Monday, 14 June 2021

Vaccination Need Not Be Compulsory To Be Universal

Covid-19 vaccination take up has been disappointingly low in many countries, or parts of countries, such as in America. Given that vaccination offers significant private and public benefits, this is surprising. Is it permissible or even required for governments to compel or incentivise vaccination, and if so, how?

First, with regard to the private benefits of vaccines. It can be that these are misunderstood by many people who lack the numeracy or inclination to calculate that the benefits to themselves of escaping a serious illness outweigh the modest inconvenience and discomfort of getting vaccinated. A similar phenomenon occurs with the consumption of products like fast food, sugary drinks, alcohol, and tobacco. In these cases it is generally accepted that governments may take measures to make the long term costs of consumption clearer - for example with higher taxes or warning labels - and that this can be justified as an enhancement of people's freedom of choice. So, in the context of Covid, governments might air advertisements bringing home to people how horrid it would be to die from it, or how bad they would feel to know that they had infected a loved one and caused their death. They might also offer cash bonuses or in kind gifts for vaccination, on the grounds that such concrete and immediate benefits would be more salient to the innumerate and hence more persuasive.

However, it is also the case that vaccination (like mask wearing, social distancing, testing, or isolating after a positive diagnosis) provides public benefits that go beyond its private benefits to the individual. For example, once you receive a positive test result it does not help you to stay home and self-isolate as you are supposed to. It does help other people by keeping them safe from the biological threat you pose, but you don't benefit from that since you already have Covid. However, you do experience the full costs of the inconvenience of self-isolation. Since humans are instinctive egoists, we count the costs and benefits of our actions to ourselves, not to society as a whole. This is the structure of any collective action problem. The thing which it is in all our interest that we all do is not in the particular interest of any of us to do and so it does not get done (without some additional prompting from social norms and government coercion, the special inventions that drive the success of the human species as master co-operators). 

It is possible that there will be a similar gap between collective and egoistic rationality in the case of  vaccination. An egoistic individual will rationally choose whether or not to vaccinate on the basis of what that decision will achieve for them. Since the decision of any one person is irrelevant to their society's epidemiological circumstances, they will only take that into account as a factor in their calculations, but not as a goal. If the egoist lives in a country like the USA or UK that presently has many Covid-19 cases, and/or is in a high risk demographic, then they already have sufficient necessary to take the vaccine (unless they can't count). However, in other circumstances - countries like Australia and Taiwan with relatively few cases at present - the egoist may rationally conclude that the inconvenience, discomfort, and tiny risk outweigh the direct benefits the vaccine would bring them, at least for now. It is here where the gap between the social interest and individuals' private interests is most glaring, and where government coercion may be justified.
Covid-19 has already killed around 10 million people worldwide (according to the Economist magazine's analysis of excess mortality). To put this into context that is a nearly 20% increase on the 55 million deaths in 2019, and higher than the 9 million killed by the then leading cause, heart disease (WHO). This is despite extensive social distancing regulations that suppressed infection rates (with greater or lesser success) at the price of vast economic costs (measured in the trillions of dollars), social disruption, and individual well-being. The key point here is that the value of universal vaccination is not just that it would eliminate Covid deaths. Extreme lockdowns can do that too. Rather, universal vaccination is an orders of magnitude cheaper way of eliminating Covid deaths. The price that each of us would have to pay to live in a Covid-free environment would fall dramatically from what we have been paying so far, but only so long as we all pay it. If more than a few attempt to free-ride on the contributions of others, then herd immunity will not be reached and Covid-19 will remain present. 

Making people pay their fair share of the contributions needed to sustain public goods is a central task and justification for modern liberal government. A liberal government makes as much space as possible for people to develop and live by their own subjective value schemes. However, it reserves the right and power to make us pay taxes for those things we have collectively agreed are worth doing, even if we personally do not agree. This is why it was legitimate and proper for governments to force everyone to follow onerous social distancing rules to achieve the public good of Covid suppression, even when lots of people disagreed with them (whether because they had their own 5G theory of what was going on or simply didn't want their social life curtailed to protect the mostly elderly people for whom the disease is most deadly). Hence, it would certainly be legitimate for governments to force everyone to take a Covid-19 vaccination for the same purpose, since that is a much less onerous price to ask everyone to pay.

Yet government coercion requires more justification than this. It should be demonstrated not only that compulsory vaccination would succeed in bridging the public-private gap, but there aren't any non-coercive interventions that could achieve that outcome at a lower cost in liberty. Actually there seems a much more obvious route: raising the immediate private benefits of vaccination or the costs of non-vaccination. We could for example return to the original idea of paying people a couple of hundred dollars to get vaccinated (which would quickly be paid back by the re-opening of the economy). Or people could be barred from public spaces and transport unless they can show a vaccine certificate or a recent PCR test (a minor but recurring inconvenience). At the most extreme, the government could simply announce that all social distancing rules will come to an end 2 weeks after everyone has been offered their 2nd vaccine and expose the non-vaccinated to the full costs of their egoism.