A vaccine mandate has to balance potential public health risks against a possible violation of personal autonomy.
COVID-19 remains a persistent major threat to public health, especially in India where less than 10 percent of the population is fully vaccinated.
The intricacies involved in the declaration of a vaccine mandate in India must be looked at carefully.
The recent wave of COVID-19
infections across the United States has created a major setback among employers, schools, and universities who were ready to finally open their offices and campuses respectively. From a ‘No mask needed for the fully vaccinated’ policy 50 days back to vaccines being made compulsory by both state administrations and private companies alike, the COVID-19 vaccine has become imperative for the recovery process from the pandemic.
Given India’s population and poor pace of vaccination, the threat of future waves of COVID-19 infections still looms large. Recently, employer institutions and service providers (both government as well as private) in the country have begun making the vaccine mandatory for their employees and customers. But given issues in supply, a vast population and inequities in vaccine distribution, what would be the ideal strategy for implementing a vaccine mandate?
When does a vaccine mandate make sense?
There is sufficient data to demonstrate that government-sponsored immunisation drives such as the Universal Immunisation Programme (UIP) and the ‘Mission Indradhanush’ have successfully increased vaccine coverage across India, resulting in the loss of fewer lives due to infectious diseases. There is also documented evidence on how vaccine hesitancy among the Indian masses has stymied the efficient distribution and adoption of vaccines.
A vaccine mandate has to balance potential public health risks against a possible violation of personal autonomy. COVID-19 remains a persistent major threat to public health, especially in India where less than 10 percent of the population is fully vaccinated. The economic fallout of the lockdowns as well as the millions of COVID-19 infections have had severe repercussions on millions of families across the country. Hence, it makes sense for institutions to demand their employees/customers to be fully vaccinated, particularly in roles that require human interactions.
However, considering the impact of a mandate on the general public, there must be certain checks and balances in place when issuing the mandate.
The Legal Aspect
There has never been a vaccine mandate ever issued either by the government or any private entity in the history of independent India. This raises the question of ‘Is making the vaccine compulsory allowed as per Indian law?‘
Though the concept of vaccine mandates is not explicitly mentioned in any law, certain provisions have been provided to the state to tackle public health crises such as the one right now.
The Disaster Management Act of 2005 paved the way for the creation of the National Disaster Management Authority (NDMA) by the Union government. Section 6 of the Act gives authority to the NDMA to formulate any policy to tackle disasters along with Section 35 of the Act, which provides the Union government certain powers to take necessary measures concerning disaster management. This includes issuing guidelines to state governments and non-governmental organisations about tackling disasters.
Hence, the current laws in place do provide the National Authority and the Union government with the power of mandating vaccines to tackle the COVID-19 disaster.
What Should the Vaccine Mandate Look Like?
It would be important to not issue a blanket mandate that applies to all of society. This can create further complications and unintended consequences like increasing vaccine hesitancy among the masses. The mandate should be restricted to employer institutions (both government – Union, States, and local governments and private sector), educational institutions (both government and private), and public service provider businesses (restaurants, gyms, etc.).
The decision must be decentralised to the local level giving the freedom to local authorities and private entities to mandate the vaccine when required. Institutions may be recommended to issue vaccine mandates before commencing work from offices for companies and offline classes for schools and universities. This can help in reducing the risk factor for those stepping out of their homes for their work or studies.
Factors to Consider
Various caveats need to be attended to before the issuance of a vaccine mandate. Mandates should be allowed only if the authority issuing them can provide a sufficient supply of reliable and approved vaccines and arrange the vaccination drive. This would also mean that the authority issuing the mandate is solely responsible for the entire vaccination process including covering all the costs incurred during procurement and inoculation.
The side effects of the COVID-19 vaccine can make certain individuals unavailable for work for a few days post-vaccination. The vaccine mandating institution should have a leave policy providing the necessary time needed for recuperation for those who take the vaccine.
At the same time, the mandate must be considerate enough to allow exemptions for certain individuals who, for health-related reasons, cannot take the vaccine. Though compulsory vaccination is a must as per the mandate, there must be an alternative in place for those who may develop an allergy or a life-threatening response to the vaccine. Instead of getting vaccinated, a regular and timely testing process may be made available for those exempted from the mandate.
There might also be instances of refusal to comply with the mandate. Though the concept of compulsory vaccinations might be harsh, the threat to public health by COVID-19 may take precedence. The implications of disregarding the mandate must be explicitly mentioned before issuing it. If there are cases of non-compliance post the declaration of the mandate despite the above provisions being instituted, the authority issuing the vaccine may be allowed to initiate action against those rejecting the mandate. However, the authority should take adequate measures to ensure business continuity, particularly where government functioning is involved.
As the pandemic rages on into its second year, the concept of making the COVID-19 vaccine compulsory is gathering steam around the globe with several countries issuing blanket mandates for accessing any sort of public services. India, which has been one of the worst-hit nations by the pandemic, must focus on equitable distribution of the vaccine as well as increasing the vaccine coverage rapidly keeping in mind the possibility of future outbreaks. A targeted vaccine mandate policy, instead of a blanket one, in India, will ensure both of the above along with facing minimum resistance from the general public.
Arjun Gargeyas is a research analyst for Takshashila Institution and Shambhavi Naik is Head of Research, Takshashila Institution.
