Article Text

Good reasons to vaccinate: mandatory or payment for risk?
  1. Julian Savulescu1,2,3
  1. 1 Faculty of Philosophy, University of Oxford, Oxford, UK
  2. 2 Murdoch Childrens Research Institute, Parkville, Victoria, Australia
  3. 3 Melbourne Law School, University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Professor Julian Savulescu, Faculty of Philosophy, University of Oxford, Oxford, UK; julian.savulescu{at}


Mandatory vaccination, including for COVID-19, can be ethically justified if the threat to public health is grave, the confidence in safety and effectiveness is high, the expected utility of mandatory vaccination is greater than the alternatives, and the penalties or costs for non-compliance are proportionate. I describe an algorithm for justified mandatory vaccination. Penalties or costs could include withholding of benefits, imposition of fines, provision of community service or loss of freedoms. I argue that under conditions of risk or perceived risk of a novel vaccination, a system of payment for risk in vaccination may be superior. I defend a payment model against various objections, including that it constitutes coercion and undermines solidarity. I argue that payment can be in cash or in kind, and opportunity for altruistic vaccinations can be preserved by offering people who have been vaccinated the opportunity to donate any cash payment back to the health service.

  • behaviour modification
  • coercion
  • technology/risk assessment
  • philosophical ethics
  • public health ethics

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  • Contributors Sole authorship.

  • Funding JS is supported by the Uehiro Foundation on Ethics and Education. He received funding from the Wellcome Trust WT104848 and WT203132. Through his involvement with the Murdoch Children’s Research Institute, he has received funding through from the Victorian State Government through the Operational Infrastructure Support (OIS) Program.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement No data are available.

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