Should COVID vaccines become mandatory?

As the battle against COVID-19 rages, Canada and other countries are grappling with an emerging question: Should the vaccine be mandatory? We spoke with London bioethicist Maxwell Smith, an assistant professor at Western University and part of the World Health Organization's ethics working group for COVID-19, about what's right, what's wrong and what will work best for different segments of the population:

FOR THE GENERAL PUBLIC

Q How will policy-makers tackle the virus if they choose not to mandate vaccines?

It's unpalatable for many political leaders, especially, to even consider something like a mandate because, of course, it does infringe on people's liberties. I think the sort of default is to make sure that we're encouraging vaccination.

Q You mentioned that mandatory vaccination among the general public is unlikely to be ethically justified, partly due to limited supply. Do you expect this to change if supply ramps up.

Not within the general public. There may be circumstances and contexts where there is support and good evidence to suggest it would make sense in health-care settings. But in the general public, I think supply will continue to be an issue.

FOR STUDENTS

Q What would happen if schools made vaccinations a requirement for children?

I think that's probably unlikely . . . It makes little sense even if we were to authorize COVID-19 vaccines for school-age children. We don't mandate seasonal flu vaccines, for instance . . . (We're not) forcing anyone to get vaccines, but just having some conditions around what it will mean for you to attend school if you don't have those vaccinations.

Q What are some of those conditions?

It differs depending on jurisdictions, but in Ontario, if your child hasn't been vaccinated, and that's one of the requirements for children to attend (school), then medical officers of health have the authority to suspend a student from attending a school, but it remains to be seen whether this would exist in the case of COVID-19 once COVID -19 vaccines are authorized within that population.”

FOR HEALTH-CARE WORKERS

Q What are the differences between mandatory flu shots and the COVID-19 vaccine?

Some would say that if you don't get that vaccine, then you can't come into work . . . You might see (this) in response to the flu and requirements for getting a flu shot. But in the context of this pandemic, it seems a little bit more problematic to adopt any of those policies.

FOR TRAVELLERS

Q If countries mandate vaccines, what would this mean for Canadians travelling abroad?

I think in some cases there will be vaccine passports requiring proof of vaccination in order to travel. And I think several ethical issues are emerging with that prospect, but we're already seeing many, including airline industries saying that they're going to implement policies like that.

Q What are some other ethical issues of vaccine passports?

Vaccine supply and the inequitable distribution of vaccines globally. We know many countries — I think over half of the world's countries — haven't administered any vaccines yet. It's going to take into 2022, 2023, and even 2024 to get those populations vaccinated in some of the lower- and middle-income countries in the world.