Ethical Dilemma Of Mandatory Vaccination

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From Dr Myelone Tharmaseelan
Malaysia currently boasts one of the highest vaccination rates in the world with a daily vaccination rate of close to half a million people per day.
There have already been 37.7 million vaccine doses administered and about 17 million people are now fully vaccinated. This amounts to over half the population.
The success of the national Covid-19 immunisation programme (PICK) has already begun to bear fruit.
Both Labuan and Sarawak have seen a significant drop in the number of Covid-19 patients warded in intensive care units as a result of the successful vaccination of 56%-60% of the adult population.
Vaccine hesitancy
Against the backdrop of impeccable vaccination numbers, there is still some vaccine hesitancy among children, parents and teachers that have dominated the headlines recently.
According to the World Health Organization (WHO), vaccine hesitancy can be
defined as the delaying or refusal of vaccine despite the availability of adequate vaccines; it is complex and context specific, varying across time, location and vaccination type, and includes factors such as complacency, convenience, and confidence.
Johor Crown Prince Tunku Ismail Sultan Ibrahim recently summoned the Johor Education Department director and 779 teachers who rejected the Covid-19 vaccine to have an audience with him to encourage the teachers to get vaccinated.
Similar sentiments were shared by the Sultan of Selangor where he expressed his displeasure over some religious teachers in the state refusing to be vaccinated.
On the other hand, it was reported on Aug 30 that two siblings along with another teenager lodged a police report at the Taman Melawati police station to exercise their right to refuse the vaccine as they were worried about the side effects of the vaccine.
State interest vs individual rights
What seems rather apparent is the tension between individual rights and the state interest in the preservation of welfare.
It is understandable that most governments would want their population to be vaccinated. Especially with the Delta variant ripping through non-pharmaceutical preventive intervention and pushing the herd immunity almost out of reach.
The Delta variant can infect some fully vaccinated people, although the unvaccinated continue to bear the brunt of the pandemic.
Once infected by the Delta strain, even fully vaccinated people can go on to transmit the virus as easily as the population that are not vaccinated. It is no surprise why there have been growing calls to make vaccination mandatory as schools can become a petri dish for sporadic infections.
While there may be some questions regarding the safety of vaccinating the young,
some 2,259 children, who were part of a vaccine study from Europe, did not display any severe side effects including that of myocarditis and pericarditis according to the European Medicines Agency (EMA).
On a positive note, EMA has since approved the use of the Pfizer (aged 12-15) and Moderna (aged 12-17) vaccines on children. Developed European countries have moved on with the majority of their adult population inoculated and children getting vaccinated.
Cuba, known for its medical revolution has taken a step further by administering vaccines to toddlers.
The Malaysian government was initially quite hesitant on vaccinating children below the age of 18, due to the possibilities of children developing cardiovascular disease and experiencing severe side effects that their developing bodies might not be able to fend off easily.
The good news is that while there is certainly a myriad of doubts on the vaccine itself, a study done by the EMA made a discovery that 2,259 children in the 12-17 age group showed their immune response was similar to those within the 16-25 age groups.
Since Malaysia has now approved administering vaccines to those below the age of 18, becoming one of the first Southeast Asian nations to do so, we can expect to reap the positive outcomes from this move over the next few months as Malaysia achieves the 80% vaccination rate.
We should be able to see less hospitalisation of children when previously these groups were the most vulnerable in the country.
The milestones achieved in the next few months is beyond a doubt crucial in ensuring the number of Covid-19 cases in Malaysia drops in order to let the people get on and about living in the new normal.
Basic human rights
Proponents of mandatory vaccination normally justify the importance of getting inoculated based on the grounds of protecting the welfare of others. They often argue that it is necessary to curtail the rights of the unvaccinated because it could otherwise cause harm toward others.
Conversely, it could be argued that mandatory vaccination can infringe on the basic human rights that the government is obliged to respect.
The public might also end up losing confidence in the government if mandatory vaccination is pushed down their throat. As the arguments for and against mandatory vaccination remain inconclusive, more compelling scientific evidence is required to support the ethical dilemma faced in such a scenario.
Pragmatically, mandatory vaccination is no guarantee that the vaccinated will be entirely spared from Covid-19 but it is beneficial in reducing hospitalisation and ensuring a shorter ICU stay, which in turn would also be of great help to the overworked and burnt out medical frontliners.
Severe Covid-19 symptoms can be greatly avoided in a healthy individual. The option and choice for an otherwise healthy individual to get vaccinated is still much better than refusing the vaccine altogether.
Vaccination is not mandatory or compulsory in Malaysia, but it is important to look at the issue from the perspective of the community and the individuals.
The government should respect the individual’s autonomy and not be quick to impose paternalistic measures on them that would infringe on their human rights.
Although evidence suggests that the benefit of vaccination outweighs the risk involved, the government should consider other lesser restrictive measures that ensure the protection of an individual’s autonomy.
Moving forward
In the absence of a mandatory vaccine policy, the government can consider other lesser restrictive options. They are as follows:
The government can emphasise the educational approach on the vaccine-hesitant population by informing them of the risk-benefit analysis of the vaccine and the importance of taking the vaccine while also addressing their concerns.The government can use behaviour nudge techniques, such as providing incentives or gift cards as the cost incurred will be minimal in comparison to them contracting Covid-19.The government should actively ensure they clamp down on disinformation on social media that further reinforces the false belief of people who hold such extreme views.The health ministry should release data and statistics that are available to bring
transparency to help the vaccine-hesitant population make an informed decision.Teachers should not be allowed to teach in schools if they are not vaccinated and continue teaching from home until they get vaccinated.Those who are fully vaccinated can play their role by sharing their experiences as studies have shown people tend to believe their own peers. Social media influencers can use their star power to influence the fence-sitters.The education ministry should consider setting up vaccination centres at schools and provide counselling for school children who refuse vaccines.In a nutshell, the government should navigate through this ethical dilemma cautiously. The government should consider other less restrictive alternatives that will protect the individual’s self-determination which is also in the state’s interest.
If done properly, the lesser restrictive measures can achieve the same desired outcome of mandatory vaccination while protecting the autonomy of the individual. - FMT
Dr Myelone Tharmaseelan is an FMT reader.
The views expressed are those of the writer and do not necessarily reflect those of MMKtT.

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