By Nicholas Goldberg
At the end of August, police in China’s Hunan province came to the home of Zhang Jianping. They questioned him about why he had not been vaccinated against COVID-19, and they took him by car to a hospital.
In a social media post that included photos and videos to back up his story, Zhang said he was very clear that he did not want to be immunized. “I am not informed. I do not consent,” he says he told the authorities. But they held down his arms and legs and forcibly injected him.
According to Yaqiu Wang, the researcher at Human Rights Watch who saw Zhang’s post, the local police and health care officials were acting in response to President Xi Jinping’s call for the vaccination of 80% of the country’s population by the end of October. Even though the central government in Beijing says “informed consent” is the rule and injections must be voluntary, Wang says many such complaints of compelled vaccination have appeared on social media.
When I first heard about this, I was horrified. For government officials to burst into people’s homes to forcibly vaccinate them seemed, at the very least, like an extraordinary violation of personal liberty.
But am I being a hypocrite?
After all, I’m a supporter of vaccine mandates in this country to get recalcitrant Americans immunized. I think it’s reasonable to bar unvaccinated people from restaurants and sports arenas and even schools if they’re not vaccinated. The justification for that goes back to the 19th century philosopher John Stuart Mill’s harm principle, which says that although people should generally be free to behave as they want, constraining their behavior is justified when their actions cause harm to others.
Couldn’t it be argued that pinning people down and vaccinating them is just the logical extension of our own mandate policies? The Chinese and the U.S. governments have the same objective — to vaccinate the maximum number of people, and stop the spread and mutation of the virus. The Chinese are just going a little further in their tactics, right?
Not right. Flat wrong. What these local officials in China are doing is entirely unacceptable.
Despite the harm principle, not every use of power is acceptable to prevent injury to others. It is justifiable to restrict a measure of liberty in pursuit of the communal good; that balance must sometimes be struck. But in the opinion of most bioethicists — and I agree — forced vaccination goes too far.
The fight over whether vaccinations should be mandatory is an old one. The first vaccine was developed in the late 1700s to fight smallpox. In 1853, the immunization of all infants against the disease was made compulsory in England, with parents who refused punishable by fines and prison terms.
That in turn led to anti-vaccination protests and even riots, according to James Colgrove, a professor of public health at Columbia University. As a result, exceptions were added to the law.
In the U.S., a case went to the Supreme Court in 1905 over whether it was within the “police power” of the state of Massachusetts and its cities to make vaccinations compulsory. The court ruled that it was.
But in neither the U.S. nor England were the authorities seeking to physically compel people to undergo unwanted immunizations. In Massachusetts, the penalty for disobeying the law was not that you were wrestled to the ground and jabbed; rather, you had to pay $5.
Today, too, our “mandates” are really not mandates in any strict sense. In the U.S., if parents don’t want their child vaccinated against COVID, it’s possible the child won’t be allowed to enroll in public school. But parents have other choices — including, in many cases, private school or home schooling.
If a restaurant bars you at the door, you can eat elsewhere. If your employer won’t let you back in the office, you can work from home or seek a new job. These rules are not meant to punish but to protect public health.
In general, it’s best to use the least intrusive means necessary to encourage vaccination and protect the population, following what ethicists sometimes call the “principle of least restriction” as well as a sense of proportionality. Robust public education persuading patients to give their informed consent is ideal. Incentives are good, too. Bans and restrictions are obviously less desirable.
Physical coercion is almost universally considered unacceptable. There’s a big difference between saying “there will be consequences” for failing to get vaccinated — and injecting people by force. The right of patients to control their bodies is a bedrock principle not just in the United States but in medical communities around the world.
“We don’t believe in our society that it is acceptable to force people to take a vaccine even though we might think their refusal to do so is stupid or misguided or irresponsible or even dangerous,” Colgrove says.
Besides, sticking people with needles against their will is unlikely to build trust or encourage widespread cooperation. Especially in China, with its history of vaccine-related scandals in which children have been given expired or faulty immunizations.
China is of course a repressive, authoritarian country. It also is, by long tradition, a country that values the community interest over the liberty of the individual. But physical coercion is an unethical and counterproductive way to accomplish the goal of reaching herd immunity, a goal that all countries should be striving for through education, persuasion and adherence to science.
Nicholas Goldberg is an associate editor and op-ed columnist for the Los Angeles Times.
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