In recent years, more people have taken a negative attitude towards vaccines. A foremost opponent of vaccines in recent decades, Robert F. Kennedy Jr., has even come to lead Health and Human Services. Anti-vaccine attitudes have serious negative effects on infectious diseases. Canada and the UK have lost their measles elimination status: the USA hit a 30-year high for measles infections and will likely soon lose our measles-eliminated status.
This leads to the debate over vaccine mandates. When, where, and how can we mandate vaccines? Every Catholic hospital and most Catholic schools continue to have vaccine mandates. These mandates face increasing pressure from Catholics who object to them. However, most existing vaccine mandates serve the common good. In fact, not only is it moral for Catholics to vaccinate, but it’s also moral for Catholic hospitals and schools to mandate vaccines, and, often, lacking such mandates would be immoral.
I hope this helps such schools and hospitals explain why they continue to have vaccine mandates. This is a shorter and more accessible version of a dense academic chapter I wrote on the topic. This shorter piece will note a limitation, then move on to vaccines helping the common good (the purpose of mandates), note a few distinctions among mandates, and then conclude.
Limitation: I Assume Expert Scientific Consensus
Before getting into detail, I need to limit this to be a manageable article. As a priest and moral theology professor, my expertise is ethics, so this will focus on ethics and assume the general and expert consensus. Microbiologists and immunologists can help if you want more science.
Based on the scientific evidence and Catholic moral theology, unless there is a medical indication otherwise, getting vaccinated against common diseases with recommended vaccines is a morally good act. Some even argue persuasively that it is usually morally obligatory for the individual. (I have covered some of this before on here.)
Vaccines and the Common Good
Principles for Mandates
Vaccine mandates are any requirement by legitimate authority to get vaccinated where not vaccinating involves some negative effect imposed by that authority. This is a broad definition where the negative effect can have various degrees of seriousness. The goal of these mandates is prevention of disease among the whole community that the one mandating cares for, whether a school, hospital or larger political entity. The least restrictive means that achieves that goal should be used (so encouraging, for example, is preferred if it achieves the goal); however, given disease prevention is a great contribution to the common good, mandates would be an option.
When we speak about the common good, we examine the good of the whole community. We are each made in the image and likeness of God. Part of that image and likeness is being made for community so there is a goodness we need to share in that community. The common good is most of all what builds up the whole community, not what helps one person over another.
Vaccines clearly serve the common good. In the early 1900s, infectious disease was over half of all deaths, while by 1997, it was a single-digit percentage. Life expectancy grew a lot in this time frame. Vaccines have been a significant part of this reduction of infectious disease deaths. Elimination of diseases like measles, smallpox and rubella in the USA is undoubtedly a good thing that is part of the common good.
Science of Vaccines
One may ask why are mandates needed? To explain why, we need to understand a bit about how vaccines work and thus serve the common good. No vaccine is 100.00% effective. However, given one cannot transmit an infection one did not catch, vaccines will stop or slow transmission at various rates of effectiveness & coverage. As a priest in my 40s, I get annual flu & covid vaccines more to ensure I don’t pass it on to others who are higher risk rather than for my own health. I don’t want to accidentally transmit it ministering to the elderly.
Measles, for example, is extremely infectious: if an unvaccinated person is exposed, there is about a 90% chance they will catch it, and the average infected person would infect 12-18 others without vaccines. If we compare this to seasonal flu, there is a 4-12% chance an unvaccinated person catches it if exposed and the average infected person would infect 0.9-2.1 others without vaccines. The standard 2-dose measles vaccine is about 97% effective, but given it’s highly infectious nature, we need about 95% vaccinated to prevent continued transmission.
In a school, even if the class is vaccinated, bringing a measles infection into a 30-student classroom will on average result in 1 student infected. If we have universal (or almost universal) coverage, there is almost no chance a student will bring measles into the school. Then, these children operate in a society that also has 95-100% vaccination so they are unlikely to be exposed, and we have an effect where measles was effectively eliminated in many developed countries. This is an undeniable common good.
Effects of Vaccines
We can see a similar common good to eliminating measles with other diseases that have been eliminated or almost eliminated in the US. These diseases often seem minor at first – some can remember childhood measles – but can also kill. Even with the most advanced modern medicine, about 1 in 850 who got measles in the past decade in the USA died of it. It is estimated that in the early 20th century before vaccines, measles infected over 500,000 a year, killing many children. Other vaccine-preventable diseases also killed many in the past.
Most vaccines are injected, so a little painful, and thus unpleasant. On top of this, if one person does not vaccinate in a city or in a school, the risk of measles is still very low as few people around are unvaccinated. Thus, some people will not want to vaccinate themselves or their children. Thus, to maintain a high rate (95%+ vaccination), mandates are often required.
Forcing people to do actions, even good actions as vaccines are, does take away a bit from the common good. We don’t force people to tithe even though it is the best option. However, in this case, the good sought requires common action, not just individual action. Forcing is a slight thing against the common good, but far less is taken from the common good than is added by disease elimination or significant disease reduction with a disease like measles.
The common good is served by requiring vaccines against measles for all as then we prevent cases and deaths.
Distinctions Between Types of Mandates
Stable vs. Unstable Genome Viruses
The comparison of measles and flu above does lead to a discussion of two types of diseases we vaccinate against. Measles has a stable genome. For such viruses, we generally have vaccines you only need a few doses of in your lifetime, and the effectiveness is usually over 90%. These viruses are stable and unchanging, so immunity lasts. Flu, however, is a much less stable virus (Covid is similar in its constant change among diseases often vaccinated against). These viruses change much more rapidly, so vaccination is often annual and has noticeably lower effectiveness. Thus, mandating them seems to generally be more of a burden on the individual without reducing disease transmission as much, so they would be harder to justify.
Who Must Get Vaccinated
Along with dividing mandates by type of virus, they can be divided by who requires vaccines. This can be generalized in three broad categories.
- First, medical and military mandates take the least to justify as the risk of transmission and negative effects are heightened by work. It is also well known that hospitals and the military require extensive vaccines, so those despising vaccines can choose another field. Medical professionals also have codes of ethics directed at caring for patients, which would include vaccinating against infection.
- Second, mandates to do something unusual, such as vaccine mandates for a green card or before visiting certain countries, are in the middle as again one can choose otherwise, but there is not the higher situational risk. For example, a green card holder with measles does not have a greater risk to society than a native-born American with measles. However, getting a green card is something unusual & not by right.
- Finally, universal or near-universal mandates, such as school mandates. These put the most burden on people as they are unavoidable. The other two can usually be avoided by relatively normal choices, but this type of mandate is functionally unavoidable, even if one could avoid it by making exceptional choices.
I think these two types of distinctions do make it so that universal mandates for annual vaccines likely don’t significantly build up the common good for what mandating them takes away. They are still recommended for almost everyone, just not mandated. However, such a distinction should help us see how we can mandate vaccines for stable viruses in all three situations and for less stable virus vaccines in the first two situations.
Conclusion: Vaccine Mandates Serve the Common Good
Ultimately vaccines and vaccine mandates serve the common good. We need mandates in Catholic institutions and the wider society to prevent disease transmission and death. We should thank those institutions that help the common good in this way: one danger with vaccines is that those opposes to them are much more vocal than those who support them. Back when the covid vaccine debate was strongest, Catholics opposing the vaccine seemed larger in the noise on the internet, but Catholics were the most vaccinated religious group (85% by January 2022), and we bucked the trend of other religious groups where those who regularly attend Mass were more vaccinated than non-practicing Catholics. I hope we continue to show leadership in promoting vaccines as Popes have done since vaccines first existed in the 1700s.
Note: I will not accept scientifically inaccurate comments: this is about ethics, not scientific data.
