Mandatory covid vaccination wouldn’t do us any good
PremiumThe idea has no scientific rationale and would be unfair in an India beset with a peculiar set of challenges
Many countries had bet on achieving high covid vaccination coverage, hoping to return to normalcy. However, with the emergence of fresh cases due to the Delta variant, mask mandates are back and booster shots are being considered. In addition, countries are imposing measures such as restrictions on the entry of unvaccinated people to public places like restaurants, sports venues and cinema halls. Countries like France, Italy and Turkey have proposed mandatory vaccination for healthcare workers and other sub-groups, a failure to comply with which could mean non-payment of salary or being barred from work. Since then, a few in India have started advocating the mandatory covid vaccination of Indian health workers. Is it a logical suggestion? Let’s examine it.
Enforcing reasonable curbs on access to public spaces to prevent the transmission of infectious diseases has been an age-old public health measure. Such restrictions serve a larger public purpose without depriving citizens of essentials. Importantly, individuals retain the choice of whether to get vaccinated or not. Therefore, these are akin to a ‘nudge’ for people to adopt healthier behaviour. In addition, over the last two centuries, laws on compulsory or mandatory vaccination have been enacted in countries like the US, UK and Australia. However, such legislative action did not mean people would be vaccinated against their will; there were fairly wide exemptions on religious, social and philosophical grounds. If unwilling to get a shot, people had to make a legal declaration stating the ground on which they sought exemption, which got them mandatory counselling on the benefits of getting vaccinated and the risk to them and others entailed in not doing so.
Does making covid vaccination mandatory in India make scientific sense? Does it follow the principles of equity and fairness? Currently licensed Covid vaccines offer far greater individual benefits, given their proven role in reducing exposure to hospitalization and death, than the group benefit of reducing transmission, which is a positive externality. The scientific evidence in reducing disease transmission is available for only a few covid vaccines, not all. The covid vaccines being used in India currently are based upon viral-vectored (Covishield and Sputnik V) and inactivated-virus (Covaxin) platforms, and there is very limited data on their role in preventing transmission. So, if the core argument of compulsory vaccination is to protect others and stop transmission, its premise is flawed. The countries which are contemplating it have mRNA-based vaccines, mainly, for which there is better evidence of a role in curbing transmission. India’s situation is unlikely to change even if mRNA vaccines are available, as the others will remain our mainstay.
In India, the demand for vaccines exceeds supply, and people are struggling to get vaccinated. Making vaccine shots compulsory for any group—say, healthcare and frontline workers—would require a diversion of doses to them, resulting in reduced availability for other eligible groups and widened vaccine inequities. Another point is that vaccines are not free for everyone in India. Jabs administered in the private sector have to be paid for, and this goes for private-sector health staff as well. Thus, making vaccination mandatory for the private-sector health staff would be coercive and unethical. Making it mandatory only for health staff in a government set-up (where they’re free) would be discriminatory.
Clearly, on the considerations of scientific rationale, equity and fairness, mandatory covid vaccination does not make any sense in India. This is so for any sub-group at any stage.While a few reasonable restrictions should be used as public-health tools, coercive measures such as mandatory vaccination should not be explored as an option.
Such an imposition might further reduce the limited trust that people have in our health services; trust suffered a major jolt with the struggle that many had to face during India’s second wave of covid.
We need to learn from the past. India has had a forgettable experience of coercive measures for family planning nearly four decades ago. It took the country another two decades after that to get family welfare activities and its population-control programme back on track. If any population sub-group shows unwillingness to get vaccinated, then health agencies should reflect on its root causes and try to address those challenges. India has successfully implemented a large-scale polio elimination programme for more than two decades, and each polio round was intended to achieve 99% coverage or above. It was achieved without enforced vaccination and through a dialogue with communities, aided by the involvement of civil society, religious leaders and other influencers. This example is what we should take as inspiration, not what other countries do.
There is no rationale in making covid vaccination mandatory for any population group whatsoever at any point of time as part of the country’s pandemic response. The situation and challenges we face in India are strikingly different from those in Western countries. Most of them have achieved fairly high vaccine coverage of their general population and have sufficient supplies of doses that are given free to all citizens. In India, assured and sustained vaccine supply should be a matter of priority, as also ensuring timely vaccination for anyone willing to get vaccinated, achieving high coverage, tackling vaccine hesitancy and delivering at least one shot to around 70% of our population. That is what will help us fight this pandemic effectively.
is a physician-epidemiologist, a public policy and health systems expert and co-author of ‘Till We Win: India’s Fight Against The Covid-19 Pandemic’.
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