting to do so.

That doesn't mean they're going to get back to work, get on that boat, or be able to travel on an airplane. They're just going to lose that privilege. Oddly enough, there may be less fighting about mandates when people realize that getting vaccinated and having proof of vaccination give you more freedom and more liberty to travel, to go to your workplace, eventually to go to the gym, eventually to go back to schools.

It's not like the usual vaccination where somebody gets it to prevent a disease that's rarely seen. Here, we're in the middle of a plague. Most people know someone who's gotten sick or even died. You're going to get more freedom if you agree to vaccinate. I think when we see the mandates come in the summer or fall, there may actually be less fighting about taking the vaccine than you might expect under a mandate.

I'm Art Caplan at the NYU School of Medicine. Thank you for watching.

Arthur L. Caplan, PhD, is director of the Division of Medical Ethics at New York University Langone Medical Center and School of Medicine. He is the author or editor of 35 books and 750 peer-reviewed articles as well as a frequent commentator in the media on bioethical issues.

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