How moral is it to refuse a vaccine?

21 November 2020

9:00 AM

21 November 2020

9:00 AM

Well thank goodness for that, eh? Just as we reached our darkest hour and resigned ourselves to an endless series of lockdowns and the ruination of everything we once took for granted, we heard that help might be at hand. With the announcement of a Covid vaccine, what the Prime Minister called the ‘distant bugle of the scientific cavalry’ was at last audible. Think Pheidippides staggering into Athens, or the great horn of Helm ringing out.

My instinct, and I expect yours, was to think something like: ‘Phew! It’ll take a month or two, maybe a year, but we’re in sight of things going back to normal. There is light at the end of the tunnel.’ Yet the more I have turned this over in my mind, the more I’ve found my inner gloomadon-popper (another felicitous phrase of the PM’s). It strikes me that the ferocious culture wars over lockdown and mask-wearing may be as nothing compared to those over vaccination.

One of the fundamental arguments in politics, perhaps the most fundamental of all, is between the liberties of the individual, and the needs of the community. Draw the slider all the way in one direction, you get Ayn Rand libertarianism; in the other, totalitarian communism and all the jollity that goes with that. This argument — sometimes a largely philosophical one — has been crystallised as a real-world, practical problem by this viral pandemic.

You can even put numbers on it. Those numbers may be disputed, but nobody sensible would deny that there is an empirical statistical relationship between private freedoms and public welfare. The more people mingle indoors, the faster the virus spreads and the more people die of it. The more people are vaccinated, the slower the virus will spread and the fewer people will die of it.

With a vaccine, the numbers aren’t even all that vague. To achieve herd immunity with a coronavirus vaccine that’s 90 per cent effective, the maths seems to be that you need 60-70 per cent of the population to get the jab. That’s about as many people as could be bothered to vote in the last general election — and, unless you’re a Lib Dem, you don’t feel dog-sick for 24 hours after you vote. Quite a lot of people, then, won’t want to take the vaccine. And the Health Secretary has been pretty bold in refusing to rule out making it compulsory. That’s already set off some mutterings about police states, Stalinism and all the rest of it.

‘It’s my personal choice’, though, is too simplistic a response, whatever the libertarian blowhards may say. There’s a reason why your individual freedom to drive south on the northbound carriage of a motorway is curtailed by law. There’s a reason why you didn’t get to make your own choice about keeping your porch light on in the Blitz. A vaccine is not an individual good — or not just an individual good. As if it needs repeating: you take it not so you don’t get the ’rona; you take it so that you don’t pass the ’rona on to someone else. If we achieve herd immunity, the virus dies out. If we don’t, it continues to circulate and those people who can’t get vaccinated — the very young, the immunocompromised, those on medicines that don’t mix with it — will be at risk of contracting the bug.

And yet and yet. It isn’t just that we’ve been conditioned by numberless science-fictional dystopias, not to mention the odd real-world one, to feel extremely uneasy about a government that injects citizens with things against their will. In this case there are many unknowns: we don’t know yet how long the vaccine will give immunity; we’re not certain what side effects it may have, or how it will interact with other conditions. There’s a good reason, God knows, to want to roll this thing out fast — but we’re having to take on trust some of the risks in doing so.

And we have a strong and just presumption in favour of our rights over our bodily integrity. That presumption is so strong it goes beyond the grave. You might, for instance, make a sound utilitarian case for the state harvesting the organs of the dead whether they like it or not: it would save lives. But we don’t do this if the deceased has opted out. We violate taboos like that with caution.

Nobody wants to turn on the news and see paramilitary vaccines officers, swathed in protective gear, kicking in doors, hauling weeping children from the arms of their anti-vaxxer parents and forcibly inoculating them. I’m pretty sure Matt Hancock, even without Dom Cummings to advise him, will be trying to avoid making those visuals a feature of the next election campaign.

So the territory of this conversation will be that of behavioural science rather than police enforcement. The whole social contract in a civilised society is just that: a social contract. It’s something voluntarily entered into, but still part of the deal. There’s a lot of upsetting, obscene and antisocial behaviour that isn’t proscribed by law — and shouldn’t be — but that doesn’t mean it’s OK to do it. Same thing the other way with a vaccine. It might be a greater wrong to force people to get the jab at gunpoint; but all things being equal, and the vaccine being shown to be safe and effective, refusing to take it will still be a wrong.

Would it be reasonable to ask people for proof of vaccination before they travel by public transport, drink in a pub, or go to work in an office? To my mind, that seems to fall on the right side of the line. But this works on the assumption that 70 million vaccine doses drop out of the sky all at once and are distributed efficiently and for free. I’m not betting my shirt on that, personally. So if the doses come in a trickle rather than a flood, who gets them first? Who distributes them? Who keeps score?

My hunch is that many people will have Strong Feelings about these matters. That light at the end of the tunnel — at least for the politicians — may turn out to be an oncoming train.

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