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Vaccines have helped successfully reduce, if not eradicate, the rates of a number of diseases, related disabilities and deaths across the world. However, there has been a relatively recent resurgence in infectious diseases, such as measles, in countries where they were thought to have been largely eradicated. This has led to a public debate on the role of vaccines, which has been shaped by current events, as seen with the global coronavirus outbreak, in which there have been urgent calls for a vaccine. Vaccination levels have been impacted worldwide as a result of hesitancy-driven anti-vaccination (‘anti-vax’) movements, which have a long history and have recently resurfaced in the last few decades. Regulating the anti-vax movement will require the balancing of various human rights, including to the right to life, the right to health, freedom of speech, freedom of religion, conscience and expression and the right to education.
The decision to delay or refuse vaccination puts medically vulnerable groups such as children, infants, the elderly and the immunocompromised at high risk of infection. Vaccinations enable the fulfilment of a number of human rights, including the right to life (Article 6 ICCPR) and the right to health (Article 12 ICESCR). Vaccines can thus be regarded as one of the most credible and cost-effective pathways to securing the highest standard of these human rights. Therefore, legislation that mandates vaccinations upholds these rights. However, it simultaneously infringes on the rights of those in the anti-vax movements, such as the right to bodily autonomy and freedom of religion, conscience and expression.
Vaccine Affordability and Human Rights
The novel coronavirus outbreak that is currently a global concern has important implications for the vaccination debate. Although a vaccine for coronavirus is presently in the testing stage, there have been concerns that new vaccines may not be affordable for sections of the population. Countries like the United States are currently grappling with the need for private sector investment into a new vaccine. However, reliance on private research and pharmaceutical companies negatively impacts the ability of the government to set price controls for these vaccines. This will have a detrimental effect for financially disadvantaged individuals who may find themselves unable to afford vaccines, thereby impacting their right to health and potentially their right to life.
Compulsory Vaccination Schemes and Human Rights
Despite the preventative health benefits vaccines bring, mandatory vaccination programmes have been controversial. Whilst supporters of such endeavours have equated mandatory immunisation legislation to smoking bans, sceptics tend to distrust vaccinations. The anti-vax movements are fuelled by number of factors including (but not limited to) myths that they cause autism (a myth that has been consistently debunked by scientists), the rise of social media, religious beliefs, propaganda from extremist groups and distrust in public health services. As a result, exemption rates are rising, especially in Australia and the United States. However, non-medical exemptions (e.g., objections for philosophical or religious reasons) are not the only route to vaccination abstention. These contentious debates over mandatory vaccination include balancing the benefits of compulsory vaccination initiatives with the rights of the child, rights of religious freedom, the right to education and finally, the rights to dignity, self-determination and bodily autonomy (e.g., as enshrined in the right to give free and informed consent and the right to not be coerced into medical treatment). Such discussions are necessary, especially with the compulsory vaccination question being revisited here in the UK after NHS data revealed that vaccine uptake rates have dropped in England and the World Health Organization announced that the UK lost its measles-free status in 2019.
The debate gets complicated when one starts considering the intricacies of the balancing act. One the one hand, public authorities have an obligation not to interfere with a person’s right to bodily autonomy in respect of medical treatment. On the other hand, refusing to vaccinate one’s child may infringe with their rights and their best interests. Parents are often responsible for the decision not to vaccinate their children, especially for children under the age of consent. This can have wide ranging consequences particularly in countries that have implemented laws requiring children to be vaccinated prior to attending school. Mandatory vaccination programmes protect the children’s right to health, but is it justified to then deny them access to another right, such as the right to education? States are required to provide compulsory primary education under Article 13 ICESCR. Denying a child’s access to primary education by imposing mandatory vaccination, and potentially denying them their bodily autonomy, will only hurt children more. However, research into the demographics of the anti-vaccine movement in the United States has shown that parents opting out of vaccines were more likely to be white, wealthy, live in more affluent neighbourhoods and have better access to healthcare.
Mandatory vaccinations may also conflict with freedom of religion, conscience and expression. Religious motivations have been used to refuse medical treatment and are nowadays sometimes used as a reason to refuse vaccinations. There is a differing approach to vaccination amongst religions, and whilst no religion expressly forbids vaccinations, some object to aspects of vaccinations such as the use foetal tissue in some vaccines. Therefore, compulsory vaccinations for certain types of vaccines have the potential to infringe upon an individual’s freedom of religion. However, authorities are able to limit the exercise of people’s freedom of religion to protect public safety and order, health or morals and the rights and freedoms of other individuals. The limitation must be necessary and proportionate and could be applicable for certain mandatory vaccines that protect public safety and health.
Rights of the Individual vs. Rights of the Collective
Another human rights debate connected to the issue of compulsory vaccination is the balancing act states must take in respecting, protecting and fulfilling the rights of the individual versus the rights of the wider population. Epidemics pose clear, widespread risks to global populations, as they can spread quickly in a globalised society. As such, vaccines not only prevent the spread of diseases amongst the immunised, they also operate as a means of ‘herd protection’ and indirectly protect the right to health for those who are immunocompromised and individuals who are unable to receive vaccinations. However, this is only effective when the majority of individuals in a given population are vaccinated. Herd immunity becomes further compromised when people refuse vaccinations.
There are a number of solutions that States may utilise to strike a balance between mandatory vaccinations to protect the population at large and the respect for an individual’s autonomy, fundamental rights and freedoms. Such solutions may include substantial fines, partial restrictions of freedom and sourced education from qualified health professionals about the medical benefits and risks of vaccines. However, these may not be enough to appease advocates on either side of the debate. Despite the undeniable benefits that vaccinations bring to both individuals and society, it still raises a wide range of valid human rights issues. Fighting the anti-vax movement requires careful engagement with these issues and success in this endeavour will depend on how we approach this debate.