health

Do Covid vaccine mandates work?


A growing number of countries are exploring making Covid jabs compulsory for the general population, but is it the right approach?

Which countries are opting for mandatory Covid vaccinations?

Austria has announced plans to make Covid jabs mandatory from February, with Germany indicating it may follow suit. Greece, meanwhile, has already announced mandatory jabs for the over-60s, while Indonesia and Turkmenistan are among those that have already made Covid jabs mandatory.

Why are they taking this approach?

Many of the countries exploring mandatory vaccination of the general population are doing so in the face of rising levels of Covid that have led to the reintroduction of severe measures including lockdowns.

In Germany, for example, many hospitals are under severe strain while the number of new Covid cases has hit unprecedented highs in recent weeks striking a record of 79,051 new cases on 24 November, according to data collated by Johns Hopkins University.

According to Hans Kluge, the WHO’s Europe director, the situation now faced by Europe and central Asia is down to a number of factors including insufficient vaccination coverage, and the relaxation of public health and social measures.

“Most people hospitalised and dying from Covid-19 today are not fully vaccinated,” he said last month.

The emergence of the variant Omicron has added to concerns given early signs it may be more transmissible than Delta and have some ability to dodge the body’s immune responses, leading many countries – including the UK – to ramp up efforts to ensure the population is as well protected as possible through vaccination, including booster jabs. Some countries believe the best way to do this is through mandatory Covid jabs.

Does mandatory vaccination work?

Vaccines against Covid have been shown to be safe and effective, particularly at preventing severe disease and death, and may reduce the need for severe social measures such as lockdowns. Mandatory vaccination programmes offer the potential to not only increase the level of uptake but the speed at which people head for the jabs. But how well such programmes work depends on a number of factors, including the level of opposition.

“Vaccine mandates work – as Italy, the US and Australia have shown for other vaccines. Will they work for Covid? There is more uncertainty in the public about the long term safety profile so more resistance,” said Prof Julian Savulescu, director of the Oxford Uehiro Centre for Practical Ethics at the University of Oxford, adding in the UK there was the added factor of high levels of natural immunity.

Italy already had 10 mandatory vaccines for children, with some evidence suggesting the laws have had a positive impact on vaccine uptake. However the EU-funded Asset project, which look at the impact of mandatory vaccination in a number of countries, found no clear link between the approach and vaccine uptake.

In April the World Health Organization (WHO) said it “does not presently support the direction of mandates for Covid-19 vaccination, having argued that it is better to work on information campaigns and making vaccines accessible”.

But speaking last month, Robb Butler, executive director for WHO Europe, said conversations on the compulsory jabs needed to be had. “Mandatory vaccination can but doesn’t always increase uptake,” he said.

Are there downsides to mandatory vaccination?

There are a number of concerns, including that it may risk undermining public confidence in public health measures.

“I think the main problem is public backlash, increase in polarisation and the possibility of political parties gaining ground on the anti-vaxx ticket,” said Dr Samantha Vanderslott of the Oxford Vaccine Group. “Also it might ignore improvement of vaccine services and access to vaccines,” she said.

Savulescu also pointed out concerns. “The risks are public confidence in government but more importantly, liberty should only be restricted to the least extent necessary. Unless the public health system is on the verge of collapse, it is hard to justify treating the decision to treat the unvaccinated differently to the decision to smoke, drink alcohol, eat unhealthily, not exercise etc,” he said, adding if mandatory policies were brought in, they should be as selective as possible.

“The Greek approach of making [Covid] vaccination mandatory for over 60s is more ethically defensible than the Austrian or German proposals to make it mandatory for all adults,” he said.

Will the UK introduce mandatory jabs?

The health secretary, Sajid Javid, has said the UK “won’t ever look at” mandatory vaccinations for the general public.

While the UK decided to make Covid jabs a condition of work for frontline health and social care workers, mandatory vaccination of the general population would be a very different matter.

Besides the ethical concerns, the situation faced by the UK is different to many countries in Europe.

“The UK has a high level of immunity now – natural or from vaccination. Importantly, it has good protection of the elderly, who are the main group putting pressure on hospitals,” said Savulescu, noting data from the Office for National Statistics suggests in early November 92.8% of adults in England would have had antibodies to Covid either from vaccination or natural infection. “There is not a lot of point to a mandatory policy in the UK – Austria, for example, has much lower coverage.”



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