Approximately half of all Americans, and many around the world, are reluctant to get vaccinated for COVID-19—a disease that has killed millions and shut down economies globally for more than a year—despite public-health campaigns confirming the vaccines’ safety and effectiveness, and in some cases, even despite incentives. With more infectious variants presenting greater risks where vaccination rates are lower, there are clear public-health reasons to encourage vaccination. But where encouragement is failing to bring countries or communities to herd immunity, are vaccine mandates becoming necessary?

Arthur L. Caplan is the Drs. William F. and Virginia Connolly Mitty Professor, and the founding head of the Division of Medical Ethics, at the New York University Grossman School of Medicine. Caplan distinguishes between “strong” vs. “weak” vaccine mandates, according to whether exceptions are strictly health-related or include other considerations, as well as public vs. private mandates. All types of mandate, he says—including strong public mandates—are already in effect for other diseases, in the U.S. and around the world. In the American case, Caplan expects that, once the U.S. Food and Drug Administration fully approves the vaccines, more widespread mandates will follow. A lot can be achieved, he thinks, through partial mandates for segments of the population such as health-care workers, and from private entities insisting on vaccination for their workers or customers. But, Caplan says, there’s been a danger in putting too great a focus on personal autonomy during a deadly medical crisis on this scale: “Morally, the community’s interest starts to overcome the individual’s choice.”

Phoebe Maltz Bovy: Why has there been such resistance to vaccine mandates?

Arthur Caplan: In the U.S. and in many other parts of the world, there is a kind of moral failure to provide a foundation for mandates. The moral failure is this: The U.S. has emphasized in its public discussions of COVID the rights of individuals to choose whether or not to vaccinate. And in many parts of the country, there have been efforts to go out of the way to protect the rights of the unvaccinated. Meaning, You can’t make me disclose my vaccine status. You can’t make me have to carry any kind of a passport or card to prove vaccination status. You can’t exclude me from a job or college. In the U.S., but other nations as well, a skimpy notion of liberty, and a bizarre focus on the rights of people who don’t want to vaccinate, have dominated the ethical discussion. It’s hard to build a mandate with people saying that we have to orient our laws and legislation toward protecting the privacy and mobility of the unvaccinated.

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