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The unintended consequences of COVID-19 vaccine policy: why mandates, passports and restrictions may cause more harm than good
  1. Kevin Bardosh1,2,
  2. Alex de Figueiredo3,
  3. Rachel Gur-Arie4,5,
  4. Euzebiusz Jamrozik5,6,
  5. James Doidge7,8,
  6. Trudo Lemmens9,
  7. Salmaan Keshavjee10,
  8. Janice E Graham11,
  9. Stefan Baral12
  1. 1School of Public Health, University of Washington, Seattle, Washington, USA
  2. 2Division of Infection Medicine, University of Edinburgh, Edinburgh, UK
  3. 3Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
  4. 4Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
  5. 5Oxford-Johns Hopkins Global Infectious Disease Collaborative (GLIDE), University of Oxford, Oxford, UK
  6. 6Ethox and the Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
  7. 7Intensive Care National Audit and Research Centre (ICNARC), London, UK
  8. 8Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
  9. 9Faculty of Law and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  10. 10Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
  11. 11Department of Pediatrics (Infectious Diseases), Dalhousie University, Halifax, Nova Scotia, Canada
  12. 12Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Dr Kevin Bardosh; bardosh_kevin{at}hotmail.com

Abstract

Vaccination policies have shifted dramatically during COVID-19 with the rapid emergence of population-wide vaccine mandates, domestic vaccine passports and differential restrictions based on vaccination status. While these policies have prompted ethical, scientific, practical, legal and political debate, there has been limited evaluation of their potential unintended consequences. Here, we outline a comprehensive set of hypotheses for why these policies may ultimately be counterproductive and harmful. Our framework considers four domains: (1) behavioural psychology, (2) politics and law, (3) socioeconomics, and (4) the integrity of science and public health. While current vaccines appear to have had a significant impact on decreasing COVID-19-related morbidity and mortality burdens, we argue that current mandatory vaccine policies are scientifically questionable and are likely to cause more societal harm than good. Restricting people’s access to work, education, public transport and social life based on COVID-19 vaccination status impinges on human rights, promotes stigma and social polarisation, and adversely affects health and well-being. Current policies may lead to a widening of health and economic inequalities, detrimental long-term impacts on trust in government and scientific institutions, and reduce the uptake of future public health measures, including COVID-19 vaccines as well as routine immunisations. Mandating vaccination is one of the most powerful interventions in public health and should be used sparingly and carefully to uphold ethical norms and trust in institutions. We argue that current COVID-19 vaccine policies should be re-evaluated in light of the negative consequences that we outline. Leveraging empowering strategies based on trust and public consultation, and improving healthcare services and infrastructure, represent a more sustainable approach to optimising COVID-19 vaccination programmes and, more broadly, the health and well-being of the public.

  • COVID-19
  • vaccines
  • health policy
  • infections, diseases, disorders, injuries
  • public health

Data availability statement

There are no data in this work.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Handling editor Seye Abimbola

  • Twitter @KevinBardosh, @ID_ethics

  • Contributors KLB wrote the original draft. All authors contributed substantially to the development, revision and finalisation of the manuscript.

  • Funding Funding was provided to KLB through a Wellcome Trust Society and Ethics Fellowship (10892/B/15/ZE). EJ and RG-A also received funding from the Wellcome Trust UK (grant numbers 221719 (RG-A and EJ) and 216355 (EJ)). TL received funding from two University of Toronto Connaught grants: Advancing Anti-Corruption, Transparency and Accountability Mechanisms to Tackle Corruption in the Pharmaceutical System, and Advancing Rights-based Access to COVID-19 Vaccines as part of Universal Health Coverage.

  • Competing interests Within the past 2 years, AdF was involved in Vaccine Confidence Project collaborative grants with Janssen Pharmaceutica outside of the submitted work and holds a Merck grant to investigate COVID-19 vaccine attitudes.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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