Vaccines, obligations and refusals

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(from Alphonsian Academy blog)

In this speech I would like to take up the discussion on the vaccination obligation started in apreviouspost, starting from the distinction we have made between legal obligation and moral obligation, well aware that these categories are far from univocal and that they are the subject of centuries-old discussions. In the public debate we talk mostly – it is obvious – about the legal obligation and the right that the State has or does not have to impose vaccinations by forcing, if necessary, citizens. Personally, we share the position of the National Committee for Bioethics, which in 2020, in the context of the Covid-19 pandemic, stated “that, in the event that the seriousness of the health situation and the long-term unsustainability of restrictions on social and economic activities continue, compulsory vaccination should not be ruled out, especially for occupational groups that are at risk of infection and transmission of viruses; this obligation should be lifted if there is no longer a significant danger to the community”[1]

If we place ourselves on an exquisitely ethical horizon, the notion of obligation cannot be understood as a norm, so to speak, external to the person that imposes a certain behaviour, enjoining or forbidding, towards and in the interest of another subject, even a collective one, but must be traced back to the notion of moral responsibility and the obligatory force of the good and of the various human goods. These are two different modes of obligation and the difference does not lie in the nature of the duty in itself, but in the reason for which the will realises a good. When speaking of vaccines, the reference is to the good of life and health, so that, from an ethical point of view, recourse to vaccines is governed by the same rules as any other form of therapy. Since health is a fundamental personal good, taking care of oneself and of the people entrusted to us and connected to us, including the social reality in which we are immersed, constitutes a moral responsibility. The means by which we take care of ourselves are chosen on the basis of a general criterion of proportionality in which biomedical factors, circumstantial factors and personal factors play a part. No one would say that it is compulsory to undergo an appendectomy for a person who does not have acute appendicitis, but if appendicitis does occur, then it is clinically appropriate and right, in principle, to undergo an appendectomy. However, while it is still clinically appropriate to have an appendectomy, one cannot say that it is irresponsible not to have one because one is on a trip to the middle of the tropical rainforest and is unable to access adequate medical care. 

It would therefore be inaccurate to say that vaccines are in principle mandatory, just as it would be unacceptable to say that they are not in principle morally mandatory[2]. In the case of bio-medical interventions, one cannot speak of obligations or non-obligations in an absolute way without considering the individual situations: if a certain vaccine represents for a certain subject – according to medical experts – the only valid defence against the risk of contracting a serious infectious disease, there is a moral obligation to receive it. If, for example, yellow fever is endemic in a certain country, there is a general moral (as well as legal) obligation for all travellers to be vaccinated against yellow fever, and this obligation is part of everyone’s duty to take reasonable care of themselves. The same obligation obviously does not exist for those who go to the French Riviera. In the case of endemic or epidemic diseases, the obligation to take care of one’s own health with appropriate and proportionate means is accompanied by the obligation of solidarity to provide, as far as I can, for public health, a component of the common good. It is therefore correctly stated in the New Charter for Health Care Workers, No. 69, that “from the point of view of preventing infectious diseases, the development of vaccines and their use in the fight against such infections, by means of compulsory immunisation of all the populations concerned, undoubtedly constitutes positive conduct”. [3]If a person cannot be vaccinated for medical reasons (e.g. immunodepression) or for subjective reasons (e.g. invincible repugnance to vaccines involving the use of embryo-derived cell lines), it is still their responsibility towards themselves and others to take every precaution not to fall ill and not to contribute to spreading the infection.

If, therefore, we focus on the legal aspect of the vaccination obligation, we are obviously led to emphasise the coercion that the legal obligation exerts ab extrinsically on the individual’s conscience and self-determination. If, on the other hand, we take a more properly ethical view, we understand that the vaccination obligation – when circumstances require it – is the expression of a moral and, therefore, an inner obligation. The moral obligation of which we speak can only derive from a process of discernment that is not inspired by an individualistic self-determination deaf to the call of values and indifferent to the existence of others, but is informed by the genuine dynamic of love towards oneself and one’s neighbour and which translates into a capacity for care and solidarity, especially towards persons marked by a condition of greater fragility and vulnerability[4]

If we are in tune with the sensitivity of the Holy Father, it is clear that the obligation to vaccinate, in the present circumstances, is based on charity: ‘vaccinating is an act of love’[5]. On the basis of the information offered by the most accredited science and listening to the indications that arise from human wisdom expressed in civil law, everyone is called upon to assume their responsibilities. It may happen that a person in good faith believes that vaccination against Covid-19 is harmful, for himself or for others, and that there are better and safer ways to overcome the pandemic crisis, but such a serious decision must be weighed with caution and after careful information. We need to distance ourselves from programmatic denialism, which is linked to a systematic distrust of society and an anti-scientific vision that sometimes borders on superstition, just as we need to avoid irresponsible and self-assertive forms of self-referentialism that are oblivious to the impact of our choices on the common good. Considering that the rejection of the vaccine is mostly due to phobias or misinformation or prejudicial closure to any interference of social interest in the private sphere, once again it is clear that the always invoked autonomy is presented as a purely formal category, empty of content and full of ambiguity[6].

Those who refuse the vaccine should not forget that their refusal may constitute a risk not only for themselves, but also for others, especially the most fragile, and that one must compare the weight of one’s reasons with the duty to protect personal and public health, including the urgency of not overloading doctors and health facilities already put to the test by the pandemic. In this relational perspective and solidarity, the Vatican Commission Covid-19 said that “on the moral responsibility to undergo vaccination […] should be reiterated as this issue also involves a relationship between personal health and public health, showing the close interdependence[7]Responsible refusal has been referred to in the sense that those who refuse vaccination should take responsibility for it, including some financial consequences[8], but, taking the category of responsibility in an ethical sense, it would be equally appropriate to speak of irresponsible refusal.

p. Maurizio P. Faggioni, OFM


[1] National Bioethics Committee, Vaccines and Covid-19: Ethical aspects of research, cost and distribution, 27-11-2020, no. 5, 17 (http://bioetica.governo.it/media/4115/p140_2020_vaccini-e-covid19_it.pdf).

[2]  This is how the Note of the Congregation for the Doctrine of the Faith on anti-Covid vaccines expressed itself, with an imprecise use of the technical language of morality. The same Note “recommends” them, using language that is unusual for moral theology and ordinarily used in the documents of the WHO and other medical bodies. Apart from this questionable way of expressing itself, the Note is very explicit with regard to the civic duty to vaccinate or, for those who do not want to, to protect the health of others with appropriate behaviour.

[3] Pontifical Council for Health Care Workers, New Charter for Health Care Workers , Vatican City 2016, no. 69.

[4] Examines the issue of compulsoriness in the light of the underlying ethical models: J. González-Melado, M.L. Di Pietro, ‘La vacuna frente a la COVID-19 y la confianza institucional’, in Enfermedades Infecciosas y Microbiología Clínica 2020. (in https://doi.org/10.1016/j.eimc.2020.08.001). 

[5] Francis, Videomessage for the “It’s up to you” initiative, 18-8-2021: “Getting vaccinated, with vaccines authorised by the competent authorities, is an act of love. And helping to get the majority of people vaccinated is an act of love. Love for oneself, love for family and friends, love for all peoples. Love is also social and political, there is social love and political love, it is universal, always overflowing with small gestures of personal charity capable of transforming and improving societies’ (Spanish original, translated into https://www.vaticannews.va/it/papa/news/2021-08/videomessaggio-sulle-vaccinazioni.html).

[6]  Cf. M. Cozzoli, “Vaccines. L’ordine morale vincola al pari del legale”, in Avvenire, 29-10-2021 (https://www.avvenire.it/opinioni/pagine/vaccini-l-ordine-morale-vincola-al-pari-del-legale)

[7] Vatican Commission Covid-19, Vaccine for All. 20 points for a more just and healthy world, 29-12-2020, no. 13 (in https://www.vatican.va/roman_curia/pontifical_academies/acdlife/documents/rc_pont-acd_life_doc_20201229_covid19-vaccinopertuttti_it.html).

[8]See G. Del Missier, R. Massaro, “No vax, no party. Sull’obbligatorietà of the vaccine anti-COVID”, in The Kingdom. Moralia blog 23-12-2020 (https://ilregno.it/moralia/blog/no-vax-no-party-sullobbligatorieta-del-vaccino-anti-covid-giovanni-del-missier-roberto-massaro).

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