Article Text
Abstract
COVID-19 vaccine requirements have generated significant debate. Here, we argue that, on the evidence available, such policies should have recognised proof of natural immunity as a sufficient basis for exemption to vaccination requirements. We begin by distinguishing our argument from two implausible claims about natural immunity: (1) natural immunity is superior to ‘artificial’ vaccine-induced immunity simply because it is ‘natural’ and (2) it is better to acquire immunity through natural infection than via vaccination. We then briefly survey the evidence base for the comparison between naturally acquired immunity and vaccine-induced immunity. While we clearly cannot settle the scientific debates on this point, we suggest that we lack clear and convincing scientific evidence that vaccine-induced immunity has a significantly higher protective effect than natural immunity. Since vaccine requirements represent a substantial infringement of individual liberty, as well as imposing other significant costs, they can only be justified if they are necessary for achieving a proportionate public health benefit. Without compelling evidence for the superiority of vaccine-induced immunity, it cannot be deemed necessary to require vaccination for those with natural immunity. Subjecting them to vaccine mandates is therefore not justified. We conclude by defending the standard of proof that this argument from necessity invokes, and address other pragmatic and practical considerations that may speak against natural immunity exemptions.
- COVID-19
- public policy
- ethics
Data availability statement
There are no data in this work.
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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Data availability statement
There are no data in this work.
Footnotes
Twitter @Becky_Brown13, @Neonatalethics
Contributors All authors contributed equally to the development of the manuscript. JP is responsible for the overall content as the guarantor.
Funding This study was funded by the Research and Innovation, Arts and Humanities Research Council, UK Research and Innovation/Arts and Humanities Research Council (AH/V013947/1).
Competing interests JP, JS and DW are supported by the UKRI/ AHRC funded UK Ethics Accelerator project, grant number AH/V013947/1. JS receives funding from the Uehiro Foundation on Ethics and Education, NHMRC, Wellcome Trust, Australian Research Council, and WHO. He is a Partner Investigator on an Australian Research Council Linkage award (LP190100841, October 2020-2023) which involves industry partnership from Illumina. He does not personally receive any funds from Illumina.
Provenance and peer review Not commissioned; externally peer reviewed.
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