Compulsory vaccination against Covid-19, a public health duty and a democratic commitment
Press release of the French National Academy of Medicine and the National Academy of Pharmacy 1
July 9, 2021
Since the launching of the national vaccination campaign against Covid-19, the National Academy of Medicine has expressed itself publicly on 7 occasions through press releases. In particular, it recalled and explained that only universal vaccination would make it possible to control the pandemic during the year 2021 (December 14, 2020); and that the implementation of the vaccination program should be accelerated (December 30, 2020).
The French National Academy of Medicine has recommended:
– the vaccination of all pregnant women at risk or with co-morbidity (March 2, 2021);
– the compulsory vaccination against Covid-19 for health professionals, staff of EHPADs and caregivers of the elderly (March 8, 2021);
– the need to create a vaccination pass rather than a health pass (April 29, 2021);
– the mandatory vaccination against Covid-19 (May 25, 2021);
– the suspension of reimbursement for RT-PCR and antigenic tests performed for personal convenience (June 23, 2021).
These positions have preceded a debate that should no longer be avoided in the face of the epidemic resurgence fueled by the Delta variant. The principle of voluntary vaccination is now showing its limits, which compromise access to the level of collective immunity essential to avoid an epidemic resurgence in the 4th trimester. The opinions of the French National Academy of Medicine issued since the launching of the vaccination strategy are supported by the Pasteur Institute study presented on June 29, 2021, which concludes that vaccination is currently “the most effective approach for controlling the epidemic”. The following day, the High Health Authority (HAS) also estimated that “Consideration on the vaccination obligation could be extended to the whole population”.
Various informative and incentive approaches have been developed for people still reluctant to be vaccinated against Covid-19, without conclusive results. Health authorities are now discussing the possibility of a legislation on compulsory vaccination.
In this context, ethical arguments must imperatively be added to public health arguments. While individual freedom must be respected, it is nonetheless limited when there is a danger for others. In the face of Covid-19, vaccination is not only a civic gesture, it is an ethical imperative. It is important that the political decisions arbitrated following the current consultation in progress, be informed, supported and accompanied by the opinions of personalities representing the fields of health and ethics and by the representative bodies of health democracy.
For caregivers and professionals in charge of the elderly and vulnerable people, compulsory vaccination against Covid-19 is essential in the light of the principles of solidarity and reciprocity. It also concerns the paramedical and administrative hospital staff, ambulance drivers, firemen, etc. Each caregiver is required to do everything possible in order to “do no harm”. Doctors and pharmacists share a duty to set an example to their patients and play a major role in promoting vaccination. The principles of benevolence and non-maleficence are at the foundation of the ethics of care and support. Knowingly, endangering the lives of vulnerable people in one’s care blurs the meaning of collective effort and compromises its effectiveness. The protection of the most vulnerable is a democratic requirement at the very basis of the fight plan against the pandemic. The morbidity and mortality induced by nosocomial Covid-19 call for individual responsibility and spirit of commitment, respect for ethics and good practices. The same should be true for other professions working in an environment that favors contamination risks. Deferring the vaccination of health care workers is to implicitly consent to new healthcare-related contaminations.
For the entire population aged 12 and over, compulsory vaccination against Covid-19 is the only realistic option in terms of personal responsibility and commitment to solidarity, making it possible to preserve one’s own health and that of others and to achieve collective immunity. Compulsory vaccination is necessary when an effective and well-tolerated vaccination can control a severe, life-threatening infection that is uncontrollable by any other means. Several diseases have justified such a decision in France: smallpox (1902-1984), diphtheria (1938), tetanus (1940), tuberculosis (1950-2007), poliomyelitis (1964). More recently, 11 infant vaccines were made mandatory in 2017.
Promoting mandatory vaccination means recognizing the urgent need to mobilize the national community in the fight against a new pandemic flow linked to SARS CoV-2 variants. This requires a communication effort targeting isolated, vulnerable or excluded people who do not have access to relevant information.
The French National Academy of Medicine and the National Academy of Pharmacy also recall our duty of international solidarity towards populations deprived of the privilege to benefit from vaccination.
For the National Academy of Medicine and the National Academy of Pharmacy:
– Covid-19 combines all the characteristics that justify the vaccination obligation;
– The “vaccination pass” should be able to attest the compliance with this obligation;
– The implementation of the vaccination obligation should be accompanied by a national communication campaign favoring a targeted pedagogy of shared responsibility, avoiding any stigmatization, as part of a democratic commitment;
– Vaccination solidarity is essential internationally.