The Ethics of Selective Mandatory Vaccination for COVID-19

COVID-19 vaccine boosters for young adults: a risk benefit assessment and ethical analysis of mandate policies at universities

In 2022, students at North American universities with third-dose COVID-19 vaccine mandates risk disenrolment if unvaccinated. To assess the appropriateness of booster mandates in this age group, we combine empirical risk-benefit assessment and ethical analysis. To prevent one COVID-19 hospitalisation over a 6-month period, we estimate that 31 207-42 836 young adults aged 18-29 years must receive a third mRNA vaccine. Booster mandates in young adults are expected to cause a net harm: per COVID-19 hospitalisation prevented, we anticipate at least 18.5 serious adverse events from mRNA vaccines, including 1.5-4.6 booster-associated myopericarditis cases in males (typically requiring hospitalisation). We also anticipate 1430-4626 cases of grade ≥3 reactogenicity interfering with daily activities (although typically not requiring hospitalisation). University booster mandates are unethical because they: (1) are not based on an updated (Omicron era) stratified risk-benefit assessment for this age group; (2) may result in a net harm to healthy young adults; (3) are not proportionate: expected harms are not outweighed by public health benefits given modest and transient effectiveness of vaccines against transmission; (4) violate the reciprocity principle because serious vaccine-related harms are not reliably compensated due to gaps in vaccine injury schemes; and (5) may result in wider social harms. We consider counterarguments including efforts to increase safety on campus but find these are fraught with limitations and little scientific support. Finally, we discuss the policy relevance of our analysis for primary series COVID-19 vaccine mandates.

Attitudes toward COVID-19 vaccine mandate: The role of psychological characteristics and partisan self-identification

Governments around the world are increasingly considering vaccine mandates to curb the spread of COVID-19. In May 2022, we surveyed 394 residents of South Dakota to examine predictors of popular attitudes toward a COVID-19 vaccine mandate. We investigated the role of Big Five personality traits, right-wing authoritarianism, and social dominance orientation, as well as partisan self-identification, evangelical identity, and COVID-19 vaccination status. Results showed that Big Five personality traits (openness and emotional stability), right-wing authoritarianism, social dominance orientation, evangelical identity, and partisan self-identification are linked to attitudes toward a COVID-19 vaccine mandate. Our findings underscore the politicization of the COVID-19 pandemic as well as the impact of dispositional factors on attitudes toward mandatory COVID-19 vaccination.

The Ethical Significance of Post-Vaccination COVID-19 Transmission Dynamics

The potential for vaccines to prevent the spread of infectious diseases is crucial for vaccination policy and ethics. In this paper, I discuss recent evidence that the current COVID-19 vaccines have only a modest and short-lived effect on reducing SARS-CoV-2 transmission and argue that this has at least four important ethical implications. First, getting vaccinated against COVID-19 should be seen primarily as a self-protective choice for individuals. Second, moral condemnation of unvaccinated people for causing direct harm to others is unjustified. Third, the case for a harm-based moral obligation to get vaccinated against COVID-19 is weak. Finally, and perhaps most significantly, coercive COVID-19 vaccination policies (e.g., measures that exclude unvaccinated people from society) cannot be directly justified by the harm principle.

ChatGPT Output Regarding Compulsory Vaccination and COVID-19 Vaccine Conspiracy: A Descriptive Study at the Outset of a Paradigm Shift in Online Search for Information

BACKGROUND

Being on the verge of a revolutionary approach to gathering information, ChatGPT (an artificial intelligence (AI)-based language model developed by OpenAI, and capable of producing human-like text) could be the prime motive of a paradigm shift on how humans will acquire information. Despite the concerns related to the use of such a promising tool in relation to the future of the quality of education, this technology will soon be incorporated into web search engines mandating the need to evaluate the output of such a tool. Previous studies showed that dependence on some sources of online information (e.g., social media platforms) was associated with higher rates of vaccination hesitancy. Therefore, the aim of the current study was to describe the output of ChatGPT regarding coronavirus disease 2019 (COVID-19) vaccine conspiracy beliefs. and compulsory vaccination.

METHODS

The current descriptive study was conducted on January 14, 2023 using the ChatGPT from OpenAI (OpenAI, L.L.C., San Francisco, CA, USA). The output was evaluated by two authors and the degree of agreement regarding the correctness, clarity, conciseness, and bias was evaluated using Cohen's kappa.

RESULTS

The ChatGPT responses were dismissive of conspiratorial ideas about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) origins labeling it as non-credible and lacking scientific evidence. Additionally, ChatGPT responses were totally against COVID-19 vaccine conspiracy statements. Regarding compulsory vaccination, ChatGPT responses were neutral citing the following as advantages of this strategy: protecting public health, maintaining herd immunity, reducing the spread of disease, cost-effectiveness, and legal obligation, and on the other hand, it cited the following as disadvantages of compulsory vaccination: ethical and legal concerns, mistrust and resistance, logistical challenges, and limited resources and knowledge.

CONCLUSIONS

The current study showed that ChatGPT could be a source of information to challenge COVID-19 vaccine conspiracies. For compulsory vaccination, ChatGPT resonated with the divided opinion in the scientific community toward such a strategy; nevertheless, it detailed the pros and cons of this approach. As it currently stands, the judicious use of ChatGPT could be utilized as a user-friendly source of COVID-19 vaccine information that could challenge conspiracy ideas with clear, concise, and non-biased content. However, ChatGPT content cannot be used as an alternative to the original reliable sources of vaccine information (e.g., the World Health Organization [WHO] and the Centers for Disease Control and Prevention [CDC]).

How Mandatory Can We Make Vaccination?

The novel coronavirus (SARS-CoV-2) pandemic has refocused attention on the issue of mandatory vaccination. Some have suggested that vaccines ought to be mandatory, while others propose more moderate alternatives, such as incentives. This piece surveys a range of possible interventions, ranging from mandates through to education. All may have their place, depending on circumstances. However, it is worth clarifying the options available to policymakers, since there is sometimes confusion over whether a particular policy constitutes a mandate or not. Further, I illustrate a different kind of alternative to mandatory vaccination. Rather than seeking less coercive alternatives to a mandate, we might instead employ an alternative mandate, which requires people to do something less than get vaccinated. For instance, we might merely require people to attend an appointment at a vaccine clinic. Whether this mandatory attendance policy is justified will depend on specific circumstances, but it represents another way to promote vaccination, without mandating it. In some cases, this may represent an appropriate balance between promoting public health goals and respecting individual liberty.

How low can you go? Justified hesitancy and the ethics of childhood vaccination against COVID-19

This paper explores some of the ethical issues around offering COVID-19 vaccines to children. My main conclusion is rather paradoxical: the younger we go, the stronger the grounds for justified parental hesitancy and, as such, the stronger the arguments for enforcing vaccination. I suggest that this is not the reductio ad absurdum it appears, but does point to difficult questions about the nature of parental authority in vaccination cases. The first section sketches the disagreement over vaccinating teenagers, arguing that the UK policy was permissible. The second section outlines a problem for this policy, that it faces justified vaccine hesitancy. The third section discusses three strategies for responding to this problem, arguing that there may be no simple way of overcoming parents' reasons to resist vaccinations.

Lessons Learned from the COVID-19 Pandemic and How Blood Operators Can Prepare for the Next Pandemic

Humans interact with virus-infected animal hosts, travel globally, and maintain social networks that allow for novel viruses to emerge and develop pandemic potential. There are key lessons-learned from the coronavirus diseases 2019 (COVID-19) pandemic that blood operators can apply to the next pandemic. Warning signals to the COVID-19 pandemic included outbreaks of Severe acute respiratory syndrome-related coronavirus-1 (SARS-CoV-1) and Middle East respiratory syndrome-related coronavirus (MERS-CoV) in the prior two decades. It will be critical to quickly determine whether there is a risk of blood-borne transmission of a new pandemic virus. Prior to the next pandemic blood operators should be prepared for changes in activities, policies, and procedures at all levels of the organization. Blood operators can utilize “Plan-Do-Study-Act” cycles spanning from: vigilance for emerging viruses, surveillance activities and studies, operational continuity, donor engagement and trust, and laboratory testing if required. Occupational health and donor safety issues will be key areas of focus even if the next pandemic virus is not transfusion transmitted. Blood operators may also be requested to engage in new activities such as the development of therapeutics or supporting public health surveillance activities. Activities such as scenario development, tabletop exercises, and drills will allow blood operators to prepare for the unknowns of the next pandemic.

The unintended consequences of COVID-19 vaccine policy: why mandates, passports and restrictions may cause more harm than good

Vaccination policies have shifted dramatically during COVID-19 with the rapid emergence of population-wide vaccine mandates, domestic vaccine passports and differential restrictions based on vaccination status. While these policies have prompted ethical, scientific, practical, legal and political debate, there has been limited evaluation of their potential unintended consequences. Here, we outline a comprehensive set of hypotheses for why these policies may ultimately be counterproductive and harmful. Our framework considers four domains: (1) behavioural psychology, (2) politics and law, (3) socioeconomics, and (4) the integrity of science and public health. While current vaccines appear to have had a significant impact on decreasing COVID-19-related morbidity and mortality burdens, we argue that current mandatory vaccine policies are scientifically questionable and are likely to cause more societal harm than good. Restricting people's access to work, education, public transport and social life based on COVID-19 vaccination status impinges on human rights, promotes stigma and social polarisation, and adversely affects health and well-being. Current policies may lead to a widening of health and economic inequalities, detrimental long-term impacts on trust in government and scientific institutions, and reduce the uptake of future public health measures, including COVID-19 vaccines as well as routine immunisations. Mandating vaccination is one of the most powerful interventions in public health and should be used sparingly and carefully to uphold ethical norms and trust in institutions. We argue that current COVID-19 vaccine policies should be re-evaluated in light of the negative consequences that we outline. Leveraging empowering strategies based on trust and public consultation, and improving healthcare services and infrastructure, represent a more sustainable approach to optimising COVID-19 vaccination programmes and, more broadly, the health and well-being of the public.