With the rise of the COVID-19, the question of government involvement in the lives of citizens continuously rises to the forefront of many conversations. In Boston, Massachusetts, members of the Bay State protested legislation mandating influenza vaccination for certain members of the community. A poll conducted by Boston.com found a 3-to-2 ratio in favor of the legislation. With such a polarized response, it is paramount to consider the ethical implications of mandating vaccinations — is this a case of government overreach or public safety?
At the end of August, Massachusetts put a statewide mandate into effect: “Influenza immunization will be required for all children 6 months of age or older who are attending Massachusetts child care, pre-school, kindergarten, K-12 and colleges and universities.” The mandate was instituted as part of Gov. Baker and his advisors’ efforts to fight the effects of COVID-19 in Massachusetts. The way that I see it, there are several reasons for instituting the mandate. COVID-19 and the flu initially have similar symptomatology; medical facilities are overburdened and medical resources have dwindled since the beginning of COVID-19. Despite protests outside the State House, Massachusetts stands by their decision with support from the Department of Public Health.
Some applaud the mandate, while others claim that it infringes on their American constitutional rights — recall the 3-to-2 split previously mentioned. The problem at hand resembles a controversy that has existed since the Founding Fathers signed the United States into existence. How much power should the government possess, and how much say does the government have in the lives of its citizens? I make no attempt at offering an answer to that question but acknowledge it for the purpose of contemplation of the following question: Does the State of Massachusetts, ethically, have the right to mandate widespread vaccination?
Yes, given some conditions.
Consider the services being utilized and the funding that supplies the services. Vaccination has been mandated for individuals using the public education system — a system, by and large, funded by tax dollars. Homeschoolers and college students who exclusively attend class online and never step foot on campus are exempt and do not fall under the mandate.
Imagine that the owner of a candy shop states that every customer is allowed to have a free piece of candy on Sundays. As part of his arrangement, he receives reimbursement from city hall’s tax revenue. While all citizens of the town have the right to their free piece of candy, some might choose not to partake, despite their indirect contribution.
Let us go one step further. Say the clerk is told by city hall that customers must wash their hands before taking a free piece of candy on Sundays. The candy is still free, but the clerk is required to maintain a measure of sanitation. Again, all citizens have a right to their piece — given they maintain rules of sanitation — but an individual skeptical of handwashing may choose to not wash their hands and, therefore, does not get their piece.
The analogy describes the problem at hand: A tax allows access to a free public service under the caveat of sanitation prior to consumption.
The education system is in place to benefit the majority — to provide education to those of all socioeconomic status, race and backgrounds. Theoretically, it does not discriminate (in reality, it very much does, but I digress). The education system is focused on the community — it is a service of the public, by the public and for the public. In essence, the mandate takes a utilitarian approach to vaccination: The individual’s rights are circumcised for the rights of the majority.
Let me restructure the question at hand: Does Massachusetts, ethically, have the right to mandate widespread vaccination in order to utilize public services that are funded by the community?
There is no obligation to attend a public institution, just as there is no obligation to take a free piece of candy on Sundays. Massachusetts is working to reduce the burden of COVID-19, and, in the process, prevent the spread of disease from one user to another user. Other states should follow suit. An individual who is unable to vaccinate themselves because of an underlying condition will be reliant on herd immunity. They have the right to use the public service just as much as any other user, but they are impacted by a condition outside of their control. Because of this, the community must accommodate.
Mandates like the vaccination mandate in Massachusetts will always distill to the question of governmental influence on the individual. Therefore, if a user fails to opt out of a public service and they receive the benefits of that service, they must also accept the ethical and equitable considerations of the majority. In the context of a worsening pandemic, state governments and the public must understand these considerations in order to reduce the burden of disease on our nation and health infrastructure.
JOSEPH WILLIAMS is an MPH candidate at the Yale School of Public Health. Contact him at firstname.lastname@example.org.