Ethical Dilemma Of Mandatory Vaccination — Dr Myelone Tharmaseelan

If done well, lesser restrictive measures can achieve the same desired outcome of mandatory vaccination while protecting the autonomy of the individual.

Malaysia currently boasts one of the highest vaccination rates in the world, notching up a daily vaccination rate of close to half a million people per day.

There have been 37.7 million vaccine doses administered, and about 16.7 million people fully vaccinated. This roughly amounts to over half of the population.

The success of the National Covid-19 Immunisation Programme (PICK) is beginning to bear fruit.

Labuan and Sarawak have also seen a significant drop in cases of Covid-19 patients in ICUs as a result of the successful vaccination of 56 to 60 per cent of the adult population.

Other key metrics like the number of deaths and serious hospitalisations due to Covid-19 have also reduced drastically, despite the prevalence of the Delta variant in Labuan and Sarawak.

The government has already started administering vaccines for students, with the first batch from Sarawak, which has achieved a high vaccination rate of 80 per cent. Other states are expected to follow suit very soon.

While this comes as a good move by the government, vaccine hesitancy among parents and students alike continues to be a huge challenge for health care workers, despite the proven efficacy of vaccines.

According to the World Health Organization (WHO), vaccine hesitancy is defined as the delaying or refusal of vaccination 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.

Tunku Ismail Sultan Ibrahim of Johor recently summoned the Johor Education Department director and 779 teachers who had rejected Covid-19 vaccination to have an audience with him, in order to encourage the teachers to get vaccinated.

Similar sentiments were shared by the Sultan of Selangor, when he expressed his displeasure at some religious teachers in the state who had refused to get vaccinated.

On the other hand, it was reported that two siblings, along with another teenager, lodged a police report on August 30 to exercise their right to refuse the vaccine as they were worried about the side effects.

Conflict Between State Interests And Individual Rights

What seems apparent is the tension between individual rights and state interests in the preservation of welfare.

It is understandable that most governments would want their population to be vaccinated, as the current spread of the Delta variant is preventing herd immunity. from being achieved.

Last month, the Infectious Diseases Society of America (IDSA) estimated the threshold for herd immunity to be 90 per cent of the population, instead of the previous 60 to 70 per cent, due to the Delta strain. 

The Delta variant can infect some fully vaccinated people, although the unvaccinated will 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 ones who are not vaccinated.

It is no surprise that there have been growing calls by various parties for the government to vaccinate adolescents under 18. Many have also appealed to the government to make it mandatory to vaccinate school-going children before the reopening of schools in October.

Hence, this is why the more children are inoculated, the quicker they can go back to school and get on with their education.

Medical experts have long supported the idea of children getting vaccinated, although it there might be concern that some children could develop rare cases of myocarditis and pericarditis, following the administering of mRNA vaccines.

Although some 2,259 children aged between 12 and 17, which was part of a European Medicines Agency (EMA) study group, did not display any severe side effects including myocarditis and pericarditis, the EMA has not concluded that vaccines will have zero to no side effects in children.

However, the EMA has approved the use of the Pfizer (for children aged 12 to 15) and Moderna (for children aged 12 to 17) vaccines. Studies have proven that the long-term benefits of the vaccine outweighs its side effects.

European countries have inoculated the majority of its adult population and children. Cuba has taken a step further by administering vaccines to toddlers.

The Malaysian government was initially hesitant to vaccinate children below the age of 18, due to the possibility of them developing cardiovascular disease and experiencing severe side effects.

The good news is while there is certainly a myriad of doubts about the vaccine itself, the EMA study on the 2,259 children showed that their immune responses were similar to those aged between 16 and 25.

Since Malaysia has now approved administering vaccines to those below 18, becoming one of the first Southeast Asian nations to do so, we can expect to see positive results in the next few months as Malaysia achieves an 80 per cent vaccination rate.

We should be able to see less hospitalisation of children, when previously this group was the most vulnerable in the country. The developments in the next few months will be crucial in ensuring the number of Covid-19 cases in Malaysia be reduced.

Ethical Dilemma Of Mandatory Vaccination

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 others, especially when it imposes harm on others, especially with regard to achieving herd immunity.

Conversely, it could be argued that mandatory vaccination can infringe on basic human rights that the government is obligated to respect.

The public might also end up losing confidence in the government if vaccination is forced upon them. As 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 will be beneficial in reducing hospitalisations, which in turn would also relieve overworked medical frontliners. Severe symptoms can also be greatly avoided in a healthy individual.

Vaccination is not mandatory or compulsory in Malaysia, but it is important to look at the issue from the perspective of the community. The government should respect the individual’s autonomy and not be quick in imposing measures that would infringe on their human rights.

Although evidence suggests that the benefits of vaccination outweigh the risks, the government should consider other lesser restrictive measures that ensures the preservation of the principle of autonomy.

Moving Forward

In the absence of a mandatory vaccination policy, the government can consider other lesser restrictive options, such as:

  • Emphasising the educational approach for vaccine-hesitant individuals by informing them of the risk benefit analysis of the vaccine and the importance of vaccination, while also addressing their concerns.
  • Using behavioural nudging techniques such as providing incentives or gift cards, as the costs incurred will be minimal in comparison to individuals contracting Covid-19 and being hospitalised.
  • Clamping down on disinformation on social media that further reinforces the false beliefs of people who hold extreme views.
  • Releasing data and statistics that will ensure that vaccine-hesitant individuals are able to make informed decisions.
  • Teachers should not be allowed to teach in schools if they are not vaccinated, and will only be allowed to teach from home until they get vaccinated.
  • Malaysians who have already been vaccinated can play their role by sharing their experiences, as studies have shown that people tend to believe their own peers. Social media influencers can use their clout to influence the fence-sitters.
  • The Ministry of Education should consider setting up vaccination centres at schools and provide counselling for students 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 well, lesser restrictive measures can achieve the same desired outcome of mandatory vaccination while protecting the autonomy of the individual.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.

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