Why is there so much reluctance to make the COVID vaccine mandatory for adults?

Question

For all the talk on how its important for everyone to get vaccinated, not a single country has so far made the COVID vaccine mandatory for adults. Some states are making it mandatory for college students but none are planning to enforce it for other groups of adults. Even China isn't making them mandatory despite them having little respect for human rights otherwise and no courts to limit the power of the government.

So where does this reluctance come from? At least in the US such a law would be constitutional so the decision not to go ahead with such a mandate is purely political.

Update from August: good news, look like the mandates are coming after all, though mostly for public employees

When you write "some states", do you mean some U.S. states or some countries? — gerrit, Jun 11 '21 at 08:29
@gerrit I mean some states in the US or some states/subdivisions in other nations. I.e. Scotland in the UK or Bavaria in Germany. — JonathanReez, Jun 11 '21 at 16:57
Comments are not for extended discussion; this conversation about anecdotes regarding vaccine hesitance has been moved to chat. — Philipp, Jun 13 '21 at 13:17

score 78 · Answer 1 · answered Jun 10 '21 at 11:04

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Forced medical treatment is a very sensitive topic and is widely considered a grave violation of medical ethics, and is only applied in extreme cases of mental illness, etc.

See https://en.wikipedia.org/wiki/Involuntary_treatment

https://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.201600066

answered Jun 10 '21 at 11:04

Jacob3

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This. A TL;DR of why it's sensitive has to do with 1) religious reasons, 2) accidents and side effects, and 3) potential application in biological experiments and such against unwilling and/or unaware subjects. – Panzercrisis Jun 10 '21 at 21:00
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"is only applied in extreme cases of mental illness, etc" is a bit of an exaggeration–it's common in the US to have mandatory vaccine requirements for students to attend school (though the criteria for exemptions vary depending on the state from "my personal beliefs are opposed to vaccines" to "no exemptions except for extremely compelling medical reasons with proof") or to serve in the armed forces. – Zach Lipton Jun 11 '21 at 02:43
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@ZachLipton The armed forces is the interesting one. Unlike many countries, the US does not currently have compulsory military service. But it does still have registration. If the draft were to start again, then plenty of medical stuff (vaccines included) may effectively be required for those drafted. Not likely any time soon (I hope). – manassehkatz-Moving 2 Codidact Jun 11 '21 at 03:01
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@Panzercrisis 4) one's own autonomy and authority over one's own body...? Why is that not in your list? – Adam Barnes Jun 11 '21 at 03:55
The other half of the question is asking what a country would gain from making it mandatory as opposed to simply encouraging people to get vaccinated and to make it easily available. The answer seems to be 'not much' so it doesn't require that big hurdles to shelf the idea of forced vaccinations. – quarague Jun 11 '21 at 06:53
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@ZachLipton That's to attend particular types of schools, not all types of schools. They can still be homeschooled, at the least, and not have any vaccination requirements. When we're talking forced medical treatment, we mean "you don't have any choice or alternative", not "you can deny this, but you may then have fewer options available in other areas of your life". – zibadawa timmy Jun 11 '21 at 07:55
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There was a Chinese doctor that performed unethical genome editing on a baby. He Jianjui affair. China is not stupid. Without access to international cooperation and technologies, they cannot even stay current. As much as China lacks human rights, that is in the area of governance of "minorities". On the scientific side, they care very much about their international access and image. – Nelson Jun 11 '21 at 11:26
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@AdamBarnes At least in the US that's a religious reason. The US government doesn't give the right to bodily autonomy, but some relegions hold bodily autonomy as a core belief. – Vaelus Jun 11 '21 at 12:27
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!? Why does "I don't want other people to have a say in what I do with my body" religious? Just because there's no governmental rule on something doesn't mean the only other reason for it can be religious. – Adam Barnes Jun 12 '21 at 21:03
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@Vaelus: Bodily autonomy is hardly “religious” — it’s seen as a principle or right in many different approaches to ethical philosophy, both religious and secular. The fact it’s not a legally-guaranteed right doesn’t make it religious. – Peter LeFanu Lumsdaine Jun 13 '21 at 15:57
@ZachLipton It may be kind of offensive to conflate people whose "personal beliefs are opposed to vaccines" (all vaccines) with people who have specific articulable reasons for recognizing that a hand-full of recent experimental vaccines, all created in the same politicized fever rush, as not being worth the risk in this specific case. – Billy left SE for Codidact Jun 14 '21 at 23:09
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@BillyC. I don't believe I did that. I was talking about non-COVID vaccine mandates for students attending US schools and just wanted to clarify that they vary from state to state in how mandatory they truly are, as a mandate you can easily exempt yourself from, as is the case in some states, isn't necessarily best described as a mandate at all. But if you want to talk about conflating things, the phrase "politicized fever rush" seems to discount the whole "save millions of lives in a deadly global pandemic" motivation for quickly developing vaccines. – Zach Lipton Jun 15 '21 at 00:33

manassehkatz-Moving 2 Codidact · Answer 2 · 2021-09-12T14:28:54.380

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For one thing, as long as the approval is "experimental" or "provisional" or similar, there are many who will object on that basis, citing problems with other drugs (not necessarily vaccines) which turned out to have problems not discovered in the earliest stages of testing and distribution, like Thalidomide.

In addition, generally speaking, vaccines are not required (at least in the US) for adults, though commonly required (with religious & other exemptions possible) for children attending school - effectively requiring them for children because school attendance is required (though some exemptions there as well for home-schooling or other options, depending on local & state laws).

In general, the US does not force anyone, to do anything - mandatory schooling, for minors, being one of the few exceptions, along with Selective Service (aka "draft registration"). If you want to vote, you can, but you don't have to vote (unlike some countries). If you want to get a passport, you can, but you don't have to (and no mandatory state or national ID card). Even filing taxes: As I understand it, if you manage to live without earning any money (dependent of someone else) you never even have to file taxes. Medical insurance is, sort of, required, but actually doing anything medical is not.

As an interesting (to me, at least) example, take jury duty. Generally speaking in the US, jury duty is tied to voting registration. It actually doesn't have to be, but it is a practical solution to registering people for that purpose since they show interest by being involved in the system (i.e., they want to be able to vote), and in the US you are simply not required to register your residence and other information with the authorities. (You do need to have a Social Security Number, but that is normally assigned at birth and unless you do some related action (like pay taxes) the authorities may not know where you currently live.) Contrast this to some other places, such as Germany. As of 1978, West Germany did not have jury trials. But it did have required registration with the local police. That came into play with the hijacking trial of LOT 165 which had a jury trial in the US Court for Berlin. The jury pool was drawn from local police registration records - something which would not, could not, be done in the US, because aside from privacy issues, the US simply doesn't have that level of requirements for its citizens.

COVID-19 is a serious disease, but not necessarily more serious than the many other diseases that have vaccines available and widely distributed but not required.

There are many other medical and political issues surrounding this specific disease and the available vaccines for it. My answer would apply to any vaccine, for any disease, based on current practices, at least in the US.

edited Sep 12 '21 at 14:28

answered Jun 10 '21 at 01:49

manassehkatz-Moving 2 Codidact

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Interesting to think about children's vaccinations being effectively required through schooling. This creates a soft waiting period for newer vaccines, ending after the age when children begin attending school. – Nathaniel Jones Jun 10 '21 at 21:10
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In general, the US does not force anyone, to do anything... which you then follow with a long and still incomplete list of exceptions. The US is not a libertarian utopia by any stretch of the imagination. – Jun 10 '21 at 23:25
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@BenCrowell Actually, I gave two exceptions (1 = vaccine in school is part of "school", 2 = register for Selective Service). The others were things required in many other countries but not the US - e.g., voting, national ID card, etc. – manassehkatz-Moving 2 Codidact Jun 10 '21 at 23:53
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@BenCrowell Only the Sith deal in absolutes... freedoms like speech/2nd have limitations and statements like "the US doesn't require" also has limitations. No one serious claims the US is 100% "freedom" and that claim wasn't made here to my reading... – WernerCD Jun 11 '21 at 01:56
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And even though you're required to register for Selective Service, when the draft was in effect there were numerous ways to get exempted from serving. BTW, another exception: jury duty is mandatory. – Barmar Jun 11 '21 at 14:02
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@Barmar Actually in many places in the US (not sure if it is "all"), the jury pool is pulled from registered voters. Registering to vote is not mandatory. I know people who (I think foolishly) never registered to vote in order to avoid jury duty. I have served a number of times and found that generally (there was one exception) the courts made great efforts to make it a good experience for the jurors. But it certainly isn't always that way, and for some people it can be a true financial hardship if they are on a jury for several days. – manassehkatz-Moving 2 Codidact Jun 11 '21 at 14:20
@manassehkatz-Moving2Codidact AUIU the law is that if you're called to serve you're required to (unless you fit one of the exemptions, and some of them only get you a deferral). If the system of calling fails to find you, that's a separate issue. – Barmar Jun 11 '21 at 14:52
@Barmar I took a quick look and it seems that it varies by jurisdiction within the US but mostly "registered voters" or "MVA records" (aka drivers license). So while the law permits picking anyone (and obviously in the 19th century there was no MVA and registered voter lists were likely handled quite differently than in today's computerized world), I stand by my general statement that if you don't register to vote, and I'll add don't get a drivers license (which, by the way, many people never do), then you very likely won't get called for jury service, at least the local or state level. – manassehkatz-Moving 2 Codidact Jun 11 '21 at 15:12
@manassehkatz-Moving2Codidact You're basically talking about gaming the system. – Barmar Jun 11 '21 at 15:13
@Barmar You could argue that. But it is not, as I understand it, illegal. In a sense, it is giving up certain privileges (voting, driving) in order to avoid certain duties. – manassehkatz-Moving 2 Codidact Jun 11 '21 at 15:18
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@manassehkatz-Moving2Codidact Like you can choose to not receive any income to avoid paying taxes. – Barmar Jun 11 '21 at 15:20
@Barmar In a way, it is similar. Keep in mind that as far as taxes, there have been (likely still are) many countries where some taxes were mandatory whether or not you had any reportable income - and if you couldn't come up with a way to pay that "head tax" you were in deep trouble. – manassehkatz-Moving 2 Codidact Jun 11 '21 at 15:45
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@NathanielJones there's only a couple jurisdictions in the US where that is strictly enforced (ie only medical exemptions and those are strictly monitored). A few more jurisdictions have medical only weakly monitored restrictions, but the vast majority allow broad exemptions (eg religious exemptions with no questions asked). In general most people just go along with the doctors recommendations on vaccines so it is not an issue, but ideological segregation has made this an issue in some pockets of the country (like we will almost certainly be seeing with covid this winter). – eps Jun 11 '21 at 20:15
"For one thing, as long as the approval is "experimental" or "provisional" or similar, there are many who will object on that basis, citing problems with other drugs (not necessarily vaccines) which turned out to have problems not discovered in the earliest stages of testing and distribution, like Thalidomide." Thalidomide was not approved in the US for general use. The vaccine is not in "the earliest stages of testing". It has over a year of being tested on thousands of subjects, and months of being tested on millions of subjects. – Acccumulation Jun 13 '21 at 00:44

Wrzlprmft · Accepted Answer · 2021-06-11T20:24:33.753

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To add a mostly epidemiological argument:

The primary political goal of mass vaccination is to reach herd immunity, i.e., to make so many people immune (be it due to vaccination or having survived the disease) that the virus cannot spread anymore because one person infects less than one person on average. If an infectious disease has a basic reproduction number R₀, the proportion p of people that need to be immune to achieve herd immunity¹ is p = 1−1/R₀.

Now, the basic reproduction number of Covid 19 is estimated to be below 4 (details depend on hygienic measures, variants and so on), which is not horribly high. The reason why Covid 19 is so successful is not its reproduction number but that it was completely new and thus nobody was immune to begin with (combined with a few factors like long incubation times, asymptomatic spreading, etc.). For the sake of the argument, let’s work with R₀ = 4. Then we get p = 0.75, i.e., 75 % of the population need to be successfully vaccinated (or otherwise immune) to achieve herd immunity².

As long this fraction of the population is willing and capable to get vaccinated, there is low epidemiological benefit from making vaccination mandatory. And even if you have less than 75 % willing, there are more efficient and less controversial ways to achieve 75 % than compulsion, as you do not need to convince almost everybody. Finally, if your willingness is far below 75 %, compulsory vaccination will likely be hard to enforce and politically dangerous, so you wouldn’t be amongst the likely states to enforce vaccination, anyway.

Contrast this with the measles, which has a much higher reproductive number such that about 95 % of the population need to be immune to achieve herd immunity². It is for this reason that we still get measles outbreaks in and around communities who tend to oppose vaccination. For the measles, vaccinating almost everybody is much more important, and vaccination has been indeed made mandatory or close to mandatory in many states.

¹ … in a perfectly homogeneous population. Real populations are more complicated, but this is a sufficiently good approximation for this argument.
² Mind that at these numbers, you must take into account vaccine efficiency, i.e., how many of the people receiving vaccination actually become immune. For example, if a vaccine has an efficiency of 98 %, you cannot achieve a higher ratio of immunity through vaccination, even if everybody is vaccinated.

edited Jun 11 '21 at 20:24

answered Jun 11 '21 at 14:58

Wrzlprmft

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Many Republican states are significantly below 75% vaccinated, unfortunately. But a good answer otherwise, accepting. – JonathanReez Jun 11 '21 at 16:28
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Many countries are far away from 75% willingness to get vaccinated. And new variants apart to have a higher R0, which consequently requires a higher vaccination rate to attain herd immunity. There are good, practical reasons to think compulsory vaccination is problematic but epidemiology is not it. – Konrad Rudolph Jun 11 '21 at 17:32
@JonathanReez: I addressed this to some extent. – Wrzlprmft Jun 11 '21 at 19:03
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Not only are real populations more complicated, the vaccine-hesitant/refusers specifically cluster, leaving enough breeding grounds to overwhelm the rest of the herd. Raw 1/R_0 does nothing, and conversely enforced mandatory vaccination will break these clusters. Epidemiology is all about network characteristics ("contact tracing"). Pretty close to -1. – obscurans Jun 11 '21 at 19:20
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@KonradRudolph: Well, the question was not why some states don’t do it, but why no states do it. If you have far less than 75 % willingness, compulsory vaccination will be so hard to enforce that you are not among the likely candidates to do this anyway. All things being equal, I am pretty confident that compulsory vaccination would be much more up for debate if Covid 19 hat an R of 20 – but then again, far from all things would be equal in that case. – Wrzlprmft Jun 11 '21 at 19:21
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@SurpriseDog: Natural immunity would already be included in R₀. – Wrzlprmft Jun 11 '21 at 19:26
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@obscurans: If that were true, we would be regularly overrun by measles epidemics and would never have gotten rid of the smallpox. Sure, a measles outbreak in an undervaccinated community will not remain completely isolated to that community, but it will also not overrun the entire population. Also, it’s not all about network characteristics. Sure, network models with correct parameters are more exact, but basic models are a sufficiently good approximation of reality for many purposes and in particular communicating the point I am making here. – Wrzlprmft Jun 11 '21 at 19:45
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The claim that the primary goal is herd immunity is extremely dubious, but your numbers are optimistic even in that case. The 75% figure presumes a perfect vaccine, which we don't have, and the figure of R0 < 4 is likely untrue for the Delta variant. – Jack Aidley Jun 11 '21 at 20:02
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side note: measles outbreaks in Germany have about half of the cases adults, specifically people in the age cohort that was vaccinated once in childhood before the 2nd measles vaccination was introduced and who (and/or whose GP) forgot to get a 2nd one later on. (I learned this when the RKI said in the discussions before measles vaccination became mandatory for kindergarden, school, public health system that the proposed law doesn't really address the problematic subpopulation) – cbeleites unhappy with SX Jun 11 '21 at 21:31
@JackAidley The answer already addresses your 2nd point (see the 2nd footnote). – JBentley Jun 12 '21 at 14:07
@obscurans well... as long as the virus stays within the unvaccinated part and doesn't have enough cases to overwhelm the hospitals, it should be all good. The only thing that matters in the end is how many hospital beds you have available for treatment (aka "flatten the curve") – JonathanReez Jun 12 '21 at 15:39
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@JonathanReez which is, well, exactly the point. What do vaccine refusers do? Stay at home and not socialize with the rest of the vulnerable population?? – obscurans Jun 12 '21 at 22:27
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@Wrzlprmft measles not overrunning us all, why? The vaccination rate is >90%, and more importantly, nobody claims a new outbreak is "fake news" and complains when public health authorities forcibly quarantine them all. That's why there's outbreaks, not epidemics. – obscurans Jun 12 '21 at 22:35
@obscurans: How does this contradicts my point? Going by those numbers, the US is at least close to herd immunity (details depend on vaccination rates of adults or immunity due to previous infections) and quarantines do the rest. I also fail to see any mechanism how an infected cluster can overwhelm a herd-immune herd. The cluster will likely infect those who are in contact with it and not immune, but those do not efficiently spread the virus because of herd immunity. – Wrzlprmft Jun 13 '21 at 09:10
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@Wrzlprmft : That we managed to eradicate some very scary diseases some decades ago, it doesn't mean we could do it now, thanks to social media. Social media is a breeding ground for misinformation, where large masses with next to no knowledge in biology can convince themselves and each other that they know it better than the scientists. Even germ theory denialism, which wasn't a thing before social media, is now growing at an alarming rate. "if you listen to official science, then you're a sheep. If you listen to us, you'll be a rational and conscious being. Which one do you want to be?" – vsz Jun 13 '21 at 09:19
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Current R0 estimate is 3 for the original western wave of 2020, maybe 5 for UK "Kent", and currently 8 for the Delta variant. So it's almost tripled in a year. For comparison measles gets up to about 18 or 20. – Stilez Jun 13 '21 at 14:04
This argument doesn't work if all people had to be vaccinated to reach herd immunity though. :) – Deschele Schilder Jun 13 '21 at 22:11
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Child to mother: "Why do you have a dot on your arm?" Mother; "that's my smallpox vaccination I got as a child." Child; "Why haven't I got one?" Mother; "because it worked." – RedSonja Jun 14 '21 at 09:09

gnasher729 · Answer 4 · 2021-06-12T06:33:19.140

In the UK, there is at this moment no good reason to make vaccinations compulsory. Every single dose that the British national health service (NHS) can lay their hands on is immediately (within days) injected into someone.

Some people expected a slowdown due to anti-vaxxers. This hasn't happened yet for several reasons: The Indian variant (now named the "Delta" variant) has very strongly affected minorities that were reluctant to get vaccinated - now they learn that they are the only ones with significant numbers of deaths, and guess what: everyone is queuing up. Lots of lies have been spread, for example one website telling people from one African country in their own language that the vaccine was designed to kill them within one year. You can't keep up lies like this forever, people are wising up. And of course many anti-vaxxers are just big-mouthed contrarians and not very good at believing their own lies. So once they have the choice of acting according to their own lies or staying healthy, they suddenly decide to stay healthy. In London, young people are queuing up in the thousands now to get vaccinated.

In addition, while vaccination isn't compulsory, there is major pressure on people. My own next holiday requires me to be vaccinated. I would be in real trouble with my boss if I wasn't vaccinated. And so on. And being unvaccinated puts you more and more into a minority with social pressure.

So the UK isn't going to run out of people wanting to get vaccinated for a while. Then we'll see how Covid is still spreading. And then it could become compulsory. At a time when most people are vaccinated and don't care or actually support if it becomes compulsory.

PS. The UK government is blamed for not stopping incoming flights from India. The huge number of new infections is almost completely due to non-vaccinated people, which is driving vaccinations up right now.

PPS: Some recent actions: One US hospital told about 160 employees that they will be laid off if they don’t get vaccinated. And in Pakistan, there are plans that anyone not vaccinated could get their SIM cards blocked. And news: In the UK, 52% of all self-declared anti-vaxxers are now vaccinated.

The UK in particular is going to be very hesitant to mandate vaccines after 2009. During the swine flu outbreak, they made vaccines mandatory for health care workers. That was also an "emergency use" vaccine whose long-term effects had not been studied. It ended up having horrible, permanent long-term effects for people with a certain genetic mutation, got pulled off the market, and those affected successfully sued the government. With that precedent on the books, it's unlikely they'd expose themselves to that much legal risk except as a last resort. — bta, Jun 11 '21 at 22:32
@bta sources: https://www.theguardian.com/uk-news/2016/aug/11/swine-flu-jab-most-likely-led-to-narcolepsy-in-nurse-who-killed-herself-coroner https://en.wikipedia.org/wiki/Pandemrix?wprov=sfti1 - looks like similar (rare) rates to AZ clotting. But I think we can all agree that if people had been required to have that vaccine (especially healthcare workers, many young, at the start of the rollout, before we knew about the clotting) there would have been significantly more backlash when it was linked. — Tim, Jun 12 '21 at 21:05
"And of course many anti-vaxxers are just big-mouthed contrarians and not very good at believing their own lies." ...like they are not very good at believing the majority's lies? I am so glad that these people exist, even if I may not agree with them on specific topics, because otherwise, the gene pool of opinions would be so narrow that we would be an easy prey for totalitarianists. Hence, I suggest you think twice about that derogatory spin in your answer. — , Aug 31 '21 at 06:06

Arno · Answer 5 · 2021-09-12T10:02:23.857

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This answer applied to the situation in early June 2021.

In most countries, it just wouldn't make any sense yet to make the vaccine mandatory for the general public. This is because there are usually enough people willing to be vaccinated to use the available doses.

The main exception seems to be the US (at least some states thereof), and Hongkong. There were some reports of some African countries failing to use available vaccine doses, but there the logistics seem to be at least as much of a problem than vaccine resistance.

As far as I know, vaccine resistance in the US is very unevenly distributed geographically; and in quite a few places a significant fraction >30% of the population voices their intent to not be vaccinated at all. In these places there is of course a good reason to make the vaccination mandatory, but at the same time enforcement is going to be infeasible. The central government can make the rules, but it relies on the local authorities to enforce them. If too many of them are anti-vaccination, it just won't work.

edited Sep 12 '21 at 10:02

answered Jun 10 '21 at 08:49

Arno

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It would also make sense in China where priority is given to cities with known outbreaks. They haven’t vaccinated the entire country yet but certain cities have enough shots for all. – JonathanReez Jun 10 '21 at 09:01
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Israel's vaccination rate seems to be flatlining at 60%, after very high rates early on. It seems the US is not the only exception. Canada has overtaken Israel in number of first doses already, only Seychelles, Malta, and tiny countries have gives more first doses than Canada. https://ourworldindata.org/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&country=USA~GBR~ISR~DEU~ARE~ARG~FRA®ion=World&vaccinationsMetric=true&interval=total&perCapita=true&smoothing=0&pickerMetric=total_vaccinations_per_hundred&pickerSort=desc – gerrit Jun 11 '21 at 08:41
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@gerrit: Careful, I think we're mixing percentages here. In general, the percentage of population vaccinated seems to be reported as total population, whereas 30% of the population voicing their intent not to take the vaccine would be 30% of the adult population. Since the adult population is often less than 80% of the total population, I would expect that Israel is flatlining at 75% of adult population, so would have 25% of non-vaccinated adults. – Matthieu M. Jun 11 '21 at 14:24
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@gerrit: Do you have any indication that the flatline is due to people refusing the vaccine, or could it be either a shortage, or a segment of the population not being considered for vaccination? – Matthieu M. Jun 11 '21 at 14:24
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It's not just the US, France has notorious hesitancy towards vaccines in general. – eps Jun 11 '21 at 20:18
@MatthieuM. it flatlined in late march, it's definitely not an issue of shortages. About 25% of the population is ineligible due to age so with 60% vaccinated that puts hesitancy/refusal at about 15%. – eps Jun 11 '21 at 20:24
As an example of the last paragraph, population density is a strong predictor of vaccination rate. The highest density counties are sitting at 50+ percent while low density counties are often only in the 20's with some as low as 15%. And low density counties tend to be much older than the rest of the country. Of course population density is also a fantastic predictor of political lean, but accounting for that it still seems low density trump districts have more hesitancy than higher density trump districts. – eps Jun 11 '21 at 20:37
@eps: speaking from a perspective of what we consider rural in Germany, there are several aspects of life here that mean someone living in high population density surroundings will have more "circumstantial" pressure/incentive towards vaccination: e.g. there's a whole lot of a difference between being quarantined in a small flat vs. house (or even farm) plus garden. Even the quarantine may be less strict - a friend got infected (at work) but because their house is sufficiently large the health authority did not quarantine the husband who was allowed to go on with forestry work. We also have... – cbeleites unhappy with SX Jun 11 '21 at 21:10
... far better (pleasanter) possibilities to meet outdoors - we don't chat with the neighbour on the staircase but over the fence. I seem to recall a Canadian study from last summer that concluded that in rural areas infections are likely to peter out because of the highly skewed distribution of numbers of people infected by one: 7-8 out of 10 do not infect anyone else, 1 - 2 infect another 1 or 2, and 1 is a superspreader infecting many. Unless we have a closely knit cluster (e.g. religious sect - but they'd also likely keep it to themselves) the rural "superspreader" may not meet... – cbeleites unhappy with SX Jun 11 '21 at 21:15
...sufficently many during the critical time window. I may say that even if I'd change my lifestyle to hermit, I likely cannot "save" as many contacts as a railway commuter has on their daily 2 - 3 h commute. – cbeleites unhappy with SX Jun 11 '21 at 21:18
Australia has high vaccine hestitancy also. Presumably because it's been so effective at containing the spread in the first place (largely due to low population density, rather than any good management IMO ... but the politicians are happy to take the credit...) – GreenAsJade Jun 13 '21 at 01:09
This is unfortunately seriously understating vaccine hesitancy. Look at Russia or even Bulgaria--the latter even has access to Western vaccines aplenty. – the gods from engineering Sep 12 '21 at 04:49
@Fizz The situation in early June was very different from now. Back then, it didn't make sense to make the vaccine mandatory, because there were enough reasonable people left to be vaccinated first. The time when vaccination mandates started to make sense in Europe was maybe a month ago. (And I find it very frustrating that so little is happening). – Arno Sep 12 '21 at 10:08

score 14 · Answer 6 · edited Jun 10 '21 at 20:25

Constitutional concerns. In many countries, it's more or less questionable if the constitution allows to make a law which forces all citizens to undergo medical procedures. In many cases, the constitutional protections of bodily autonomy are rather vague, and many politicians would rather not want to test their limits in court. Especially not in a situation like this where such a constitutional court ruling would receive a lot of public attention. COVID-19 containment measures ran against constitutional barriers before, and it didn't make the politicians who pushed them look very good in the public perception.
Ethical concerns. One generally accepted core principle of medical ethics is patient autonomy. The idea that a patient who is conscious and in a clear state of mind has the right to decide what is best for them and refuse medical treatments. As with any ethical question, there is of course room for debate. But many medical professionals follow codes of ethics which would prohibit them from performing medical procedures against the explicit wishes of the patient.

During the COVID-19 pandemic, many politicians showed solidarity with the medical community by assuring them their full support and listening to their advice. It would not look very good for these politicians if they would now switch side and start to debate ethical questions with the same medical professionals.
Resistance among the population. While the majorities in most countries are pro vaccination, there are small but vocal minorities in many countries who are skeptical of vaccination. Those movements often have a considerable overlap with those who are also skeptical of government authority in general. Whether or not these groups have a point is not relevant here. But a government-mandated vaccination program would give these movements the hook they need to recruit more people and to become more radicalized (a few of them are already radicalized to the point of committing acts of terrorism). This could turn these movements into a serious threat. But making vaccinations voluntary (only very, very encouraged) takes away the political justification for their cause.

It should be also noted that being sceptical of vaccination is entirely different from being sceptical of only some particular vaccines for reasons like their lack of maturity and potential side-effects. — Theodore Tsirpanis, Jun 10 '21 at 22:33
While agreeing, I should point out that medical ethics and most laws, do not allow free choice if you are in a medical state to present an active significant risk to others wellbeing. So there's that to consider too, although its rarely an actual "issue" in reality. — Stilez, Jun 13 '21 at 14:08
@Stilez: well, that would be isolation/quarantine for contagious diseases (incl COVID-19). But the isolated would still be allowed to refuse medical treatment, possibly via advance healthcare directive. — cbeleites unhappy with SX, Jun 13 '21 at 15:24

Thomas Koelle · Answer 7 · 2021-06-11T08:18:21.010

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In Denmark the biggest issue was the doctors. Their Union said that their members would refuse to forcefully inject needles into people that did not want it.

Edit: This was upvoted so I will just add how I recall how I recall it went.

Politicians were debating this an afternoon where we were still fairly afraid. It seemed like there could be a consent for mandatory vaccines, then the doctors trade union tweeted that they would newer do it, and also tweeted the politicians also didn't want videos uploaded by people being forcefully vaccinated, and then politicians agreed and it was never debated again.

edited Jun 11 '21 at 08:18

answered Jun 10 '21 at 12:28

Thomas Koelle

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However, "mandatory vaccination" doesn't necessarily mean forced vaccination - it could also mean that you go to jail if you don't get the vaccine. – Reasonably Against Genocide Jun 10 '21 at 17:53
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As far as I know, it's not really any union, but the fact that a lot of doctors world wide still swear a modern version of the Hippocratic oath upon graduation and treating people against their will contradicts that oath in most cases. – Nobody Jun 10 '21 at 19:39
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"Mandatory vaccination" can also mean "your school, workplace, or other entity refuses to let you in if you don't get the vaccine," which is certainly coercive in a sense, but doesn't involve literally holding people down to force them to be injected or imprisoning them for refusing. – Zach Lipton Jun 11 '21 at 02:47
@Nobody it was Lægeforeningen that I have decided to translate to Union. – Thomas Koelle Jun 11 '21 at 08:59
Do you mean "they would never do it"? – Azor Ahai -him- Jun 11 '21 at 14:24
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Can you add some sources (even if they are in Danish)? And add dates (to some degree of accuracy. At the very least, the year) and places/publications (own website/newspaper/television)? – Peter Mortensen Jun 13 '21 at 12:57
Sounds to me rather the turning point in a political debate - there may have been bigger obstacles in the sense that a) something bigger may have turned up if the debate had gone on considering it a possibility (constitutional reasons?) and b) theoretically one may say that physicians have the right to refuse, but public health services will hire some who don't to take care of those people who don't go voluntarily for vaccination. (very loosely similar to how abortions are handled here in Germany: doctors have the right to refuse performing them, so they are done by those who don't) – cbeleites unhappy with SX Jun 13 '21 at 14:07
Interesting point about the "videos uploaded by people being forcefully vaccinated". In China, politicians would be happy to see those videos uploaded, because there is a long tradition of public shaming in China. During the Mao regime, there was a thing called "struggle session" where people who were not aligned with the political mainstream were publicly humiliated, not unlike the show trials e.g. during Nazi germany. Hence, the ability to stay fine with pictures like that may be considered a sensitive indicator of our commitment (or lack thereof) to human rights and solidarity... – Aug 31 '21 at 06:32
...so, appealing to solidarity with respect to Covid ("we are responsible for other people's lives") can quickly turn into obvious fascism, if we are accepting that people are harmed so others can be saved. In fact, China's forced organ transplants among the Uighurs clearly show where such kind of "humanitarianism" leads to: "useless" young Uighurs are sacrificed so that old "valuable" Chinese can live. See https://en.wikipedia.org/wiki/Organ_harvesting_from_Falun_Gong_practitioners_in_China – Aug 31 '21 at 06:37

o.m. · Answer 8 · 2021-06-13T14:08:58.583

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In Germany the decision appears to be political as well. There are quite drastic measures in the "legal toolbox" for pandemic response, and most of them had not been used for many decades. Citizens forgot that the laws were on the books. During the recent pandemic the laws regarding a "pandemic situation of national scope" (which COVID is) were changed, but mandatory vaccinations are not planned right now.

There is a small but vocal minority who mix conspiracy theories, questioning the legitimacy of the state, and partly justified criticism of the handling of the pandemic. As in the US, some likened their resistance to the persecution of the Jews by the Nazis, with stars labeled "unvaccinated" and the like.
In response, the government promised that the vaccination would be voluntary.

It would be politically damaging for the current government to go back on their often-repeated public statement, and no other government appears likely after the next elections that would do so.

edited Jun 13 '21 at 14:08

answered Jun 10 '21 at 04:52

o.m.

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When checking my Impfpass (vaccination document), I saw that some of the other vaccinations are labeled as mandatory. Can't recall which now, probably Polio and such, and I don't have a context when they're mandatory (i.e., for infants or whatever). I'm looking forward to the public discussions next year, when people will try to add COVID to the list of mandatories... – AnoE Jun 11 '21 at 09:50
@AnoE, it would be impolite to ask your age, but do you have the yellow or white one? Regarding making it mandatory, I don't see a government with either the Greens or the Union in it doing that, and I don't see a government without one or both. – o.m. Jun 11 '21 at 09:56
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@AnoE: wikipedia tells me: Western Germany mandated vaccination against diphteria and scarlet fever 1946 - 54 and smallpox until 75 - 83 (obligations were reduced in a stepwise manner). Eastern Germany had mandatory vaccination against Tbc and smallpox from 1953 on, polio, diphtheria, and tetanus from 61 on, pertussis from 64 and measles from 70 on and smallpox mandatory vaccination ended in 80 - 82 (also stepwise). Since 2019/20 measles vaccination is mandatory for certain subpopulations. – cbeleites unhappy with SX Jun 11 '21 at 12:20
... wrt public discussion of mandating covid vaccination: if online newspaper comments are an indication, the pubic discussion is starting already - I see calls for manding covid vaccination and the mentioned vocal minority, let's say, express their fear of such a mandate. – cbeleites unhappy with SX Jun 11 '21 at 12:24
@o.m. the yellow one ;) But cbeleites unhappy with SX already gave nice info as well. – AnoE Jun 11 '21 at 13:19
Would those laws actually apply? Aren't they only for Ebola-level epidemics? (Not rhetorical questions - perhaps address it in your answer?) – Peter Mortensen Jun 13 '21 at 13:04
@PeterMortensen: so many people [including me] thought... But: a) large parts of these laws apply to contagious diseases in general (i.e. it is left to the executive, including e.g. the RKI which belongs to the federal ministry of health) to decide what is appropriate for which disease. b) SARS-CoV2 was included into the list of particular diseases in this law where it resides happily along with (among others) Ebola, salmonella and chicken pox (varicella). c) these laws have seen substantial changes in the last 1 1/4 year. So in a sense the answer is: they are for any disease that the ... – cbeleites unhappy with SX Jun 13 '21 at 13:45
... parliament decides to be sufficiently important. One of the IMHO substantial changes was that in addition to quarantine (which has always been around as a measure, but for which there needs to be a sufficiently substantial probability of the quarantined person to have the disease in question) the new SARS-CoV2 section allows e.g. curfew/lockdown/stay-at-home-orders by executive directive for people who are not under suspicion of having contracted the disease. At the level of the law, this includes btw fully vaccinated people (who are exempt from that law by an executive order)... – cbeleites unhappy with SX Jun 13 '21 at 13:58

score 8 · Answer 9 · edited Jun 13 '21 at 13:24

Summary:

control aversion/reactance means that mandating may lower achieved vaccination rates
it's maybe not necessary from a public health system perspective
there are subpopulations for which at the moment it is not clear whether vaccination is advantageous for them personally,
and vaccinating them is also likely inefficient from a public health perspective (i.e., better vaccinate someone with high risk)
high risk groups risk mostly their own life, so the "danger to others" argument is also questionable for them.

Two additional points to what has been mentioned already

Control aversion aka reactance: mandating can backfire

The alternative to mandating COVID-19 vaccination is (highly) recommending it. It is not clear whether mandating vaccination will in the end lead to higher overall vaccination.

control aversion (see also reactance) describes the phenomenon that enforcement lowers compliance because people resent being forced.
One may say that with moving from voluntary to mandatory vaccination the motivation moves (to some extent) from intrinsic to extrinsic - and extrinsic motivation often isn't as good as intrinsic motivation when it comes to compliance.
This is also related to the suspicion that mandating is only necessary if the vaccination isn't all that good. Thus, mandating can inspire distrust - particularly if the discussion is already perceived as not very transparent, honest and open. (with all the ingredients for a vicious cycle)
And to the suspicion that other freedoms are threatened as well, i.e., we may get an increasing general distrust in politics/government.
Mandating means legally requiring people to get vaccinated. They still need to do that, though. The question for the practical result thus includes how/to what extent vaccination is to be enforced.
There are contraindications even for mandated vaccinations, not everyone can be vaccinated. One obvious difficulty is thus people who do not want to be vaccinated under the mandate to get more or less* spurious medical certificates that they cannot be vaccinated. Sure, some physicians here in Germany who provided spurious certifications that the bearer cannot wear a mask are on trial now.

Constitutional requirements...

... obviously vary a lot between countries. Here in Germany, a law that restricts constitutional rights (freedoms) must be proportionate.

Part of this is that the (legitimate) goal cannot be reached by less harsh measures, and that the difference in how far one gets towards this goal compared to weaker measures such as voluntary vaccination is sufficiently large.

In Germany right now (June 21) polls say that about 80 % of the adult population want to get vaccinated on a voluntary basis.
About half of the parents say they want their kids to be vaccinated, even though at the moment there isn't even a general recommendation for 12 - 15 year-olds (see below).
Some 4.5% of the population are officially registered as having been infected (for them a single shot of vaccine is recommended with a waiting time of at least 6 months after infection). Dark numbers are not very well known, but for some working age subpopulations 100 - 130% have been found, and 300 - 600% for children.
This leaves maybe 10 - 15% of the population who are still fully susceptible and not willing to get vaccinated. This fraction may be clustered together, so I'd expect noticeable outbreaks, but unless vaccine efficacy turns out to be low in practice (which would in itself make mandating questionable) it's unlikely to threaten the public health system.

Further, there is no vaccine (yet) approved for children under 12 of age, and for the 12 - 15 age group the Standing Committee on Vaccination (STIKO) concluded that at the moment the data on adverse events and infection outcomes allows them to recommend this vaccination only for risk patients in this age group.

A back of the envelope calculation: Four deaths that were found to be due to COVID-19 in the children + juvenile according to this preprint unfortunately they don't report the total number of cases, but the RKI dashboard currently shows roughly 360,000 cases for ages 0 - 14 (and btw. about 3,550 deaths of all causes in 2019). That would mean a case fatality rate of 1 in 90,000 which overestimates the risk for children and juveniles because I miss the case numbers for 15 - 17 year-olds and also the dark number estimates of 300 - 600%, which would mean a yet substantially lower risk of death.
Another IMHO important point in the preprint is that they say at the moment, no reliable estimates of long-term consequences of COVID-19 in children and juveniles are available because the potential symptoms coincide with a whole range of symptoms caused by lockdown and quarantine/isolation measures.
In contrast, they say that for older adult risk groups the risk assessment is in favor of vaccination even if all deaths registered as suspicious for being vaccination related were in fact caused by the vaccination (somewhere between 1 : 14,000 and 1 : 58,000 for Europe)

In general, I'd say (my opinion) that mandating vaccination would require the risk assessment to be even much clearer in favor of the vaccination than "only" recommending.

Another public good that one may consider is the danger an infected person is to others. In the age group 60 and older, Germany has a case fatality rate of about 10%, whereas it was roughly 0.15% below that age, overall maximum after 2nd wave i.e. before vaccination of the high risk groups rally took off: 3%. With an R0 of about 3, without any measures, one may say one infected causes on average 0.1 death. Actual R had a maximum at about 1.4 (excluding the start of the 1st wave when no one knew they could even be infected) and that was before the lockdown light measures started. With these numbers we can reasonably say that vaccinating a hypothetical young healthy individual may save 0.04 deaths. Vaccinating an additional above-60-year-old can save up to 0.1 death (assuming that the virus will become endemic and anyone will eventually be exposed to it). So for that healthy young it is neither clear whether vaccination is advantageous for themselves, nor is it efficient from a public health perspective: vaccinating a young healthy person saves a tiny "amount of death" for themselves, and a smaller fraction of a death in other people. Even if there is no one left in the high risk group who wants to be vaccinated (or can be coerced into vaccination by whatever enforcement level is considered OK), it may be considered unethical under these circumstances to enforce vaccination in healthy young people as long as there are high risk people left who could be forced as well.

(The situation may change over time: at some point the high risk group may be completely vaccinated, data for a more precise assessment of the vaccination for healthy young people will become available, vaccinations may get more efficient and also safer, variants more dangerous also for healthy young people, etc.)

As for mandating vaccination of high risk groups: the largest fraction of risk there is with themselves. As long as they are mentally fit, one may argue that at the very least in societies that accept e.g. the right to assisted suicide it is up to them to decide whether they run this risk or not.
An exception may be, e.g., inhabitants of nursing homes who have contact mostly to other high risk people. However, a nursing home making vaccination (masks, testing, etc.) mandatory if you want to move there is a much weaker measure than a legally mandating these measures.

I think the German Dunkelziffer is dark figure (not "dark number"). — Peter Mortensen, Jun 13 '21 at 13:26

score 7 · Answer 10 · answered Jun 10 '21 at 23:43

As noted in the question, this is completely constitutional in the US. Requiring universal vaccination would not be a human rights crisis. Before vaccines even existed, there were well established laws in countries like the US and England allowing people to be involuntarily quarantined, even for long periods, which I think most people would consider a much worse infringement of personal liberty.

The big barrier is simply utilitarian. Before a vaccine was made mandatory in a particular country, the people making the laws in that country would want to have some articulable reason for doing so. There is no such reason. Doses of the vaccines are being manufactured as fast as possible. If one person on the planet doesn't get vaccinated, some other person will get that dose instead.

Herd immunity does not depend on getting some percentage of the population vaccinated. In the California county where I live, currently 57% of adults are vaccinated. That actually is herd immunity under the present circumstances, because by definition herd immunity is what obtains when the rate of transmission is decaying exponentially rather than growing exponentially. If everyone suddenly started behaving as they had before the epidemic (not wearing masks, hooking up at bars, ...), we would lose herd immunity, but then regain it as more people became immune through infection. Since the population of people that are at high risk from the disease have mostly already chosen to get vaccinated, that would happen without very many deaths -- and because this disease only really kills adults (with infinitesimally few exceptions) all such deaths would occur among adults who had chosen not to get vaccinated.

There is the argument that we need to get people vaccinated in order to stop the creation of new and possibly more dangerous/infectious variants of the disease. This actually doesn't make much sense, because of the fixed production capacity. Since the disease actually seems to be in abeyance in my area of the US, it might actually be better if people here didn't get vaccinated. Then those doses could go to Uzbekistan or Nigeria, and hopefully prevent the development of dangerous variants there.

That's a good answer presuming that governments are actually shipping off extra doses to other countries. But in reality the US is stockpiling them currently and only allowing a limited quantity to leave the borders. — JonathanReez, Jun 11 '21 at 00:02
Good answer. But I disagree with: involuntarily quarantined, even for long periods, which I think most people would consider a much worse infringement of personal liberty. Doing something physically to someone's body is, arguably, more permanent and therefore damaging than telling people where they can/can't go. — manassehkatz-Moving 2 Codidact, Jun 11 '21 at 03:04
@JonathanReez NZ TV tells me today that the US is funding 500 million vaccinbe doses for counteries less able to buy them. — Russell McMahon, Jun 11 '21 at 11:33
@RussellMcMahon Just political theater. In reality, the US severely disrupted vaccine manufacture in India by economic sanctions (and that didn't only impact India - for example it slowed down the UK vaccination programme in March and April because of reduced international supply.) — alephzero, Jun 11 '21 at 15:38
@JonathanReez: The Biden administration is publicly discussing exporting vaccines very soon. They just haven't started doing it yet. As far as I know, there aren't any doses being systematically thrown out or allowed to expire, nor are manufacturers dialing back production. — , Jun 11 '21 at 19:58
As far as I know the constitutional right to privacy has included the right to refuse medical treatments, I contend whether forced vaccination is constitutional at all. — Neil Meyer, Jun 11 '21 at 20:02
"abeyance": "2. Suspension; temporary suppression; dormant condition. [Mid 17th century]" — Peter Mortensen, Jun 13 '21 at 13:09

score 6 · Answer 11 · edited Jun 13 '21 at 15:43

I think one point missed by most of the previous answers, is that vaccination has effectively had a history of being politically weaponised in the past, against many large groups.

People don't forget that, so there is a large underlying willingness to believe and be deeply suspicious.

While laws can coerce many things, there are limits to what can be demanded by law without invoking mass civic disobedience, and ending up with a worse situation than you would have had without it. A population has a general sense of what is perceived by it, as reasonable or unreasonable, and what enforcement is okay or not okay.

Causes of public suspicion

When you consider mass vaccination, you need to look at it in the context of things both real and fantastical, because this is emotion you're discussing:

The worldwide war on truth vs. truthiness, conspiracy theories, and sowing of distrust

QAnon (look how many people were willing and eager to believe theories about satanic pedophiles, 9/11, and conspiracy theories generally)
Bill Gates microchipping the world
Some elite controlling everything for the last few thousand years
Fake news claims
The Big Lie

Politicians who themselves deny that COVID-19 matters

USA (previously)
Brazil
Others?

Reasonable fears by those ignorant of scientific and medical matters

First mRNA style vaccines
Concerns about genetic modification, tampering at the DNA level (most people wouldn't know the difference between DNA and RNA, and anyway, how do scientists know that it can't or won't modify in some way they hadn't thought of?)
Previous medicines that have had serious effects down the line
Mass use of an entirely new type of medicine (will it be forced on us? After only a few months testing?)

Widespread belief in other healing methods

If people believe in magic, spiritual healing, or a "just world" run by deities, will they be more prone to see a pandemic as something that is by that deity's choice, and morally wrong to be interfered with by humanity? ("God sent AIDS to punish the gays for transgressing His law", COVID-19 has had similar claims too. If you see COVID-19 as Gods righteousness, what does that make vaccination?)

Abuse/weaponisation of vaccines previously

People in some countries and cultures, may be unaware of this. But vaccine programs and vaccinations have been abused in the past. Tested in developing countries with poor results hidden, or used to trace, identify and hunt down persons of interest (Bin Laden in Pakistan, for example). People in many cultures and of many ethnic backgrounds do remember these and are deeply suspicious of vaccines as a result.
More broadly, this is within a context of not-uncommon officially sanctioned medical abuse - think of women sterilised in some countries and programs, without being told that's what was going to happen, or other horrific examples that breached trust in the medical world.
Consider even older established vaccines such as polio, were already being treated with suspicion and the disease eradication program outcomes over recent years.

Which means that....

With such a bunch of strong motives by so many, combined with all the other reasons (medical ethics/freedom of choice political beliefs, etc.) it becomes politically impossible to force vaccination on the world in most countries.

Enough people would refuse to be complicit to make the delivery chain work (production, distribution, vaccination delivery staff, and doctors)
Politicians, being vote and sentiment sensitive, would feel that to be an unreachable proposition, as a bottom line
If approved and delivered, the backlash from the population would be immense. Rioting, civil disobedience and plain noncompliance/refusal.

And...

By the time vaccines have become available and tested, uptake is very high anyway and social perception acts to support further uptake (you can see your friends and neighbours doing it, so you're more likely to agree to do it)
It may prove unnecessary to coerce, enough uptake may happen by peer pressure and exhortation, that coercion was never required too.

So it's a non-starter, pure and simple, however attractive in theory.

Update - examples of historical track record (as requested in comments)

One of the comments asks for more examples of misuse of vaccines, and the resulting long term historical distrust of modern public medicine, related to vaccines and more broadly, modern health medicine campaigns.

I think Lowes & Montero “The Legacy of Colonial Medicine in Central Africa” (2018) PDF direct link is a good starting paper, so I'll quote from its summary:

Over the course of several decades, millions of individuals were subjected to medical examinations and forced to receive injections of medications with dubious efficacy and with serious side effects, including blindness, gangrene, and death. The sleeping sickness campaigns constituted some of the largest colonial health investments, and for many, these campaigns were their first exposure to modern medicine (Headrick, 1994; Lachenal, 2014).

There is a large body of anecdotal evidence from Africa of mistrust in medicine leading to under-utilization of health care [note 2]. Relatedly, research in developing countries has highlighted that even when there is access to high-quality preventative and therapeutic tools, demand remains puzzling low (Dupas, 2011; Dupas and Miguel, 2017; Banerjee et al., 2010). Motivated by work from anthropology and history which links colonial medical campaigns against sleeping sickness and mistrust in medicine (Feldman-Savelsberg et al., 2000; Lachenal, 2014), we hypothesize that the colonial medical campaigns may have had a series of unintended effects on both beliefs about modern medicine and the success of modern health interventions. The campaigns may have affected use of medicine because: villagers were forced to receive injections, many of the medications had serious negative side effects, and the medications were ineffective. Additionally, the campaigns may have also caused the spread of contagious diseases because of the re-use of unsanitary needles during the campaigns (Pépin, 2011; Lachenal, 2014).

Note 2: For example, during the 2014 Ebola outbreak in West Africa, some communities rejected health workers and did not follow recommended practices to avoid transmission of the virus (Blair et al., forthcoming). In northern Nigeria, communities boycotted the polio vaccination leading to a large outbreak of a nearly eradicated disease (Jegede, 2007).

Also with useful references, "Determinants of trust in the ﬂu vaccine for African Americans and Whites", by Freimuth et al (2017), which states in its summary that:

...the American Academy of Arts and Science (AAAS), calls for research on the role of trust in vaccine decisions, particularly within “at-risk communities”where social norms may contribute to lower vaccine trust and greater vaccine hesitancy (AAAS, 2014). Reﬂecting upon both calls, we recognized the need for research on trust as it relates to vaccine disparities, as growing evidence indicates African Americans experience greater distrust and vaccine hesitancy when compared to their White peers (Quinn et al., 2017) .... Major theoretical work surrounding vaccine trust comes from the World Health Organization's (WHO) Strategic Group of Experts on Vaccination (SAGE). SAGE hypothesizes that trust is a major factor in vaccine hesitancy, contributing to vaccine delay and refusal (MacDonald, 2015). Trust inﬂuences vaccine hesitancy at many levels, including “trust in the effectiveness and safety of vaccines, the system that delivers them, including the reliability and competence of the health services and health professionals and the motivations of policy-makers who decide on the needed vaccines” (MacDonald, 2015, 4162) ...[polling data shows that] trust in pharmaceutical companies is at an all-time low (Harris Poll, 2015; Gallup Poll, 2016). A recent study conﬁrmed 65% of American adults trust the CDC and 63% trust the FDA (Kowitt et al., 2017). Trust in the role these institutions play in the vaccine process is less studied. Qualitative investigation revealed widespread mistrust in the motives that drive pharmaceutical companies, as well as some skepticism regarding the competence of government agencies in developing appropriate inﬂuenza vaccines (Quinn et al., 2016).

Sociological evidence demonstrates that in general, African Americans are significantly less trusting than Whites, likely due to historical and contemporary experiences of discrimination and racialized social norms (Smith, 2010). Medical distrust is also widespread in the Black community, stemming from a long history of medical racism and abuses and reinforced through ongoing experiences of discrimination in health care (Freimuth et al., 2001; Gamble, 1997). Numerous studies have conﬁrmed the impact medical racism and events like the Tuskegee Syphilis Study have had on trust in medical research (McCallum et al., 2006), on trust in physicians (Benkert et al., 2006), and on trust in the healthcare system more broadly (Boulware et al., 2003) ...

Sadly, much of the distrust is self-created - by unethical behaviour within highly developed countries, towards countries in developing regions and at tomes towards minorities and the less privileged. Therefore much of the history in this area, is racially and ethnically slanted, as the above studies demonstrate.

Comments are not for extended discussion; this conversation has been moved to chat. — JJJ, Jun 11 '21 at 18:59
Re "Others?": Yes, Tanzania (due to President John Magufuli). — Peter Mortensen, Jun 13 '21 at 13:49

NetServOps · Answer 12 · 2021-06-14T02:03:53.923

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I suspect the government won't have to make it mandatory because workplaces will do the job for them by implementing policies that essentially say: 'You can't work here unless you are vaccinated'. According to The New York Times:

The bottom line is that companies are legally permitted to make employees get vaccinated, according to recent guidance from the federal agency that enforces workplace discrimination laws, the U.S. Equal Employment Opportunity Commission.

They will most likely able to do this because they will argue that they have a duty of care to all employees and the policy is in line with that.

So, while you can refuse the vaccine, you may find your activity extremely limited when you can't go to work or can't fly overseas. Therefore, there would be no need to create an overt government mandate

My view is that this is what will happen in the next year.

edited Jun 14 '21 at 02:03

answered Jun 10 '21 at 06:17

NetServOps

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Employment laws differ widely from country to country. Some can terminate "at will," others only "for cause." And refusing a non-mandated vaccination may or may not be legimitate cause. – o.m. Jun 11 '21 at 16:05
@o.m. Your points, while correct, are also obvious. The original question clearly singled out the US therefore my response was in that context. – NetServOps Jun 12 '21 at 00:10
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The OP compared the US with other places, including China, and wanted a global answer. I think. But my observation was "just" a comment. – o.m. Jun 12 '21 at 04:00
@o.m. I understand your point however the mention of China was simply to compare and contrast against the US, it seemed clear to me OP was looking for an answer about the US response. I also assumed from the OP's post that they are not in China (based on their comments about China) therefore my view is its a waste of time to discuss what China would do as its not relevant to the OP's location. – NetServOps Jun 12 '21 at 08:29
That begs the question why a negative (PCR) test wouldn't be sufficient, especially when the majority would be fully vaccinated. Why do you think this will hold up in a court of law? You could address this in your answer. – Peter Mortensen Jun 13 '21 at 13:40

score 1 · Answer 13 · answered Jun 12 '21 at 22:31

I conjecture that there might be a significant fraction of political decision makers in the west, that view Covid-19 as a kind of "fire drill" against future biological warfare. If one accepts the risk of biological attacks, however minor, as a given, it is pretty clear that the target of these attacks is not people's physical lives (like a bomb directly threatens lives), but rather their social behavior, their political views, their economic decisions as responses to the biological hazards.

Consequently, it is not that far-fetched to assume a certain awareness among policy-makers, that any measures that severely aggravate the social, economical or political damages of a biological attack, play into the hands of the attackers. One such damage could be, that people might fail to recognize distinctions between supposedly democratic systems and totalitarian systems, which might lead them to ask, why they should still support democracy. In the view of a totalitarian attacker, this could certainly be considered an ideal success, and hence, provoke further attacks.

Therefore, if one can suppose, that there is a natural will to defend one's system against intrusion, manipulation and hostile takeover, it is perfectly understandable in my opinion, that even if Covid-19 does not literally fall into the category of a biological warfare manoeuver, many politicians see it as a strategic symbol of one, and struggle to develop responses that defeat the intentions of hypothetical enemies, and allow them to get ahead of their "political competition".

score -1 · Answer 14 · answered Jun 11 '21 at 19:59

Involuntary treatment typically only happens when a person has been deemed mentally unfit to decide on his own medical treatments. There also often is a issue of a threat from the unstable person either to himself or someone else. Sometimes in emergencies medical practitioners are given the right to save a person's life, but this can still be superseded by a DNR

Generally speaking a person's constitutional right to privacy also insure he has the right to refuse medical treatments. There is a slew of bio-ethical concerns that if this is to happen. When we start forcing vaccines on people it strikes me that this is the same type of justification that led to the mass sterilization of ethnic minorities in the early 20th century.

Unfortunately the medical profession does not operate in a moral vacuum, the end does not justify the means. We are going to have to find a way to achieve herd immunity without forgoing people right to choose over there bodies .