The Ethical Quandary Surrounding the COVID-19 Vaccine

Graphic by Arola Oluwehinmi

PART I: INTRODUCTION

The year is 2025. Many people still wear masks upon entering a public space, and the politicization of vaccines and the pandemic as a whole occupy nightly news segments. We can no longer remember a time when words like “COVID,” “quarantine,” and “pandemic” aren’t spoken on a daily basis. Cut to 2022, where we have a high success rate for the vaccines, but a large portion of the country’s population has yet to receive a dose. The mounting scientific evidence to the efficacy of vaccines affirms the importance of getting vaccinated if there is any hope of eradicating the pandemic—and yet, only 64% of our country’s population are fully vaccinated. Why does this discrepancy exist? 

Despite the myriad of reputable sources that have attempted to inform the masses about the importance of getting vaccinated, the COVID-19 vaccine has become a politicized national problem with a toxic culture between “anti-vaxxers” and the general public. Often, people refer to their own personal philosophies as to why they shouldn’t get vaccinated. Saying “it’s my choice” or “this doesn’t impact anyone else” is an argument that stems from a long-time philosophical theory about autonomy and free will. This is often the only philosophical argument put forward by people against receiving the vaccine. However, there are other values and principles that challenge this argument and unpack the bioethical dilemma at play. In contrast to the arguments of free will and autonomy, principles such as utilitarianism, the harm principle, positive freedom, and the nudge theory exemplify the importance of getting vaccinated. 

PART II: FREE WILL & AUTONOMY

The crux of the anti-vaccination argument comes from the concept of free will and one’s ability to make an autonomous decision. Principlism is a bioethics framework that emphasizes the importance of four principles: beneficence, nonmaleficence, justice, and, finally, autonomy. Autonomy refers to making a self-decision free from controlling interference by others. The foundation of many people’s right-to-choose argument stems from the principle of autonomy and the notion that people are entitled to their own autonomous decisions. Free will is a natural-born right all people are entitled to and puts forward the concept that people can freely choose any action they wish to make. People believe this freedom extends to choices they make about their body, such as the right to refuse a vaccination even if it is mandated. However, this reasoning fails to recognize another key principle featured in principlism: beneficence. Beneficence is using power and authority to do good and benefit or promote the well-being of other persons. Beneficence and autonomy come into conflict when someone is making a choice they believe to be autonomous but not acknowledging the indirect influence their action has on others. One’s refusal to get vaccinated is choosing to ignore the other people involved who can become collateral damage to their action. 

PART III: RIGHTS THEORY

Rights theory is a comparable theory that corroborates the claim that not getting vaccinated is a personal liberty and everyone has a right to refuse. Rights theorists say that due to our inalienable rights found in the Declaration of Independence, a person is permitted to be free from societal requests. However, this theory often dismisses the question of responsibility and duty. When someone with access to vaccinations refuses a vaccine, they are not only putting themselves in harm but others as well. From an ethical perspective, no one has a right to harm others. Under this framework, it says to anti-vaccination believers that no one has a right to refuse a vaccine when we know doing so causes harm to others. There have been documented cases where one person’s unvaccinated status directly led to outbreaks for those who were vaccinated. Moreover, the Supreme Court case Jacobson v. Massachusetts held that mandating vaccinations was a legitimate exercise of state governments’ power to guard the health, welfare, safety, and morals of citizens. True freedom under the rights theory cannot exist when it only recognizes the freedom of the individual person without acknowledging the potential harm to others. The view that being forced to take the vaccine is an infringement on one’s personal rights is a misinformed stance that ignores the philosophy of utilitarianism, the leading argument for why we must all get vaccinated.

PART IV: UTILITARIANISM

The controversy of receiving the COVID-19 vaccine is constantly framed in terms of individual self-interest. Those people that justify anti-vaccination on the grounds of free will and autonomy have some validity, but it is more of a morally complex issue due to how our self-interested decisions can affect others. Utilitarianism is a philosophy that suggests that the actions and policies we make should increase the maximum amount of universal happiness. Referred to as the “Greatest Happiness Principle,” utilitarianism forms the core of debate surrounding the vaccine as it demonstrates how all citizens should get vaccinated for the sake of public health and increasing utility, or happiness. Getting vaccinated contributes to our population being able to reach herd immunity and the ability to return to normal life, which would create a greater amount of general happiness. It may be the case that people who don’t want to get the vaccine but do will lose some happiness. However, the happiness gained from the decreased spread and better public health will outweigh this potential decrease in happiness and therefore, vaccination should be pursued on utilitarian grounds. 

PART V: THE HARM PRINCIPLE

Persisting with this theme on freedom, Mill supplies a sophisticated ethical proposition called the Harm Principle. Mill created this principle in 1859 as an argument for free speech, saying that limiting free speech would inflict harm on society and prevent social progress. This principle has held along throughout history as a foundation in modern democratic societies for policy and law-making due to the simplicity in its statement: we should be free to pursue our individual will, as long as it does not cause harm to someone else. A person’s own happiness, Mill wrote, is insufficient reason for making a decision. John Mill, one of the most significant contributors to utilitarianism, states, “A person may cause evil to others not only by his actions but by his inaction, and in either case he is justly accountable to them for the injury.” Mill’s argument implies that the inaction of not getting vaccinated can cause harm to other people. Humans have the freedom of choice, and with that choice comes potential risk to oneself. However, this freedom does not extend to risking others and is limited by the harm it could cause for others. As Mill puts it, “The only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others.”

PART VI: POSITIVE FREEDOM

Positive freedom, as presented through the African communitarian philosophy of Ubuntu, furthers the notion that we must think bigger than just ourselves when making a decision. Positive freedom refers to acting upon one's free will but acknowledging the broader society, which can place limitations on a person's choices. On the other hand, negative freedom is being free from any constraints from external factors. This allows deliberation on the “freedom to choose” concept, which both positive and negative freedom enthusiasts would be in favor of, but to differing degrees. Though it may sound ideal, negative freedom is flawed when applied to society because disregarding the community when making decisions is harmful. The Ubuntu philosophy advances this argument with the isiZulu phrase “Umuntu ngumuntu ngabantu,” which translates to “I am because we are.” This phrase emphasizes the importance of community, and how the good of one person can be reflected back to the community as a whole. Using this philosophy when referring to the anti-vaccination argument illustrates the big-picture idea of pro-vaccination reasoning and why we must do our part as citizens to get vaccinated. When someone refuses to get vaccinated on the grounds that it is their freedom to do so, it is ignoring the needs of your community. 

PART VII: NUDGE THEORY

Nudge Theory and our decisional heuristics explain how it is not always wise to rely on autonomy when making a decision. Autonomy is a complicated concept; our theories of autonomy and rights come from a time that was relatively more simple in terms of medical conditions, and we cannot translate it to modern-day thinking. There are so many conflicting sources of information, and it isn’t always logical to rely solely on autonomy when there are professionals who know more than us and can nudge us in the right direction. The structure of the “choice environment,” or the context in which we live and act, shapes what we internalize as autonomously desirable, and evidence suggests that humans aren’t very good thinkers when it comes to making our own decisions. We possess cognitive heuristics that influence our autonomy and the choices we make by referring to patterns of thinking. For example, anchoring is a heuristic where we over-rely on an already known piece of information when making a decision. Our confirmatory heuristic means we interpret evidence according to things we already believe and warp the evidence to fit our beliefs. For example, people who refuse to get vaccinated might argue this on the grounds that there are more vaccinated people hospitalized for COVID than unvaccinated. This is an accurate statistic but doesn’t take into account the only reason it is true is because there are more people vaccinated in general. Individuals take a fact but fail to view it holistically, rather only so it fits their idea of what is right. When we use these presumptuous justifications to make decisions, destructive “I do what I want to” mentalities can manifest.

To fix this, the nudge theory suggests that we can and should use “nudging” to shape people’s actions in a beneficial way. In healthcare, physicians have implemented nudging to encourage patients to take their medicine, participate in tests, and get vaccinated. There are levels to nudging, from simply providing information to actively guiding a patient to the right choice. In the context of the pandemic, nudging has been done in the form of mandates. When people are told they must be vaccinated in order to enter an establishment or go to work, they are making their decision based on someone else’s demands. Nudging reveals how our autonomy is not always reliable due to preconceived patterns of thinking we have. When our autonomy subconsciously categorizes our decision-making processes, it fails to view each ethical dilemma as its own entity, inhibiting our ability to make a sound decision. 

PART VIII: MOVING FORWARD

The conflict between either side of the vaccine argument originates from having different liberties in conflict. People who are refusing vaccination use the claim that people in a free society should be able to do to their bodies what they wish. However, this group’s negligence to get vaccinated infringes upon the liberties of other people who cannot feel safe or resume normal activities until the risk of infection is thoroughly limited. Armed with ideas such as utilitarianism and the harm principle, and the application of positive freedom, the misinformed stance on making an autonomously sensible choice of anti-vaccination proves to be illogical. 

There are many philosophical frameworks outside of autonomy that we can use to illuminate this dilemma from a different perspective. These principles are aided by scientific evidence that work in tandem to suggest there are many moral justifications as to why we should get vaccinated. Data has shown that the vaccines work; it is just a matter of people refusing to believe in science. Based on the analysis of these various philosophical ideas, it is suggested that, on utilitarian grounds, we must get vaccinated because making a decision regarding the vaccine is bigger than ourselves. It is imperative that citizens understand this is a matter of public health, recognizing the science is verifiable, and that we must look to these philosophies as rationales when it comes to making a choice that has the potential to change the trajectory of this pandemic.