Mandatory vaccines: Ethics, legality and constitutionality around compulsory inoculation – Prof Dhai

Freelance healthcare journalist Chris Bateman is joined by Professor Ames Dhai, the founder and former director of the Steve Biko Centre for Bioethics at the Wits Faculty of Health Sciences. What’s more, Dhai also serves as the vice-chair on the Ministerial Advisory Committee for Covid-19 vaccines. She joined BizNews to discuss Covid-19 vaccination and mandatory inoculation in South Africa. Dhai says that, “if we had to go [with] mandatory vaccination – and we pulled from constitutional principles – looking at limiting one’s right to autonomy and autonomous decision making, we would need to ask, ‘what would be the purpose of the limitation?’ – Jarryd Neves

Professor Ames Dhai on what’s required to mitigate resistance to mandatory vaccination:

I want to commend the companies that have gone ahead and started instituting processes for mandatory vaccination in their workplaces. I think it’s so important to remember our interrelatedness. Nothing else in our history has highlighted how interrelated we are as a human society, both nationally and internationally. We can draw from Ubuntu principles to illustrate this very nicely. I think because we have failed to get people to understand the importance of being vaccinated – not only to protect myself, but also to protect you – we need to allow for public health ethical principles to now take over.

The public health ethical principles are very much in line with our Constitution and the limitations of certain rights in our Constitution. If we had to go [for] mandatory vaccination – and if we pull from constitutional principles and looked at limiting one’s right to autonomy and autonomous decision making – we would need to ask, “what would be the purpose of this limitation?” The purpose of the limitation would be the public health importance of the limitation – the fact that we need to have as many people out of hospital as possible.

If you look at who is actually occupying our ICU and high care at the moment, these are the unvaccinated. We need to take the pressure off our hospitals [and our] health care workers.  We need to ensure that our health care workers functioning goes beyond just Covid because, currently, much of health care has suffered because of the focus and need for treatment of Covid illness and complications. I think we could make an ethical and legal argument in terms of why the purpose of limiting autonomy in this regard is so important.

We also look at the other means that could achieve the same ends. I think we all we need to admit to ourselves, as a society, that other means have failed. We started off with – and we’ve continued – with our mask’s, social distancing and hand washing. But I would submit that these are not enough. It seems as if the vaccine would be the most appropriate in this situation, to take that stress off the health care sector.

On the vaccine rollout so far and problems surrounding it:

There’s an urgency in the situation and I think our country must wake up to that urgency. I think where we went wrong, right at the outset, is the president making statements saying vaccines will not be compulsory. They will be voluntary and you only take the vaccine if you want to take the vaccine. I think it’s a very aspirational way to go. But I think he actually has been devoid from real life issues on the ground. Already at the time that he started making these statements, the anti-vaxxer sentiment had permeated social media.

I really wish that he had actually he had consulted – maybe he did, but I wonder who he consulted with – but I wish he had consulted appropriately, informed himself adequately and made the statements with qualifications. It’s fine to make the statement, but qualify why it would be important for everyone to vaccinate. Should there be a problem – if we left it to everyone and everyone or the majority did not go for vaccination – what the problems would be, and how the state would then have to address these problems. This is where I think [the President] has failed us on the vaccine confidence issues.

On incentives as part of the mandatory vaccine approach:

It could be one aspect, but I do wish that whenever we come up with these so-called inspirational ways in which to actually get the vaccines going, [that] we look at results scientifically. Around the world, there has been incentivisation to take the vaccine. How well has it worked? Has it actually matched up with mandatory vaccination in certain workplaces?

And no, it hasn’t. We have a number of countries around the world that, initially, looked at the incentivisation route – but rapidly moved to the mandatory vaccination route as soon as they realised that the Delta [variant] was relentless. The Covid-19 situation was not being contained. So, they did go the mandatory vaccination route for certain workplaces like health care workers and other essential services – and government services as well.

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