The Unintended Consequences of COVID-19 Vaccine Policy: Why Mandates, Passports, and Segregated Lockdowns May Cause more Harm than Good
BMJ Global Health (accepted for publication)
29 Pages Posted: 1 Feb 2022 Last revised: 28 Nov 2022
Date Written: February 1, 2022
Vaccination policies have shifted dramatically during COVID-19 with the rapid emergence of population-wide vaccine mandates, domestic vaccine passports, and differential restrictions based on vaccination status. These policies have prompted ethical, scientific, practical, and political controversy; however, there has been limited evaluation of their potential unintended consequences. Here, we outline a comprehensive set of hypotheses for why these policies may be counter-productive and harmful.
Our framework considers four domains:
1) behavioral psychology,
2) politics and law,
3) socioeconomics, and
4) the integrity of science and public health.
While COVID-19 vaccines have had a profound impact on decreasing global morbidity and mortality burdens, we argue that current population-wide mandatory vaccine policies are scientifically questionable, ethically problematic, and misguided. Such policies may lead to detrimental long-term impacts on uptake of future public health measures, including COVID-19 vaccines themselves as well as routine immunizations. Restricting people’s access to work, education, public transport, and social life based on COVID-19 vaccination status impinges on human rights, promotes stigma and social polarization, and adversely affects health and wellbeing. Mandating vaccination is one of the most powerful interventions in public health and should be used sparingly and carefully to uphold ethical norms and trust in scientific institutions. We argue that current COVID-19 vaccine policies should be reevaluated in light of negative consequences that may outweigh benefits. Leveraging empowering strategies based on trust and public consultation represent a more sustainable approach for protecting those at highest risk of COVID-19 morbidity and mortality and the health and wellbeing of the public.
Funding: Funding was provided to KB through a Wellcome Trust Society and Ethics Fellowship (10892/B/15/ZE). EJ also received funding from the Wellcome Trust UK (grant numbers 221719 and 216355).
Declaration of Interests: Within the past two years, AdF was involved in Vaccine Confidence Project collaborative grants with Janssen Pharmaceutica outside of the submitted work and holds a Merck grant to investigate COVID-19 vaccine attitudes.
Keywords: COVID-19; vaccine policy; public health; epidemics
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