Requirements for certain groups of people to be vaccinated against COVID-19, known as vaccine “mandates,” have generated significant debate, including in institutions of higher education and health care settings in the United States. More mandates are likely to be instituted in the United States as vaccine manufacturers seek full approval from the Food and Drug Administration, virus variants drive surges, and vaccination rates plateau. We outline below six key points to consider when determining the human rights implications of COVID-19 vaccine mandates. These perspectives allude to the U.S. context, but many are applicable globally as vaccines become more widely available.
1. There is strong legal grounding in the United States for vaccine mandates in public and private settings.
Vaccine mandates have a long history as an important tool to ensure the public’s health. In the context of COVID-19, the question is less whether mandates can legally be instituted and more how they can be ethically and equitably structured to protect human rights.
2. Mandates can be ethical and rights-respecting if availability, accessibility, and acceptability of high-quality vaccines are widespread and equitable.
Any entity contemplating a mandate must ensure that all people subject to the mandate can receive vaccination according to the four pillars of the right-to-health framework: Availability, Accessibility, Acceptability, and Quality (AAAQ). Steps that must be taken to adhere to the AAAQ framework for people subject to a COVID-19 vaccine mandate include:
- the opportunity to receive culturally sensitive, free, accurate, and detailed information from trusted sources in their preferred language to address vaccine-related concerns;
- the option to receive free vaccination at a time that works for their schedule;
- the offer of free childcare to facilitate receiving the vaccine and for any needed recovery time;
- free transportation to a vaccination site; and
- the guarantee of paid time off (where applicable) to receive the vaccine and to recover from any vaccine-related side effects.
3. Any entity instituting a mandate must provide reasonable accommodation for people for whom vaccination is not advisable.
Some people cannot receive vaccination for religious or medical reasons (e.g., allergic reactions to vaccine contents or specific underlying health conditions). These people must be offered alternative transmission mitigation strategies, such as regular COVID-19 testing and mask-wearing, and should not suffer any consequences from being unable to meet a vaccine mandate.
4. Mandates should never apply to people who are in detention.
People who are detained should be offered vaccines and provided accurate information from trusted sources to answer their vaccine-related questions, but vaccines should never be mandated for them while in detention, nor as a condition of their release. The disparate power dynamic for people in detention creates an inherently coercive situation in which mandating vaccination would be a clear rights violation. Anyone vaccinated in detention must be provided with their complete medical and vaccination records upon transfer or release to facilitate their ability to meet future proof-of-vaccination requirements.
5. People who have received vaccines that have been approved by the World Health Organization (WHO) should be considered to have satisfied any vaccine mandate.
Entities instituting mandates should accept all vaccines authorized for use by the WHO, even if the vaccine has not been approved by the country’s own regulatory body. An entity could offer an available higher-efficacy vaccine to people subject to its mandate who have previously received a lower-efficacy vaccine, provided that mixing vaccines is endorsed by medical and public health authorities. However, people in this situation should not be required to accept the offer to meet the mandate.
6. Any vaccine mandate should be reevaluated regularly as the circumstances of the pandemic evolve.
By observing the above points, mandates can respect rights while helping advance population health. But mandates should not remain in place longer than needed. As stated by the WHO, any mandate should be periodically revisited to “ensure it remains necessary and proportionate to achieve public health goals,” particularly in the rapidly evolving context of the COVID-19 pandemic.