Is it ethical to force individuals to be vaccinated for the greater good or does this violate personal autonomy and bodily rights?

The Moral Debate 

Written by: Urvii Pradhan (25-O6)

Designed by: Nicole Lim (26-E2)

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[Part Two of Is it ethical to force individuals to be vaccinated for the greater good? ]

Role of Vaccination

Vaccines are a cornerstone of modern medicine and one of the most effective tools in preventing the spread of infectious diseases. Through the administration of antigens, vaccines prime the immune system to recognise and fight pathogens, allowing for a rapid and timely response upon subsequent exposure to the virus. According to the Centers for Disease Control  (CDC), vaccines have the ability to prevent approximately 50 million deaths between 2021 and 2030. Such statistics serve as a reminder to emphasise what a critical role immunisation plays in safeguarding public health and reducing the occurrences of widespread and deadly outbreaks. Despite the plethora of information readily available on vaccines, the ethical tension remains in deciding whether vaccine mandates are truly justified or should an individual’s autonomy take precedence. 

Prioritising Personal Autonomy 

A key aspect of this argument lies in understanding the debates surrounding this topic, while also acknowledging the complexities and nuances which underpin its existence. Firstly, what constitutes personal autonomy? A commonly accepted definition is the capacity of an individual to act in accordance with their own will and choices, free from external coercion or interference. This statement implies that each individual is entitled to a set of rights and freedoms which should not be compromised by government imposed policies. However, the concept of mandates is often contradictory to this belief. It involves an official instruction or requirement which must be followed by members of society who may face unfavourable consequences as a result of their noncompliance. 

The Three Conditions

Having considered both spectrums of this argument, my stand is that vaccine mandates are largely justifiable, provided that certain conditions are satisfied prior to its implementation. I wish to argue that mandatory vaccination is ethically justified on the basis of 3 concepts: Utilitarian Principle, Mill’s Harm Principle and the Social Contract Theory which will be discussed in this essay. 

Concept of Utilitarianism

One of the conditions necessary is that the vaccine being mandated has sufficient medically accurate data to back up its efficacy and safety. One example of such a vaccine is MMR, used in protection against measles, mumps and rubella. Demicheli et al. (2021) found a total of 138 studies with more than 23 million children. Out of these studies, 51 studies (10 million children) assessed vaccine effectiveness, while 87 studies (13 million children) evaluated unwanted effects of the vaccine. With reference to protection against measles, results from seven studies (12,000 children) showed that one dose of vaccine was 95% effective in preventing measles. Seven per cent of unvaccinated children would catch measles and this number would fall to less than 0.5% of children who receive one dose of vaccine. 

Similarly for mumps, results from six studies (9915 children) showed that one dose of vaccine was 72% effective in preventing mumps. This rose to 86% after two doses, (3 studies, 7792 children). In unvaccinated children, 7.4% would catch mumps and this would fall to 1% if children were vaccinated with two doses. 
Lastly, for rubella, the vaccine was 89% effective. As for unwanted side effects due to the vaccine, the studies found that MMR, MMRV and MMR+V vaccines did not cause autism (2 studies 1,194,764 children), encephalitis (2 studies 1,071,088 children) or any other suspected unwanted effect.


This study proves that MMR is a highly effective and safe vaccine which seems to have a favourable risk-benefit ratio. According to the Centers for Disease Control and Prevention (2023), children should receive at least 2 doses of MMR vaccines with the first dose at 12-15 months and the second dose at 4-6 years of age. Subsequently, MMR and MMRV vaccines protect people for life against measles and rubella, while immunity against mumps may decrease slightly over time. That being said, the frequency of dosage for MMR is relatively low while long-term protection is provided against the diseases. As such, we can use the Utilitarian Principle, to justify mandates for MMR vaccines. This principle states that the ethically justified course of action is one which provides the greatest good for the greatest number even if it may mean sacrificing the interests of a few. In this context, the few refers to the vaccine-hesitant or skeptical.

There will always be misconceptions and misguided beliefs about vaccines, ones which stem from no scientific basis or evidence. According to the American Academy of Allergy, Asthma and Immunology, a 1998 study which raised concerns about a possible link between MMR vaccine and autism was soon retracted by the journal that published it, acknowledging that it was significantly flawed. To date, there is no compelling evidence to suggest that MMR vaccines may be the cause of autism amongst children or SIDS (Sudden Infant Death Syndrome). Hence, the government can and should mandate vaccines like MMR without any significant ethical concerns.

Nature of Disease

Another condition that needs to be considered is the nature of disease, particularly its extent of transmission. A quantifiable measure of the contagiousness of diseases is R₀, also referred to as the Basic Reproduction Number. Delamater et al. (2019) explains that it is “an epidemiological metric used to describe the contagiousness or transmissibility of infectious agents and is affected by numerous biological, sociobehavioral, and environmental factors that govern pathogen transmission”. Put simply, R₀ tells you the average number of people that will contract the disease from one person that is infected. Commonly known infectious diseases such as measles, chickenpox, smallpox and polio have relatively high-ranking R₀ values of 12-18, 10-12, 3.5-6 and 5-7 respectively. 

Although this model does have its limitations, we are able to link the concept of the R₀ to Mill’s Harm Principle to ethically justify mandates of the aforementioned vaccines. This principle states that “the only purpose for which power can be exerted over any member of a civilised community, against their will, is to prevent harm to others.” Hence, government intervention, such as mandatory vaccination can be justified in a situation where remaining unvaccinated poses significant risk to public health. According to Farrenkopf (2022), research published by the Kaiser Family Foundation found that there were 692,000 preventable COVID-19 hospitalisations amongst unvaccinated adults between June and November 2021 in the United States. Additionally, these hospitalisations required the expenditure of medical resources and healthcare personnel which taxed a healthcare system that was already overburdened. In this same paper, it was also highlighted how “countless stories have also emerged on how treatment of the unvaccinated was often at the detriment of other patients.”, providing examples of how those in need of immediate surgery were turned away as 90% of the beds were taken by unvaccinated patients infected with COVID-19 (Washington Post, 2021). Hence, we observe that remaining unvaccinated by one’s free will, especially in the context of a crisis situation like a pandemic has the potential to cause harm to a much wider population. In these cases, it should be ethically justified for governments to take action and introduce mandates as remaining unvaccinated no longer remains a personal choice but rather becomes a liability to public health.

The Alternative View 

The arguments made in relation to vaccine mandates also depend on the interpretation of how herd immunity may be reached. Bullen et al, explains how the accumulation of immune individuals can often lead to two different outcomes- elimination of the disease or a state of endemic equilibrium. Some diseases can be eradicated completely, and this process is usually expedited through interventions like vaccines. Examples of such diseases are polio, measles, and rubella. Other diseases may continue to persist at a relatively stable level, through ongoing transmissions. A possible reason for this disparity may be due to immunity waning over time as new variants arise, increasing the likelihood of post-vaccination infections. Therefore, even after reaching or perhaps exceeding the Herd Immunity Tolerance (HIT) value, elimination is deemed to be almost impossible and the pathogen continues to circulate. Examples of pathogens which demonstrate this pattern include Influenza, Respiratory Syncytial Virus (RSV), and other seasonal coronaviruses. Consequently, the moral rationale for mandates is thus weakened as vaccines may be seen to play a role in “delaying” infection rather than ‘preventing’ it, thereby diminishing the ethical justification for enforcing them. 

As explained earlier, imposing hard mandates for the aforementioned vaccines, such as Influenza, RSV, etc is not as easily justified. An alternative, softer approach should be undertaken instead. This could involve governmental authorities encouraging vaccination amongst the public, in accordance with the Social Contract Theory which suggests that individuals agree to accept certain responsibilities in exchange for gaining protection for themselves and others, particularly the immunocompromised who cannot be vaccinated. Therefore, vaccination should be portrayed as a moral and collective obligation to be upheld amongst members of a community. Instead of outlining legal consequences due to noncompliance, perhaps the public can be nudged through reminders for upcoming available appointments for vaccinations. This prevents unnecessary intrusion being created and aligns with the medical principle of the least restrictive alternative. This principle emphasises on finding the most effective solution that achieves the desired outcome with fewest limitations on an individual’s autonomy.

The Power of Education & Public Trust  

Additionally to reduce vaccine resistance, resources can also be diverted towards improved education and knowledge of the vaccine’s role, safety and potential side effects. This allows for greater public trust and vaccine confidence. Through maintaining transparency regarding the vaccine, the vaccine-hesitant will feel more reassured knowing that the government bodies are acting in their interests. As a result, there may be a larger proportion of the population that is willing to be vaccinated voluntarily without the need for implementing widespread mandates which also helps to reduce the ethical tension of coercive policies infringing on individual rights and freedoms. 

Taking into account the discussions in this essay, I still believe that vaccine mandates, particularly hard mandates, are ethically justifiable. However, this is on the grounds that the following conditions are present, namely the vaccine is proven to be safe and effective as well as the disease is highly contagious. By applying the Utilitarian Principle, Mill’s Harm Principle and the Social Contract Theory, we are able to observe that mandatory vaccination can serve to protect communities and maintain a well-functioning healthcare system. That being said, not all contexts warrant hard mandates due to lower transmissibility of the pathogen or reducing immunity over time. In such situations, improved public education, timely reminders, and increased transparency seems to be more ethically appropriate. In this case, decisions regarding vaccinations need to be adapted and focus on persuasion rather than coercion. Ultimately, the priority of government institutions should be to safeguard public health while striving to preserve public trust and look after an individual’s autonomy as far as possible. This essay hopes to emphasise that vaccination policies should be guided by ethical frameworks and be rooted in scientific evidence. Mandates of either soft or hard nature should be implemented only after careful and thorough evaluation of the factors highlighted previously.

Word Count: 1802

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