Compulsory vaccination in Brazil: a bioethical reflection on the measure / Vacinação compulsória no Brasil: uma reflexão bioética sobre a medida

O presente artigo teve como objetivo discutir a compulsoriedade da aplicação vacinal no Brasil à luz dos princípios bioéticos. Para tanto, analisaram-se os desdobramentos históricos do manuseio dos imunizantes no país e identificaram-se as interferências dos princípios propostos pela bioética no tocante à aplicação segura e eficaz de vacinas. Reforçando-se a notoriedade da temática no cenário atual, debateram-se, ainda, as novas perspectivas que a pandemia de covid-19 propiciou no que concerne à vacinação compulsória. Por último, examinou-se o papel do Estado quanto ao equilíbrio a ser encontrado na busca pela consolidação dos direitos sanitários inerentes ao corpo social e os deveres das entidades públicas, por via do Programa Nacional de Imunizações, na garantia da exímia aplicação da Constituição Cidadã de 1988. A pesquisa teve abordagem qualitativa, construída a partir de revisão bibliográfica de cunho integrativo. Concluiu-se pelo caráter elementar das campanhas de vacinação obrigatória, sobretudo em cenários de incerteza populacional quanto à segurança dos imunizantes, em que o papel dos entes governamentais é enfatizado pela necessária conservação da saúde pública.

This article aimed to discuss the compulsory application of vaccines in Brazil in the light of bioethical principles. Historical developments related to the handling of immunizers in the country were analyzed and interferences of the principles proposed by bioethics regarding the safe and effective application of the vaccine were identified. Also, reinforcing the notoriety of the theme in the current scenario, a debate was presented about the new perspectives that the Covid-19 pandemic provided with regard to compulsory vaccination. Finally, the role of the State was examined regarding the balance to be found in the search for the consolidation of the health rights inherent to the social body and the duties of public entities, through the National Immunization Program, in guaranteeing the excellent application of the Citizen Constitution of 1988. The research has a qualitative approach built from a bibliographic review with an integrative nature. As a conclusion, this study reveals the elementary nature of mandatory vaccination campaigns, especially in scenarios of population uncertainty regarding the safety of immunizers in which the role of government entities is emphasized by the necessary conservation of public health.

The Dilemma of Compulsory Vaccinations-Ethical and Legal Considerations.

The high childhood vaccination coverage in Israel leads to a low rate of morbidity from the diseases against which the vaccination in administered. However, during the COVID-19 pandemic, children's immunization rates declined dramatically due to closures of schools and childcare services, lockdowns, and guidelines for physical distancing. In addition, parents' hesitancy, refusals, and delays in adhering to routine childhood immunizations seem to have increased during the pandemic. A decline in routine pediatric vaccine administration might indicate that the entire population faces increased risks for outbreaks of vaccine-preventable diseases. Throughout history, vaccines have raised questions about their safety, efficacy, and need among adults and parents who feared or hesitated to vaccinate their children. Objections derive from various ideological and religious reasons or concerns about the possible inherent dangers. Mistrust in the government and/or economic or political interests also raise concerns among parents. The importance of providing vaccines to maintain public health, as opposed to the autonomy of the individuals over their body and their children, raises ethical questions. In Israel, there is no legal obligation to get vaccinated. It is imperative to find a decisive solution to this situation without delay. Furthermore, where democratically one's principles are sacred and where one's autonomy over one's body is also unquestionable, such a legal solution would not only be unacceptable but also rather impossible to enforce. It seems that some reasonable balance between the necessity to preserve public health and our democratic principles should apply.

From COVID-19 vaccine candidates to compulsory vaccination: The attitudes of Italian citizens in the key 7-month of vaccination campaign.

INTRODUCTION: The aim of the study is to understand the evolution of COVID-19 vaccine acceptance over the key 7-month vaccine campaign in Italy, a period in which the country moved from candidate vaccines to products administered to the public. The research focus points to evaluate COVID-19 vaccine attitudes in adults and their children, propension towards compulsory vaccination, past and present adherence to anti-flu and anti-pneumococcal vaccines, and the reasons for trust/mistrust of vaccines. METHODS: Italian residents aged 16->65 years were invited to complete an online survey from September 2020 to April 2021. The survey contained 13 questions: 3 on demographic data; 8 on vaccine attitudes; and 2 open-ended questions about the reasons of vaccine confidence/refusal. A preliminary word frequency analysis has been conducted, as well as a statistical bivariate analysis. RESULTS: Of 21.537 participants, the confidence of those in favor of the COVID-19 vaccine increases of 50 % and the number of people who wanted more information decreases by two-third. Willingness to vaccinate their children against COVID-19 also increased from 51 % to 66.5 %. Only one-third of the strong vaccine-hesitant participants, i.e. 10 %, remained hostile. Compulsory vaccination showed a large and increasing favor by participants up to 78 %, in a way similar to their propensity for children's mandatory vaccination (70.6 %). Respondents' past and present adherence to anti-flu and anti-pneumococcal vaccines does not predict their intentions to vaccinate against COVID-19. Finally, a semantic analysis of the reasons of acceptance/refusal of COVID-19 vaccination suggests a complex decision-making process revealed by the participants' use of common words in pro-and-cons arguments. CONCLUSION: The heterogeneity in the COVID-19 vaccine hesitancy, determinants and opinions detected at different ages, genders and pandemic phases suggests that health authorities should avoid one-size-fits-all vaccination campaigns. The results emphasize the long-term importance of reinforcing vaccine information, communication and education needs.

Applying Two-level Utilitarianism and the Principle of Fairness to Mandatory Vaccination during the COVID-19 Pandemic: the Situation in South Korea.

In response to the COVID-19 pandemic, Korean society has sought to vaccinate most of its population. Consequently, the Korean government has attempted to make vaccination compulsory by promoting awareness of its benefits. The administration has pushed for mandatory vaccination by claiming that vaccination is more beneficial than harmful, based on a utilitarian view. However, this view is difficult to justify based on the two levels of utilitarianism presented by R. M. Hare. Compulsory vaccination cannot satisfy the universalizability, nor the satisfaction of preference, and exposes the difficulties of utilitarianism. In addition, mandatory vaccination is difficult to justify based on the perspective of fairness theory, that is, "justice as the fairness" of John Rawls and H. L. A. Hart's principle of fairness. From the point of view of Hare's utilitarianism and fairness theory, it has been shown that mandatory vaccination is not easily justified. In reality, the power of the state continues to strengthen, and we should examine this situation from a critical point of view.

Vaccine Hesitancy: The Fight against Misinformation in the Digital Society

The contestations arising from the introduction in various European countries of mandatory vaccination against Covid-19 for certain categories of workers are expressions of a profound malaise, not new and common to Western societies. Misinformation about vaccines is not a new phenomenon, but has been heightened due to the rise of social media, clearly evident during the Covid-19 emergency. These conflicts have a significant social impact and can hinder the struggle against the spread of the virus. This work analyses the origins and legal implications of this growing social mistrust in science, which jeopardises the stability of the constitutional order, founded on the principles of trust and solidarity.

Conscientious Objection to Compulsory Vaccination? Lessons from the Case-Law of the European Court of Human Rights and a Test Employed by the Czech Constitutional Court

The paper aims to analyse several theoretical problems concerning the recognition of the right to conscientious objection to compulsory vaccination. Our interest in the matter has stemmed from our domestic experience in the Czech Republic, ie a country with a traditional, comprehensive system of compulsory vaccination, but also a country in which the Constitutional Court recognised that, under certain conditions, conscientious objections to compulsory vaccination may be successfully invoked. The Constitutional Court created a special four-prong test for public authorities to ascertain whether the conscientious objection is legitimate to the case at hand and compulsory vaccination should not be enforced. We believe that sharing the Czech experience and pinpointing its crucial, but also debatable, aspects (especially the legal basis for the recognition of conscientious objection and the test itself) may be a useful comparative material for other states with a system of compulsory vaccination, or states which contemplate its introduction, possibly even against Covid-19. However, to add a broader European perspective, the paper will also examine the context of the relationship between compulsory vaccination and conscientious objection in the light of the Convention and will analyse the relevant case-law of the Strasbourg Court. A definitive answer as to whether a conscientious objection to compulsory vaccination may entail the protection of Article 9 of the Convention has not yet been given by the Strasbourg Court. Nevertheless, we argue that the case-law indicates that, under certain conditions, conscientious objections could attract the guarantees of Article 9 in future cases.

Medical Residents' Behaviours toward Compulsory COVID-19 Vaccination in a Tertiary Hospital in Italy.

To maintain safety conditions in the provision of care and assistance, and to protect healthcare workers (HCWs) and patients, the Italian government required compulsory COVID-19 vaccination for HCWs, including medical residents (MRs). The aim of this study was to assess COVID-19 vaccination coverage in MRs in a large tertiary hospital in Italy, before and after the introduction of compulsory vaccination, according to demographic characteristics and specific residency. A database on COVID-19 vaccination status and infection of resident medical doctors was created. Descriptive statistics and logistic regressions were carried out on the data. A total of 1894 MRs were included in the study. Being vaccinated in the same hospital as the residency program was significantly related to the year of residency and being enrolled in a frontline residency. A significant association between compliance with the compulsory primary cycle vaccination and vaccination in the hospital residency was observed. Being enrolled in the second, third, and last years of residency, and in a frontline residency, were predictive of being vaccinated in the residency hospital. Almost 100% of the MRs participating in the study were vaccinated against COVID-19. Compulsory vaccination of HCWs, alongside greater and clearer information about the risks and benefits of vaccination, represents an important booster to ensure public health and to promote quality and safety of care.

CHASING HERD IMMUNITY: VACCINATION STRATEGIES OF RUSSIANS IN THE CONTEXT OF VARIOUS FORMS OF ENFORCEMENT TO VACCINATION

The focus of the analysis is the vaccination strategies of Russians highlighted on the basis of representations about the effectiveness of mass vaccination and the prospects for reaching the herd immunity, preferences to rely on individual or herd immunity, as well as the availability of vaccination or plans to be vaccinated. The vaccination strategies are regarded as individual decisions based on an assessment of the current situation and an interpretation of what herd immunity is and whether it is achievable. In this context, herd immunity is not just a coincidence but the result of largescale collective action. In the absence of a generally shared understanding of herd immunity and whether it is achievable, Russians prefer to rely on themselves and their health. By introducing various vaccination requirements and restrictions for the unvaccinated, the state is trying to act as a coordinator of collective action. However, an attempt to impose external demands is regarded by people as a form of enforcement of vaccination. Enforcement exerted on a single individual increases the chances of her/his vaccination but causes a repulsive effect among her/his circle of familiars. Based on data from an allRussian telephone survey (N=1503, conducted by the Foundation “Public Opinion”) and eight focus groups with supporters and opponents of vaccination from different cities of Russia, we show that various forms of enforcement of vaccination increase the risk of radicalization of relations between the state and society and also contribute to an even greater separation of individual and public interests. © 2022 Russian Public Opinion Research Center, VCIOM. All rights reserved.

A Lesson from the Green Pass Experience in Italy: A Narrative Review.

The COVID-19 outbreak has raised several global challenges related to disease management while highlighting the need to embrace a multidimensional approach in dealing with events such as. Due to the singular features of SARS-CoV-2, an appropriate medical response was required to develop new vaccines able to tackle it effectively. Mass vaccination plans were thus promptly launched around the world. However, vaccine uptake has been coupled with growing concerns that have affected people's willingness to get vaccinated. To promote compliance with vaccination campaigns, many governments introduced the use of vaccination certificates and immunization passports. Studies have discussed some benefits and cons coupled with the rollout of vaccine passports or certificates. This paper takes up and extends this discussion by showing the results of a mini- narrative review we undertook with the aim of critically summarizing the existing scholarly research on the Green Pass in Italy. In analyzing the 12 included records, we explored the scientific viability of this measure, as well as the concerns and criticisms it has raised and the recommendations that have been proposed to address them, as a starting point to consider how the lesson learned in the Italian context can contribute to informing future reflections and strategies in view ofanother pandemic event.

ARGUMENTS FOR AND AGAINST THE INTRODUCTION OF COMPULSORY VACCINATION FOR HEALTH CARE WORKERS

The refusal of vaccination by health professionals, as a scientifically proven method of protection against disease, in a time of COVID 19 is deeply worrying because they are the ones who should explain to patients the characteristics of the vaccine and its benefits. The WHO believes that the introduction of compulsory vaccination can be counterproductive and that other non-coercive measures should be employed beforehand to achieve high vaccination coverage. States should therefore strike an appropriate balance between the autonomy and the right to self-determination of health professionals and the principle that their actions must not harm patients (the principle of non-maleficence) or must contribute to patient well-being (the principle of beneficence). This paper aims to analyze the response of the Republic of Croatia to this exceptional public health crisis. The paper is divided into two main parts. The first part of the paper explores the doctrinal, legal, and social issues surrounding the model of voluntary vaccination and the model of compulsory vaccination concerning health professionals. Special emphasis is placed on reasons for vaccine refusal among healthcare professionals. The second part of the paper deals with the issues of (compulsory) vaccination of health professionals through the labor law perspective in the Republic of Croatia, but also the practices of EU Member States that have introduced vaccination as an obligation of employees. The authors focused their research on socio-legal and qualitative analysis, as well as methodological pluralism. © 2022 University of Zagreb Faculty of Economics and Business. All rights reserved.

Legality of restrictions on human rights and freedoms in a Covid-19 Pandemic: The experience of Ukraine

The purpose of the study is to examine the content of the right to health during the COVID-19 pandemic. The study focused on the legitimacy of restrictions on constitutional rights and freedoms due to mandatory vaccination and other restricition measures in Ukraine. Diversified views of scholars on this issue were established, the legislative basis for establishing restrictions on constitutional rights and freedoms of citizens was determined, and the method of normative establishment of such restrictions during the COVID-19 pandemic adopted by the Government of Ukraine was criticized. The legal positions of the European Court of Human Rights, the Constitutional Court of Ukraine and the Supreme Court of Ukraine on the legality of compulsory vaccination during a pandemic and restrictions on the constitutional rights and freedoms of citizens are presented. To achieve the goal of the research, general scientific research methods were used, such as: analysis, synthesis, modeling and ion. These methods were used to determine the constituent elements of a person's right to health care, to determine their relationship, to give specific examples of solving the problem of vaccination, to draw conclusions on the legality of vaccination and to limit certain constitutional rights of citizens.

Vavřička and Others v. The Czech Republic

For the Court, this conclusion was bolstered by the observations that vaccination was not administered against the will of the applicants;that there is no consensus between member states over a single model to achieve the highest level of vaccination;that the introduction of a legal duty to vaccinate children raises sensitive moral or ethical issues;and that the case concerns matters of healthcare policy (paras. 276–79). [...]the Court considered that the measure satisfied the proportionality test. Furthermore, the Court underlined the temporal nature of the exclusion, as all children—also when not vaccinated—can still be enrolled in primary school (para. 307). [...]the Court concluded that the Czech Republic had not overstepped its margin of appreciation and consequently that there was no violation of the right to private life (paras. 310–11). [...]the Court held, also by sixteen votes to one, that it was unnecessary to examine separately the complaints of the five child applicants under Article 2, Protocol No. 1 in light of the previous findings under Article 8 (para. 345).

“COMPULSORY” IMMUNE RESPONSE: CHALLENGES OF VACCINATION AGAINST COVID-19 (The end)2

The article adopts an interdisciplinary approach to reflecting the challenges of immunization against COVID-19: it reveals both medical and legal concerns that accompany the current vaccination model in Russia and characterize this model as unbalanced. On the one hand, the authors underline the advantages of vaccination as opposed to alternative means to address the current pandemic. On the other hand, they stipulate the risks associated primarily with the high level of uncertainty of both medical and legal parameters of the vaccination scheme adopted in Russia. The authors consequently analyze a number of medical findings on efficacy and security of the existing vaccines and conduct the proportionality test of current legal regulation that guides vaccination against COVID-19 in Russia. The article concludes with an observation that a well-balanced model of regulation should be based on high-quality research findings and be accompanied by the willingness of the state to carry out a consistent information campaign and take on the responsibility for negative side-effects experienced by some citizens who have gone through vaccination. © 2022.

The attitude of students of Lublin universities to vaccination in the COVID-19 period

Introduction. Vaccines are one of the greatest achievements of modern medicine. The compulsory vaccination schedule was introduced in Poland in the 1950s. Vaccinations are sometimes followed by adverse effects (ARV). The most common symptoms of ARV are swelling, redness and soreness at the injection site, usually lasting up to 24 hours after vaccination. Aim. The aim of our study was to check the attitude of students of Lublin universities to vaccination in the COVID-19 period. Material and methods. In December 2020 we conducted an anonymous and voluntary survey. It was uploaded and shared on the Google online survey platform. A total of 75 students participated in the study. Results. The respondents were 56 women and 19 men. Out of them 30 (40%) were from Medical University of Lublin (MUL), 15 (20%) from University of Life Sciences (ULS), 21 from University of Marie Sklodowska-Curie (UMCS) (28%) and 9 from Lublin University of Technology (LUT) (LP) (12%). Their mean age was 22 years +or- 1.1 (SD). More than half of the respondents were not interested in compulsory vaccinations before the COVID-19 pandemic. Only about 35% (18 persons) of people expressed a positive opinion about vaccines and they were students of MUL. Although 80% of respondents answered that the anti COVID-19 vaccine is necessary, but 81% thought that Poles had not enough knowledge about the vaccine. Students themselves most often obtained information about vaccines and ARVs from Internet. Conclusion. Students of MUL were the most enthusiastic about mandatory vaccinations and anti COVID-19 immunization. Poles need more reliable information about vaccine to change their attitude towards it.

The nineteenth-century experience of the kingdom of the two Sicilies on mandatory vaccination: An Italian phenomenon?

The current health emergency caused by COVID-19 disease shows several similarities with well-known epidemics of the past. The knowledge of their management and overcoming could give us useful tools to face the present COVID-19 pandemic. The Bourbon king Ferdinand I planned the first free large-scale mass vaccination programme conducted in Italy and one of the first in Europe to counteract smallpox. The vaccination campaign was characterized by many difficulties and the efforts made by the Southern Kingdoms governors were enormous. For example, the "ante litteram communication campaign", aimed at convincing the so-called "hesitant" people and at confuting the arguments of vaccination opponents, was impressive. In 1821, the compulsory vaccination significantly reduced smallpox infections and death rates. Subsequently, several experiences followed this initiative, not without doubts and debates. Smallpox was finally eradicated worldwide only on the 9th December 1979. Despite to other countries, the "mandatory vaccination" is a topic often debated by Italian scientific and social communities.

Covid-19, mandatory vaccination and fundamental rights under the Judgment of the European Court of Human Rights Vavricka and others c. Czech Republic: a false dilemma

This paper analyzes one of the most debated issues since the world pandemic was declared by Covid-19: the achievement of an effective vaccine, as the best for-mula to combat contagion and that allows a return to normality. Although, it does so from parameters somewhat remote from what is usual in doctrine, after deep reflection and reading some texts of a scientific-experimental nature on how current vaccines have been developed, their possible (or not) future consequence on the health of the recipients and its true effectiveness. in controlling the transmission of the disease and achieving a true herd immunization. © 2021, Centro Estudios Politicos Constitucionales. All rights reserved.

Mandatory vaccination and the 'seat belt analogy' argument: a critical analysis in the context of the Covid-19 pandemic.

The seat belt analogy argument is aimed at furthering the success of coercive vaccination efforts on the basis that the latter is similar to compulsory use of seat belts. However, this article demonstrated that this argument does not work so well in practice due to several reasons. The possibility of saving resources in health care does not usually apply in our societies, and the paternalist mentality that contributed to the implementation of seat belt-wearing obligation was predominant 30 years ago, but it does not apply at this moment. Furthermore, the risk/benefit analysis is totally different in both scenarios. In the case of seat belts, there is no way to discriminate between the users. In the case of vaccines, individuals present with unique circumstances that may differ substantially from those of another and might be foreseen a priori. This means that an analysis must be performed individually before vaccination is imposed. Finally, one must keep in mind that seat belts are often the only way in which we can protect third parties against a tragic hit by the occupant of another vehicle and are very efficient tools for this purpose. Vaccines, in contrast, do not always create sterilising immunity and are definitely not the only way by which we can avoid spreading a virus; immunity certificates, isolation, or even confinement may also serve as viable methods to achieve this purpose.

Ethics of vaccination prioritization and compulsory vaccination: An integrative approach

Vaccine scarcity and availability distinguish two central ethics questions raised by the Covid-19 pandemic. First, in situations of scarcity, which groups of persons should receive priority? Second, in situations where safe and effective vaccines are available, what circumstances and reasons can support mandatory vaccination? Regarding the first question, normative approaches converge in prioritizing most-vulnerable groups. Though there is room for prudential judgement regarding which groups are most vulnerable, the human dignity principle is most relevant for prioritization consideration of both medical and non-medical issues. The second question concerning mandates is distinct from considerations about persons' individual moral duty to receive vaccines judged reasonably safe and critical for individual and public health. While there is consensus regarding the potential normative support for mandated vaccination, the paternalistic government intervention of vaccine mandates requires a high bar of demonstrated vaccine safety and public health risk. We discuss stronger and weaker forms of paternalism to deal with the Covid-19 pandemic from an "integrative"approach that integrates leading normative approaches. We argue against a population-wide compulsory vaccination and support prudential measures to 1) protect vulnerable groups;2) focus upon incentivizing vaccine participation;3) maintain maximum-possible individual freedoms, and 4) allow schools, organizations, and enterprises to implement vaccine requirements in local contexts. © 2021 Martin O'Malley et al., published by Sciendo.

Compulsory vaccination: Public benefit or individual’s right limitation

Mass vaccination and its controversial assessments have become key issues under the covid-19 pandemic. Outbreaks of diseases and popularity of anti-vaccination movements require a study of legal foundations for medical interventions and freedom restrictions which are considered as the result of serious risks to health and sanitary-epidemiological well-being of the population. The question is what should be prioritized — paternalistic powers of the state or individual rights and freedoms to decide what risks to take. In terms of responsibility distribution, people often consider vaccines as more dangerous than infectious diseases [17], which makes compulsory vaccination a legal phenomenon of particular importance. In the contemporary legislation, there are various national approaches to the individual autonomy and freedoms. In some countries, vaccination is directly linked to the possibility to study (USA), in others it is associated with ‘public health’ (Australia), financial sanctions (Poland) or freedoms’ limitations (Pakistan). In terms of public health ethics, vaccination is similar to the use of seat-belts in cars, and compulsory vaccination policy is ethically justified by the same reasons as mandatory seat-belt laws [8]: at first, they were met with great opposition;later the use of seat belts acquired the significance of not only a legal but also a social norm precisely because it was made mandatory [1]. The similar approach is applicable to vaccination: the policy of compulsory vaccination can make it a social norm. However, in the legal perspective, compulsory vaccination is a compulsory medical intervention which raises the question about whether it is possible to limit individual rights and freedoms in the name of public health safety. The article considers contradictory issues in the state policy of compulsory vaccination and its legal support. The author presents a definition of compulsory vaccination, identifies its types, describes the specifics of its national legal regulation and sanctions for the refusal to be vaccinated, and explains its social necessity and expediency as a public good. © 2021, RUDN UNiversity. All rights reserved.

Immunity as relativity: German vaccination campaigns and debates in times of covid-19

»Immunität als Relativitätstheorie: Deutsche Impfkampagnen und Debatten während der Coronapandemie«. COVID-19 was a shock. The shutdown of entire societies was considered a historic turning point already in 2020. Vaccinations promised a way out of the crisis. Even before the vaccination campaigns began, they were seen as a weapon that would decide the war against the pandemic, even as a promise of salvation. These hopes were dashed in 2021. Vaccinations offered a relatively high level of, but not absolute, protection. Vaccinated people were still contagious and thus a risk to others. My article traces the history of this disappointment and the attempts to solve it. I focus on German debates about prioritising vaccine distribution, dealing with side effects, and debates about compulsory vaccination and increasing social pressure on the unvaccinated. Vaccination campaigns thus serve as a probe with which to examine social orders and social distortions. At the same time, I place the current developments in a historical perspective. I ask both about the historical roots of today’s debates and about new developments since 2020 that only become visible in a historical perspective. © 2021, GESIS - Leibniz Institute for the Social Sciences. All rights reserved.