The Policy Issue
The COVID-19 pandemic has become a catalyst for the strongest global crisis. In recent decades, there is hardly an event that would have a similar shock effect almost anywhere in the world. The pandemic has seriously hit the world economy; the first wave of the epidemic harmed the United States, the European Union and the global economy in general. Overcoming its economic consequences will take a long time; vaccination against COVID-19 not only reduces the likelihood of developing coronavirus infection and its complications (Korn et al., 2020). It is also associated with the positive economic effect of vaccination. Even in the presence of comorbid pathology, the cost of treating patients with prophylaxis was lower than in patients who were not vaccinated. Thus, the issue affects the policy arena causing a debate regarding the mandatory vaccination.
The current politics of the issue is that coronavirus vaccination is included in the approved official vaccination calendar. However, this does not make vaccination mandatory, this requires changes in legislation. At the same time, this procedure makes it legitimate to vaccinate children from 12 to 17 years old with the written consent of one of the parents (Hooste & Bekaert, 2019). The issue is still ambiguous in the policy-making process regarding the scale and mandatory vaccination. At the moment, it is obligatory only for priority categories of the population at greatest risk of infection. Everyone can be vaccinated during the year voluntarily, but there is a debate about the mandatory vaccination.
Policy Analysis Framework
Social Context
In the social context, society has split into two camps regarding the point of view on vaccination. The first group supports the introduction of mandatory vaccinations against COVID-19, based on scientific knowledge and clinical trial data (Korn et al., 2020). The second half resists vaccination, expressing various concerns about the effectiveness of vaccination and predicting its adverse long-term health effects.
Ethical Context
The main ethical challenges associated with vaccination are caused by the need to overcome the conflict between the interests of the individual and society. The introduction of mandatory vaccination may violate respect for the autonomy of the individual and respect for the right of voluntary choice. The lack of fairness in the distribution of the vaccine and its availability is also an ethical problem (Hooste & Bekaert, 2019). At the same time, the refusal to vaccinate demonstrates such an ethical issue as the lack of social responsibility and solidarity.
Legal Context
On the one hand, refusal of vaccination cannot be an offense, since it is the realization of a universally recognized right. Accordingly, vaccination cannot be ensured by the application of legal liability, since it violates the legal freedom of choice (Phelan, 2020). On the other hand, refusal of vaccination poses a threat to others, as it contributes to the further spread of the pandemic. Therefore, this paragraph in the law allows the authorities to issue an order on the mandatory nature of the vaccine.
Historical Context
The introduction of mandatory vaccination has led to a large reduction in mortality and serious complications. The introduction of vaccinations has saved millions of lives from many diseases during the global influenza, smallpox or measles pandemics (Mackin & Walker, 2021). At the same time, there have historically been cases of severe side effects after the use of the vaccine (for example, diphtheria vaccines for infants).
Financial & Economic Context
A significant reduction in morbidity is a financial advantage of using the vaccine. The cost of the vaccine is paid off by the economic benefits of implementing a vaccine prevention program. Even in the case of getting sick with COVID-19, the illness will take place in a milder form, therefore, the costs per patient will be reduced (Vaz et al., 2020). However, there is a risk of post-vaccination complications, which is an economic loss from vaccination.
Theoretical Underpinnings of the Policy
The theoretical underpinnings of the policy are based on clinical trials of various COVID-19 vaccines. Before starting clinical trials, the vaccine has passed the stages of preclinical efficacy and safety trials, the results of which are published in the public domain (Shiloh et al., 2021). However, the consequences of vaccination for children and pregnant women have not been fully studied, which affects the introduction of vaccination policy for these two population groups.
Stakeholders
The stakeholders of interest are the government, which needs to reduce morbidity in order to prevent the destruction of the economy. The stakeholders of the lack of mandatory vaccination are scammers offering alternative treatments and selling vaccination certificates.
Nursing Policy
Official nursing policy on the health care issue of vaccination is supporting it. It is officially stated in the medical community that this is the only reliable way to avoid infection or complicated course of the disease. This position was developed by the World Health Organization (Phelan, 2020). The official statement says that vaccination can significantly facilitate the fight against the spread of the virus and contributes to the creation of collective immunity.
Policy Options & Solutions
No Change
The no-change position will mean completely voluntary vaccination. Despite the fact that various stimulants are being introduced at the state level in order for the population to be vaccinated en masse. Thus, evacuated citizens are prohibited from entering cinemas, museums, shopping malls, traveling on intercity trains and appearing in other crowded places. However, there is no punishment at the official level for refusing vaccination, therefore, it cannot be considered an illegal action. The theoretical underpinning of this policy option is the absence of the term “compulsory vaccination” in the legislation. The law “On immunoprophylaxis” states that anyone can refuse vaccination, it is voluntary (Mackin & Walker, 2021). The decision of the Chief State sanitary doctor has no compulsory force.
The aspects of propaganda in this case will remain unchanged. These are advertising on social networks, on the Internet and on advertising banners. These are also incentives from the state: for example, one-time payments to all vaccinated pensioners. Leadership requirements will also be the same as at the moment: around 60% of the company’s employees will be required to have vaccination (Vaz et al., 2020). The need for interprofessional collaboration in this case will be conditioned by the need to convince the population of the need. Therefore, it will be necessary to work closely with doctors and sociologists who will help to properly convey the data to the public. Since people are more actively listening to the opinions of famous people, it will be necessary to attract people of creative professions. Musicians and actors, interacting with medical specialists and sociologists, will be able to stimulate voluntary vaccination.
The advantage of choosing this strategy will be the preservation of public peace. There will be no significant discontent among the population, therefore, conflicts will be avoided. The negative result of choosing this strategy will be an insufficient number of vaccinated. About 70% of the world’s population should receive a vaccine against COVID-19 coronavirus infection (Shiloh et al., 2021). Only then will the pandemic end and the disease will cease to pose a threat, as collective immunity will be developed. However, with voluntary vaccination, it is unlikely that the vaccination rate will reach 70%.
The cost benefits when choosing this option are not very much. The only advantage will be the absence of the need to purchase a large number of vaccines. There will be no need to increase the costs of increasing the production of vaccines against COVID-19. It will be possible to reduce the purchase of syringes, gloves and other medical equipment for vaccination points (Korn et al., 2020). The effectiveness of this method will be low: this is due to a lot of false information about vaccination. Despite the introduction of fines for spreading false information about vaccination against COVID-19, many are still distrustful of the procedure. Therefore, the percentage of unvaccinated citizens is quite high, therefore, the effectiveness of this strategy in combating the pandemic will be low.
The efficiency of that option is small: those citizens who tend to trust the government and media personalities will get vaccinated. People who actively visit crowded places, such as clubs and theaters, will also have to be vaccinated against COVID-19. However, considerable of the population will refuse vaccination because of prejudice. The utility of this method will be to preserve public peace. The introduction of stricter measures regarding mandatory vaccination may cause open resistance among the population. A large percentage of the population may be outraged by the lack of a voluntary factor, which will lead to conflicts with the authorities and citizens who support vaccination (Hooste & Bekaert, 2019). Thus, the introduction of soft incentives is the most socially acceptable method. This option is implemented in the vast majority of countries of the world at the moment. It does not require amendments to legislation or readiness for conflicts with citizens. All that is required is the organization of a competent social pro-vaccine policy and the deployment of a large-scale advertising campaign. Therefore, the implementation of this option is the simplest.
Partial Change
A partial change will imply mandatory vaccination of all citizens, except children, adolescents and pregnant women. Citizens who refuse vaccination will not be able to get a job. At the moment, this statement is valid only for person-to-person work, but with the introduction of partial change, it will also apply to employment in other areas. The theoretical underpinnings of the policy options are related to the need to maintain a balance between public peace and efficiency. Society is most likely to worry about children and pregnant women, so these groups of the population will not be subject to vaccination (Phelan, 2020). However, mandatory vaccinations against COVID-19 among the rest of the population will overcome the pandemic.
The health advocacy aspects of this option will require more evidence of the positive effect of the vaccine. It may be necessary to have a mandatory meeting of various groups of citizens (for example, at work) with an invited medical expert. Their responsibility will be to conduct scientific and educational activities among the population regarding vaccination and debunking myths and stereotypes (Mackin & Walker, 2021). In this regard, this solution provider is a need for interprofessional collaboration. In addition to educational activities, it will also be necessary to strengthen the number of vaccination posts. Therefore, it will also be necessary to strengthen collaboration with ordinary medical staff for mass vaccination.
The advantages of this solution will be an effective reduction of the risk of infection. In the process of immunization, collective immunity is formed. Thus, 70% of the population will be vaccinated, and COVID-19 stops spreading (Vaz et al., 2020). Vaccinated, being in the immediate environment of unvaccinated (pregnant women, children and adolescents), will protect them from infection. The disadvantages of this method of combating the pandemic will be a wave of public outrage. At the moment, the protests do not go much beyond the virtual reality border. However, the introduction of mandatory vaccination against COVID-19 can lead to offline conflicts. Public outrage can also be directed at the authorities, which can lead to confrontation not only between population groups, but also with the government.
When choosing this strategy, the cost benefits will be the most significant. The vaccination program against COVID-19 in this case acts as an investment in the human capital of the country. It improves the health of the population, life expectancy and labor productivity. Mandatory mass vaccination will also reduce government spending on treatment and control of the disease and complications. This method will have high effectiveness: with the introduction of mandatory state vaccination, it will be impossible to evade it. In connection with the introduction of a system of fines, employers will carefully check the availability of vaccination certificates for employees (Shiloh et al., 2021). This will lead to an increase in counterfeit certificates, and a small number of citizens will be able to afford their purchase. For this reason, the population will have only one possible option – to be vaccinated.
The effectiveness of this option is quite high: the virus will be transmitted to people with immunity to it already existing as a result of vaccination. The probability of transmission of the virus to groups of the population who have the right not to be vaccinated will also be reduced. Thus, if there is mandatory mass vaccination, it will be possible to stop the pandemic. The utility of this method will consist in the acquisition of mass collective immunity. With the help of mass vaccination, it will also be possible to help people with health or age restrictions. Due to the presence of vaccinated people in their environment, their probability of getting sick will decrease several times. The feasibility of this option is also highly likely. The coronavirus virus continues to develop new strains, but the number of vaccinated is still insufficient to achieve collective immunity. However, the introduction of mandatory vaccination will require some changes in the current legislation.
Maximum Change
Radical, or maximum, change will also involve vaccination of adolescents and pregnant women. Only people with health restrictions (for example, leukemia) will not be subject to mandatory vaccination. At the moment, the issue of vaccinating adolescents and pregnant women is controversial and voluntary. However, since children are carriers of COVID-19, part of the medical community is in favor of their vaccination. The theoretical underpinnings of the policy options are high death statistics among school teachers or kindergarten workers. COVID-19 is often asymptomatic in children and adolescents, but they are still active carriers of the disease. Thus, to stop the spread of infection, it is necessary to vaccinate its carriers, too.
The health advocacy aspects of this option will include more clinical trials on teenagers and pregnant women. It is necessary to more seriously investigate the side effects of vaccination against COVID-19, and to familiarize the public with them. It is also worth carefully calculating the dosage so that the procedure is as safe as possible. This option provides a great opportunity for inter-professional collaboration. Due to the need for new clinical trials, scientists of different specialties should unite. Thus, it will be possible to build the most humane and legal procedure for conducting clinical trials. Moreover, collaboration with sociologists will help to properly inform the public about the results obtained.
The advantage of choosing this strategy will be the unambiguous development of collective immunity against COVID-19. The incidence of infection will proceed without outbreaks, there will be no excessive burden on the health care system. As a result of vaccination of adolescents and children, not only transmission of infection will be interrupted, but also the level of carrier of the pathogen will decrease. This will eliminate COVID-19 without vaccinating citizens with a high probability of developing complications.
The disadvantage of this vaccination policy may be a large number of complications among children and adolescents. This group of the population tolerates vaccination more heavily, and in most cases the body does not recover immediately. Thus, adolescents will need more time to recover after the introduction of the vaccine. Moreover, due to the small number of clinical trials, complications may occur that were not originally intended (Korn et al., 2020). Although the cost benefits obtained as a result of immunization significantly reduces morbidity, the potential cost of treating complications after vaccination in adolescents is also quite high. Therefore, the money saved for the treatment of complications in patients can be redirected to help eliminate complications after vaccination.
Definitely, this method has high effectiveness, as it will allow to achieve 90 percent vaccination. 10 unvaccinated percent are citizens who have serious medical contraindications, so they cannot be vaccinated with any of the options. However, the effectiveness of that option is questionable (Hooste & Bekaert, 2019). Despite the emergence of collective immunity in the case of full vaccination, it will most likely not be achieved. Severe post-vaccination reactions in children and adolescents, as well as the development of complications in them, will cause public resistance. Such an approach can cause a backlash: the number of citizens who believe that the vaccine poses a health hazard will increase.
The utility of this decision also raises doubts: even the World Health Organization called for not resorting to mass mandatory vaccination of adolescents. The existing list of possible side effects for adolescents and children is not complete. Moreover, the frequency of their occurrence has not been fully studied. Thus, at this stage it is impossible to assert about utility of radical changes. The feasibility of this option is very low: the law prescribes the right of every citizen to receive secondary education. Therefore, it is legally impossible to suspend children and adolescents from classes in the absence of a vaccination certificate. In addition, due to the high probability of conflicts between the population and the authorities over childhood vaccination, such a solution is also not possible.
Building Consensus
Taking into account all the above factors, partial changes will be the most acceptable strategy for immunization of the population from COVID-19. The no-change strategy has not proved to be effective: only about half of the vaccination of the population has been achieved. Therefore, it is necessary to introduce tougher incentives to combat the pandemic and the formation of collective immunity. However, a strategy using radical changes can cause the opposite effect: active opposition to mass immunization. Society tends to protect the safety of children and adolescents, so the introduction of their mandatory immunization can cause a dangerous social situation. Thus, the most optimal option for immunization about COVID-19 will be the introduction of partial changes.
References
Hooste, W. L., & Bekaert, M. (2019). To be or not to be vaccinated: The ethical aspects of influenza vaccination among healthcare workers. International Journal of Environmental Research and Public Health, 16(3981), 1-10.
Korn, A. J., Böhm, R., Meier, N. W., & Betsch, N. (2020). Vaccination as a social contract. Proceedings of the National Academy of Sciences, 117(26), 14890-14899.
Mackin, D. V., & Walker, S. P. (2021). The historical aspects of vaccination in pregnancy. Best Practice & Research: Clinical Obstetrics & Gynaecology, 76(13), 13-22.
Phelan, A. L. (2020). COVID-19 immunity passports and vaccination certificates: Scientific, equitable, and legal challenges. The Lancet, 395(10237), 1595-1598.
Shiloh, S., Peleg, S., & Nudelman, G. (2021). Vaccination against COVID-19: A longitudinal trans-theoretical study to determine factors that predict intentions and behavior. Annals of Behavioral Medicine, 17(36), 291-292.
Vaz, O. M., Ellinǵson, M. K., Weiss, P., Jenness, S. M., Bardají, A., Bednarczyk, R. A., & Omer, S. B. (2020). Mandatory vaccination in Europe. Pediatrics, 145(2), 438-443.
