There is an ethical and political failure of leadership on Australia’s COVID-19 vaccination policy.

The arguments against making COVID-19 vaccination broadly mandatory are spurious. For example, it is true that vaccination can be described as a medical procedure. But the notion that everyone has an absolute right to refuse a medical procedure has never been law and has never been reasonable. When people make decisions resulting in actual or potential self-harm, this is rarely accepted unquestioningly. Instead, exceptional care and a compassionate response which addresses the trigger for the self-harm is the recommended prescription, in order for the harm to be made good as best it can, or for the potential harm to be averted. When it comes to people making decisions which may seriously affect others, even more care needs to be taken and the potential harm, especially when irreversible, must necessarily figure prominently in any decision-making.

So, when parents refuse potentially health-restoring treatment for their child, for whatever reason, courts regularly overturn that decision in the interests of the child. When indefensible decisions are made, which potentially occasion great harm to another or others, there is a sound basis for setting aside the decision.

Or consider compulsory primary and secondary education throughout Australia. This policy is considered of benefit to the child and of benefit to society. Attending school can be quite difficult for many and can even result in great hurt and harm for some children. Thus, considerable care needs to be taken with education in all sorts of ways, but the cogency of mandatory schooling to ensure the welfare of the child and of society is hard to dispute.

When it comes to vaccination specifically, Victoria’s 2016 “No jab, no play” legislation makes it clear that all children should have vital vaccinations, both for their own protection and protection of children and adults around them.

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At this point, one might feel compelled to ask: Where are the adults in the room? Surely, if it is sensible to vaccinate children more-or-less compulsorily against serious contagious illnesses, adults should not have lower expectations of themselves than those imposed on children. Indeed, isn’t this exactly what the national influenza vaccination entry requirement in residential aged care, and what the all-too-slow and still significantly incomplete implementation of the COVID-19 vaccination of all aged-care workers, show to be the necessary and decent thing to do? And isn’t COVID-19, in fact, a peril for some people in all age-groups, not just for the elderly?

Moreover, the sensitivity on the part of some political leaders to the worries and concerns of people who are hesitant or opposed to COVID-19 vaccinations would be more understandable if similar sensitivity was shown in response to the worries and concerns of, for instance, the unemployed, including those losing their jobs and businesses due to lockdown restrictions — unemployed persons who now have to survive somehow on a contemptibly small government payment or, for holders of certain visas, no government support at all. Treating the unemployed with this insensitivity is of no benefit to anyone, whereas vaccination typically has very real personal and large-scale societal benefits.

It frankly beggars belief that some appear to argue that requiring people to have one or two vaccination jabs, even if this were to be extended to annual vaccinations in order to account for new variants, is a greater impost upon the reluctant minority than the alternative — namely, the likely recurring impost of severe restrictions due to COVID-19 and, particularly in the absence of such restrictions, the illness or death that will eventuate among many.

Vaccination should be mandatory. Leaving people with disabilities, chronically ill and other vulnerable people to die young, or be closeted in institutions or in the home, fortunately now finds little approval. In recent times, it is expected that everyone be able to participate in the activities which make life worth living, and that there be the kind of support which would enable them to do so. Failing to have almost everyone in our society vaccinated precludes this — or, at least, it makes social life unduly dangerous for many.

Of course, it is not possible to make vaccination mandatory across the entire population right now. It may not even be possible to make vaccination mandatory for all non-home workplaces and for all public facing businesses and venues immediately. But the intention to do so, in a staggered way, can and should be announced straight away.

A great deal of detail must be worked out by governments on behalf of the public, not left to individual businesses, whether they be sole trader or multinational conglomerate, tiny or enormous. All of them employ vulnerable people and come into contact with vulnerable people, or may do so, as our society becomes more inclusive. What is needed is a clear and clear-headed plan for near-universal vaccination that has a high likelihood of minimising illness, death, and societal damage from COVID-19 in the short, medium, and long-term. We need clear vaccination targets with timelines for different prioritised groups — targets and timelines that can be brought forward when additional vaccination supplies are obtained.

Nor should such decisions be entirely left to the public health experts and officials, and await prospective state-by-state public health orders at some future, unspecified date. There is clearly disagreement among and between epidemiologists and public health officials and expert advisory groups. It is also clear that public health orders are strongly influenced by the politicians within the jurisdiction to which they apply. It is almost as clear that public health experts and officials, to some extent, tailor their advice to what they think their political leaders and their publics are prepared to accept.

There is a great deal of inertia in any society which needs to be overcome. For instance, legislation against sexual harassment and sex discrimination tended to be introduced not long before or after the United Nations’ declaration of International Women’s Year in 1975. But it is only recently — some fifty years later — that such conduct against women has properly attracted widespread condemnation. This is too slow for addressing the poor and appalling treatment of women, and it is completely unacceptable when it comes to dealing with COVID-19.

When footage first began to emerge from the city of Wuhan in the early days and weeks of the COVID-19 pandemic, many said that China’s response would never be tolerated in Western democracies. Restriction of freedoms simply would not be countenanced. Nevertheless, in a matter of weeks, similar measures were implemented in the West, drawing on some of the more effective and respectful elements of the Chinese response. And so it is that sometimes necessary, beneficial changes can occur quickly on national scales. It helps when the changes make sense and are proportionate, firm leadership is shown, and an easily understood explanation is communicated clearly to a wide range of diverse groups.

It seems to me that what is lacking most at present is, first, a sense on the part of the public that they are in safe hands, that they can trust the political and epidemiological decision-making and implementation. Chopping and changing leads to insecurity, especially when it comes to public health decisions. Second, there has been the notable failure to apply the precautionary principle in political decision-making — namely, according to one formulation, the determination to hope for the best but plan for the worst. This principle should play the leading role in any existing or looming crisis, not least because its deployment usually avoids chopping and changing, whereas relying on modelling, no matter how sophisticated, for unprecedented crises is inherently subject to the vagaries of the real world.

Once the public can be assured that even the worst can be avoided with near-ubiquitous, well-planned vaccination, it seems unlikely that there will be widespread dissent to the policy. But punting that the vaccination of 70 or even 80 per cent of the adult population is enough to cover any eventuality — well, all that is, is a punt.

And yet the public’s overwhelming need to feel safe, and the resulting recourse to the precautionary principle in one’s planning, is what is largely absent from relevant guidelines that have been issued so far: the WHO’s policy brief, “COVID-19 and mandatory vaccination: Ethical considerations and caveats”, and the Australian Human Rights Commission’s document, “COVID-19 vaccinations and federal discrimination law”.

There should, certainly, be exemptions for those who may not tolerate vaccination. The safest vaccines should be made available efficiently and quickly, and there needs to be some modification of vaccines in response to the emergence of new variants. There should also be further research undertaken to make the vaccines safer still and to establish the criteria which contra-indicate vaccination. There should be a process whereby some allowance is made for conscientious objection to vaccination.

But most important of all, there should be some genuine political leadership on Australia’s vaccination program. Pandering to a kind of misguided “populism” in order to garner the votes of the very few who oppose vaccination is a travesty of representative politics. It is, frankly, unconscionable to use the watchwords of “individual choice” and “hesitancy” amid the COVID fog, when the real source of slow and low COVID-19 vaccination is: confusing, conflicting, and counterproductive advice; poor political and public health communication (particularly with groups who already feel prejudged by the “mainstream”); poor organisation of distribution and capacity for safe injections (until recently); and the obvious shortage of the safest vaccines.

There is currently a woeful failure even to vaccinate all those with disabilities or who are particularly vulnerable — to say nothing of the support persons upon whom they depend. But if federal and state governments are to get serious about social inclusion and active participation by all, the overwhelming majority of the population needs to be vaccinated as quickly as possible.

Sometimes little children are convinced that no one can see them if they close their eyes. Our political leaders, similarly, see to think that their failures throughout this pandemic will be concealed if they refuse to mandate vaccination. But avoiding mandatory vaccination for the sake of a small number of voters who oppose it is a craven abdication of political responsibility — it is a failure of leadership that is becoming more obvious by the day.

Bernd Bartl is an academic with extensive experience teachingethics, including research and medical ethics, at Monash, Melbourne, Swinburne, Deakin, and Australian Catholic Universities, as well as tutoring epidemiology at Melbourne University. For many years, he has advocated for his son with quadriplegia, and for the social inclusion of people with disabilities.

Ethical political leadership cannot avoid mandatory vaccination
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