The case for mandatory covid vaccination

First and foremost, empirical evidence suggests that vaccines are effective and ensure adequate protection against severe illness or death. Around 770 million individuals in India have already been vaccinated with two doses, and around 17.7 million precaution doses have been administered. However, vaccine hesitancy is still a significant concern. Despite adequate availability of vaccines, many are choosing not to get vaccinated. From vaccines allegedly resulting in impotence to causing death, social media is rife with such misinformation. Behavioural economics tells us that uncertainty and information asymmetry around infectious diseases give rise to risk-seeking human decisions. Avoiding vaccination is one such decision. There are several instances from across the country of health workers being attacked while visiting villages to administer covid vaccines.

If a significant section of the population does not choose to get vaccinated, it will have three far-reaching public health implications. Consider the following: (1) Unvaccinated individuals are more susceptible to getting infected with the virus. This doesn’t only put their lives in danger, but it also allows the virus to multiply, grow and mutate. (2) The theory of natural selection tells us that this may result in the evolution of a variant which is resistant to vaccines. (3) Tautologically, it would thus endanger even the fully-vaccinated population. Thus, healthy people who are not getting vaccinated put the vaccinated and most vulnerable populations at risk, be it immuno-compromised individuals or those with comorbidities.

The collective well-being of society warrants that every resident of India should get vaccinated. There are two ways to do that. (a) A less intrusive and liberty-preserving option of creating awareness about the benefits of vaccines. Here, the Union and state governments constantly deploy behavioural interventions and carry out awareness programmes to increase vaccine uptake. But despite this being done, a significant population is averse to getting vaccinated. (b) The more intrusive option of compelling residents to get vaccinated.

But should the state compel residents to get vaccinated? If yes, would it not curtail individual liberty? The conflict between individual liberty and the common good is at the centre of this debate. One of the very popular legal maxims is “Salus populi suprema lex esto", i.e., the people’s health should be the supreme law. It is attributed to Marcus Tullius Cicero, a Roman statesman and philosopher. The health of people, especially those who are vulnerable, is indeed supreme. Many liberal political philosophers have also alluded to reasonable restrictions on liberty in pursuance of the common good.

In his theory of justice, John Rawls advocates that the most just social arrangement is that which maximizes the minimum outcome, i.e. the worst-off are as well-off as possible. As far as the covid pandemic is concerned, it is the worst-offs who are most at risk, the immuno-compromised and individuals with comorbidities.

The corollary is that for the good of society as a whole, there can be a reasonable restriction on individual liberty. For instance, the Kerala high court applied similar principles while banning smoking in public. In K. Ramakrishnan and Anr. vs State Of Kerala and Ors., the Kerala high court opined, “Smokers dig not only their own graves prematurely but also pose a serious threat to the lives of lakhs of innocent non-smokers who get themselves exposed to [environmental tobacco smoke] thereby violating their right to life guaranteed under Article 21 of the Constitution of India."

Logically, unvaccinated individuals also pose a serious threat to millions of vaccinated individuals, especially the vulnerable population, thus violating Article 21. Also, while not getting vaccinated is a personal choice, there are large public costs (in terms of healthcare costs and the impact on the economy due to pandemic restrictions) associated with it.

Surprisingly, in June 2021, the Meghalaya high court ruled that vaccine mandates imposed on shopkeepers to resume work were unconstitutional as they violated the right to privacy and livelihood. However, the Supreme Court in Olga Tellis vs. Bombay Municipal Corporation ruled that the Constitution does not put an absolute embargo on the deprivation of life or personal liberty. Further, in K.S. Puttaswamy vs Union Of India, the Supreme Court ruled that the right to privacy is not absolute. It is subject to reasonable expectations made by the state to protect legitimate state or public interests. The notion of a reasonable expectation of privacy ensures that the individual has a protected zone of privacy. Simultaneously, “...the exercise of individual choices is subject to the rights of others to lead orderly lives". If a person decides to remain unvaccinated, s/he may end up violating the rights of others to lead orderly lives.

Therefore, there seems to be a case for ‘mandatory’ vaccination, though obviously with a limited number of exceptions recognized by the government. The government should first rely on less intrusive interventions to increase vaccine uptake. However, the state may also consider ‘compulsory’ vaccination, if only as a last resort to prevent the significant risk of morbidity from more virulent covid variants.

Bibek Debroy & Aditya Sinha are, respectively, chairman, and additional private secretary (research), Economic Advisory Council to the Prime Minister