a good thesis statement for vaccinations

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http://orcid.org/0000-0003-1691-6403 Julian Savulescu 1 , 2 , 3
1 Faculty of Philosophy , University of Oxford , Oxford , UK
2 Murdoch Childrens Research Institute , Parkville , Victoria , Australia
3 Melbourne Law School , University of Melbourne , Melbourne , Victoria , Australia
Correspondence to Professor Julian Savulescu, Faculty of Philosophy, University of Oxford, Oxford, UK; julian.savulescu{at}philosophy.ox.ac.uk

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
technology/risk assessment
philosophical ethics
public health ethics

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/ .

https://doi.org/10.1136/medethics-2020-106821

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Introduction

We are in the midst of a global pandemic with COVID-19 and there is a race to develop a vaccine. At the time of writing, there are 53 vaccines in clinical trials on humans (plus five that have bypassed the full trial process) and at least 92 preclinical vaccines under active investigation in animals. There are a number of different approaches: (1) genetic—using mRNA to cause the body to produce viral proteins; (2) viral vector—using genetically modified viruses such as adenovirus to carry sections of coronavirus genetic material; (3) protein—delivering viral proteins (but not genetic material) to provoke an immune response; (4) inactivated or attenuated coronavirus; (5) repurposing existing vaccines, eg, BCG (bacillus Calmette–Guérin). 1

Given the mounting number of deaths globally, and the apparent failure of many countries to contain the pandemic without severely damaging or problematic lockdowns and other measures, there have been calls to make a vaccine, if it were approved, mandatory. 2 Mandatory vaccination has not been ruled out within the UK. 3

The first part of this article asks when, if ever, a vaccine should be mandatory. I will create a set of criteria and a decision algorithm for mandatory vaccination. I will argue that in the case of COVID-19, some of these criteria may not be satisfied. The second part of the article argues that in the case of COVID-19, it may be ethically preferable to incentivise vaccine uptake. I will justify incentivisation and discuss different kinds of incentives.

Ethics of mandatory COVID-19 vaccination

There is a large body of literature on the justification for the use of coercion in public health and infectious disease in particular. Mandatory vaccination is typically justified on Millian grounds: harm to others. According to John Stuart Mill, the sole ground for the use of state coercion (and restriction of liberty) is when one individual risks harming others. 4 The most prominent arguments from bioethicists appeal to preventing harm to others. 5–7 In the case of children, significant risk of harm to the child is also a ground for state protection. Bambery et al 8 give the example of a child taking a box of toxic bleach to school, potentially harming himself and other children. Teachers are entitled to restrain the child and remove the poison both because of risk to the child and to other children. 8 Flanigan uses a similar example of a person shooting a gun into a crowd. 5

The Nuffield Council of Bioethics produced an influential report on public health which considers when coercion and mandatory vaccination might be justified:

When assessing whether more directive policies are acceptable, the following factors should be taken into account: the risks associated with the vaccination and with the disease itself, and the seriousness of the threat of the disease to the population. In the case of incentivised policies, the size of the incentive involved should be appropriate so that it would not unduly compromise the voluntariness of consent. We identified two circumstances in which quasi-mandatory vaccination measures are more likely to be justified. First, for highly contagious and serious diseases, for example with characteristics similar to smallpox. Second, for disease eradication if the disease is serious and if eradication is within reach. 9

I will elaborate on these brief suggestions and provide a novel structured algorithm for when vaccination should be mandatory.

COVID-19 is almost unique because of the gravity of the problem at the global level: not only is there cost in terms of lives from COVID-19, there is also the extraordinary economic, health and well-being consequences of various virus-control measures, including lockdown, which will extend into the future. Probably never before has a vaccine been developed so rapidly and the pressure to use it so great, at least at the global level.

There is a strong case for making any vaccination mandatory (or compulsory) if four conditions are met:

There is a grave threat to public health

The vaccine is safe and effective

Mandatory vaccination has a superior cost/benefit profile compared with other alternatives

The level of coercion is proportionate.

Each of these conditions involves value judgements.

Grave threat to public health

So far, there have been over 1 million deaths attributed to COVID-19 globally (as of 30 September 2020). 10 In the UK alone, it was predicted in influential early modelling that 500 000 would have died if nothing was done to prevent its spread. Even with the subsequent introduction of a range of highly restrictive lockdown measures (measures which could themselves come at a cost of 200 000 non-COVID-19 lives according to a recent UK government report), 11 more than 42 000 (as of 30 September 2020) 12 have died in the UK within 28 days of a positive test.

The case fatality rate was originally estimated to be as high as 11%, but (as is typical with new diseases) this was quickly scaled down to 1.5% or even lower. 13 The infection fatality rate (IFR, which accounts for asymptomatic and undiagnosed cases) is lower still as it has become clear that there are a large number of asymptomatic and mild cases. For example, the Centre for Evidence Based Medicine reports that “In Iceland, where the most testing per capita has occurred, the IFR lies somewhere between 0.03% and 0.28%”. 14

Of course, how you define “grave” is a value judgement. One of the worst-affected countries in the world in terms of COVID-19-attributed deaths per million is Belgium. The mortality is (at the time of writing) around 877 per million population, which is still under 0.1%, and the average age of death is 80. Of course, Belgium and most other countries have taken strict measures to control the virus and so we are not seeing the greatest possible impact the virus could have. Yet others such as Brazil and Sweden have intervened to a much lesser degree, yet (currently) have rates of 687 and 578 deaths per million respectively. Sweden’s April all-cause deaths and death rate at the peak of its pandemic so far, while extremely high, were surpassed by months in 1993 and 2000. 15

The data are complex and difficult to compare with different testing rates, and ways of assigning deaths and collecting data differing from country to country. For example, Belgium counts deaths in care homes where there is a suspicion that COVID-19 was the cause (without the need for a positive test) and, until recently, the UK counted a death which followed any time from a COVID-19 positive test as a COVID-19 death. Moreover, there have been huge behavioural changes even in countries without legally enforced lockdowns. Furthermore, the IFR varies wildly by age-group and other factors. Even among survivors, there is emerging evidence that there may be long-term consequences for those who have been infected but survived. Long COVID-19 health implications may present a grave future public health problem. Nevertheless, some might still argue that this disease has not entered the “grave” range that would warrant mandatory vaccination. The Spanish influenza killed many more (50–100 million), 16 and it afflicted younger rather than older people, meaning even more “life years” were lost. It is not difficult to imagine a Superflu, or bioengineered bug, which killed 10% across all ages. This would certainly be a grave public health emergency where it is likely mandatory vaccination would be employed.

Deciding whether COVID-19 is sufficiently grave requires both more data than we have and also a value judgement over the gravity that would warrant this kind of intervention. But let us grant for the sake of argument that COVID-19 is a grave public health emergency.

Vaccine is safe and effective

There are concerns that testing has been rushed and the vaccine may not be safe or effective. 17

First, although the technology being used in many of these vaccine candidates has been successfully used in other vaccines, no country has ever produced a safe and effective vaccine against a coronavirus. So in one way, we are all in uncharted waters.

Second, any vaccine development will be accelerated in the context of a grave public health emergency.The inherent probabilistic nature of the development of any biologic means that no vaccine could be said to be 100% safe. There will be risks and those risks are likely to be greater than with well-established vaccines.

Thirdly, some side effects may take time to manifest.

This is not to support the anti-vaccination movement. Vaccines are one of the greatest medical accomplishments and a cornerstone of public health. There are robust testing procedures in place in most jurisdictions to ensure that licensed COVID-19 vaccines are both effective and safe. It is only to acknowledge that everything, including vaccination, has risks. Perhaps the biggest challenge in the development of a vaccine for COVID-19 will be to be honest about the extent of those risks and convey the limitations of confidence in safety and efficacy relative to the evidence accrued.

There is an ethical balance to be struck: introducing a vaccine early and saving more lives from COVID-19, but risking side effects or ineffectiveness versus engaging in longer and more rigorous testing, and having more confidence in safety and efficacy, but more people dying of COVID-19 while such testing occurs. There is no magic answer and, given the economic, social and health catastrophe of various anti-COVID-19 measures such as lockdown, there will be considerable pressure to introduce a vaccine earlier.

To be maximally effective, particularly in protecting the most vulnerable in the population, vaccination would need to achieve herd immunity (the exact percentage of the population that would need to be immune for herd immunity to be reached depends on various factors, but current estimates range up to 82% of the population). 18

There are huge logistical issues around finding a vaccine, proving it to be safe, and then producing and administering it to the world’s population. Even if those issues are resolved, the pandemic has come at a time where there is another growing problem in public health: vaccine hesitancy.

US polls “suggest only 3 in 4 people would get vaccinated if a COVID-19 vaccine were available, and only 30% would want to receive the vaccine soon after it becomes available.” 18

Indeed, vaccine refusal appears to be going up. A recent Pew survey suggested 49% of adults in the USA would refuse a COVID-19 vaccine in September 2020. 19

If these results prove accurate then even if a safe and effective vaccine is produced, at best, herd immunity will be significantly delayed by vaccine hesitancy at a cost both to lives and to the resumption of normal life, and at worst, it may never be achieved.

There remain some community concerns about the safety of all pre-existing vaccines, including many that have been rigorously tested and employed for years.

In the case of COVID-19, the hesitancy may be exacerbated by the accelerated testing and approval process which applies not only to Sputnik V (the controversial “Russian vaccine”). Speaking about America’s vaccine programme, Warp Speed, Donald Trump applauded its unprecedented pace:

…my administration cut through every piece of red tape to achieve the fastest-ever, by far, launch of a vaccine trial for this new virus, this very vicious virus. And I want to thank all of the doctors and scientists and researchers involved because they’ve never moved like this, or never even close. 20

The large impact on society means the vaccine will be put to market much more quickly than usual, perhaps employing challenge studies or other innovative designs, or by condensing or running certain non-safety critical parts of the process in parallel (for example, creating candidate vaccines before its approval).

While the speed is welcomed by politicians and some members of the public, the pressure to produce a candidate vaccine, and the speed at which it has been done, may be also perceived (perhaps unfairly) to increase the likelihood of the kind of concerns that lead to vaccine hesitancy: concerns over side-effects that are unexpected or rare, or that take longer to appear than the testing process allows for, or that for another reason may be missed in the testing process.

The job to be done will not only be to prove scientifically that the vaccine is safe and effective, but also to inform and reassure the public, especially the group who are willing to take the vaccine in theory—but only after others have tried it out first.

The question remains of how safe is safe enough to warrant mandatory vaccination. It is vanishingly unlikely that there will be absolutely no risk of harm from any biomedical intervention, and the disease itself has dramatically different risk profiles in different groups of the population. In an ideal world, the vaccine would be proven to be 100% safe. But there will likely be some risk remaining. Any mandatory vaccination programme would therefore need to make a value judgement about what level of safety and what level of certainty are safe and certain enough. Of course, it would need to be very high, but a 0% risk option is very unlikely.

A COVID-19 vaccine may be effective in reducing community spread and/or preventing disease in individuals. Mandatory vaccination is most justifiable when there are benefits to both the individual and in terms of preventing transmission. If the benefits are only to individual adults, it is more difficult to support mandatory vaccination. One justification would be to prevent exhaustion of healthcare services in an emergency (eg, running out of ventilators), which has been used a basis of restriction of liberty (it was the main justification for lockdown). It could also be justified in the case of protection of children and others who cannot decide for themselves, and of other adults who either cannot be vaccinated for medical reasons.

Better than the alternatives

It is a standard principle of decision theory that the expected utility of a proposed option must be compared with the expected utility of relevant alternatives. There are many alternatives to mandatory vaccination. See figure 1 for a summary of the range of strategies for preventing infectious disease.

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Strategies for prevention of infectious disease.

A popular position, especially among medical professionals, 7 is that we don’t need mandatory vaccination because people are self-interested or altruistic enough to come forward for vaccination. We can reach herd immunity without mandatory vaccination.

If this were true, all well and good, but the surveys mentioned above cast doubt on this claim with regard to the future COVID-19 vaccine. Moreover, reaching herd immunity is not good enough.

First, how fast we reach herd immunity is also important. In a pandemic, time is lives. If it takes a year to reach herd immunity, that could be thousands or tens of thousands of lives in one country.

Second, herd immunity is necessary because some people cannot be vaccinated for medical reasons: they have allergies, immune problems, or other illnesses. The elderly often don’t mount a strong immune response (that is why it is better to vaccinate children for influenza because they are the biggest spreaders of that disease 7 —although COVID-19 appears to be different on the current evidence). And immunity wanes over time—so even people previously vaccinated may become vulnerable.

Even when national herd immunity is achieved, local areas can fall below that level over time, causing outbreaks, as happened with measles recently. This is especially likely to happen where people opposed to vaccines tend to cluster toghether—for example, in the case of certain religious communities. So ideally we need better than herd immunity to ensure that people are protected both over time and in every place.

These are thus reasons to doubt whether a policy of voluntary vaccination will be good enough, though it remains to be seen.

There are other policies that might obviate the need for mandatory vaccination. South Korea has kept deaths down to about 300 (at the time of writing) with a population of 60 000 000 with a vigorous track and trace programme (although it was criticised for exposing extra-marital affairs and other stigmatised behaviours). 21 Other countries have enforced quarantine with tracking devices. There could be selective lockdown of certain groups, 22 or for intermittent periods of time.

The long-term costs and benefits of such policies would have to be evaluated. That is, we should calculate the expected utility of mandatory vaccination (in combination with other policies) and compare it to alternative strategies (or some other combination of these). How utility should be evaluated is an ethical question. Should we count deaths averted (no matter how old), life years lost or lost well-being (perhaps measured by quality adjusted life years)? 23 Should we count loss of liberty or privacy into the other side the equation?

It may be that a one-off mandatory vaccination is a significantly smaller loss of well-being or liberty than these other complex resource intensive strategies.

So we cannot say whether a mandatory policy of COVID-19 vaccination is ethically justified until we can assess the nature of the vaccine, the gravity of the problem and the likely costs/benefit of alternatives. But it is certainly feasible that it could be justified.

It is important to recognise that coercive vaccination can be justified. This is easy to see by comparing it to other coercive interventions in the public interest.

Conscription in war

In the gravest emergencies, where the existence and freedom of the whole population is at stake, people are conscripted to serve their country, often with high risk of death or permanent injury. We often analogise the pandemic to a war: we are fighting the virus. If people can be sent to war against their will, in certain circumstances some levels of coercion are justified in the war on the virus. Notably, in conditions of extreme emergency in past wars (graver than currently exist for COVID-19), imprisonment or compulsion have even been employed. 24

A more mundane example is the payment of taxes. Taxes benefit individuals because tax revenue allows the preservation of public goods. But if sufficient numbers of others are paying their taxes, it is in a person’s self-interest to free ride and avoid taxes. Indeed, paying taxes may result in harm in some circumstances. 24 In the USA, where there is a large private healthcare sector, paying your taxes may mean you cannot pay for lifesaving medical care that you would otherwise have been able to afford. Still, taxes are mandatory based on considerations of fairness and utility.

Seat belts are mandatory in the UK and many other countries, whereas they were previously voluntary. Interestingly, 50% or so of Americans initially opposed making seat belts mandatory, but now 70% believe mandatory laws are justified. 25

Seat belts reduce the chance of death if you are involved in a car accident by 50%. They are very safe and effective. Notably, they do cause injuries (seat belt syndrome) and even, very occasionally, death. But the chances of being benefitted by wearing them vastly outweigh these risks, so they are mandatory, with enforcement through fines . I have previously likened vaccination to wearing a seat belt. 25

Pre-existing mandatory vaccination

Mandatory vaccination policies are already in place in different parts of the world. Mandatory vaccination policies are those that include a non-voluntary element to vaccine consent and impose a penalty or cost for unjustified refusal (justified refusal includes those who have a contraindicating medical condition, or those who already have natural immunity). There are a range of possible penalties or costs which can coerce people. Australia has the “No Jab, No Pay” scheme which withholds child benefits if the child is not vaccinated, and a “No Jab, No Play” scheme which withholds kindergarten childcare benefits. Italy introduced fines for unvaccinated children who attend school. In the USA, state regulations mandate that children cannot attend school if they are not vaccinated, and healthcare workers are required to vaccinate. Some US states (eg, Michigan) make exemptions difficult to obtain by requiring parents to attend immunisation education courses 26 (see also 27 28 ).

Figure 2 summarises the range of coercive policies that can constitute mandatory vaccination.

Cost of mandatory/coercive vaccination.

Coercion is proportionate

In public health ethics, there is a familiar concept of the “least restrictive alternative”. 28 The least restrictive alternative is the option which achieves a given outcome with the least coercion (and least restriction of liberty).

This is a very weak principle: it uses liberty as tie breaker between options with the same expected utility. More commonly, however, we need to weigh utility against liberty. That is, a more restrictive policy will achieve more expected utility—but is it justified?

According to a principle of proportionality, the additional coercion or infringement in liberty is justified if it is proportionate to the gain in expected utility of the more coercive intervention compared with next best option. That is, additional coercion is justified when the restriction of liberty is both minimised and proportionate to the expected advantages offered by the more coercive policy.

As we can see from the previous section and figure 2, there are a variety of coercive measures. (The Nuffield Council has created a related “Intervention Ladder”, 29 though this includes education and incentives, as well as coercive measures.) Penalties can be high. In war, those who conscientiously objected to fighting went to jail or were forced to perform community service (or participate in medical research). In France, parents were given a suspended prison sentence for refusing to vaccinate their child. 30

While there are legitimate concerns that the effectiveness of these policies in different contexts has been inadequately investigated, a number of these policies have been shown to increase vaccination rates. 31

Notably, the fine or punishment for avoiding taxes varies according to the gravity of the offence. The fine for not wearing a seat belt is typically small. A modest penalty for not being vaccinated in a grave public health emergency could be justifiable. For example, a fine or restriction of movement might be justified.

Figure 3 combines these four factors into an algorithm for justified mandatory vaccination.

Algorithm for mandatory vaccination.

These four factors can be justified in several ways. They represent a distillation and development of existing principles in public health ethics, for example, the least restrictive alternative. They can also be justified by the four principles of biomedical ethics.

For example, justice is about the distribution of benefits and burdens across a population in a fair manner. Justice and beneficence, in the context of vaccination policies, both require that the problem addressed is significant and vaccination is an effective means of addressing it. Non-maleficence requires that the risk imposed on individuals be small. Respect for autonomy and justice both require that coercion be applied only if necessary and that it be proportionate to additional utility of mandatory vaccination (and that such coercion be minimised, which is a feature of proportionality).

It is important to recognise that vaccines may have benefits both to the individual and to others (the community). If the vaccine has an overall net expected utility for the individual, beneficence supports its administration.

How great a sacrifice (loss of liberty or risk) can be justified? The most plausible account is provided by a duty of easy rescue: when the cost to an individual is small of some act, but the benefit or harm to another is large, then there is a moral obligation to perform that act. I have elsewhere argued for a collective duty of easy rescue: where the cost of some act to an individual is small, and the benefit of everyone doing that act to the collective is large, there is a collective duty of easy rescue. 32 Such a principle appropriately balances respect for autonomy with justice.

Whether mandatory vaccination for any disease can be justified will depend on precise facts around the magnitude of the problem, the nature of the disease and vaccination, the availability and effectiveness of alternative strategies and the level of coercion. Elsewhere I compare mandatory vaccination for influenza and COVID-19 in more detail. 27

Better than coercion? Payment for risk

Given the risks, or perceived risks, of a novel COVID-19 vaccine, it would be practically and perhaps ethically problematic to introduce a mandatory policy, at least initially (when uncertainty around safety will be greater). Is there a more attractive alternative?

The arguments in favour of vaccination, particularly for those at lower risk (children, young people and those previously infected) can be based on a principle of solidarity. After all, “We are in this together” has been a recurrent slogan supporting pandemic measures in different countries. Those at low risk are asked to do their duty to their fellow citizens, which is a kind of community service. Yet they have little to personally gain from vaccination. The risk/benefit profile looms large for those at lowest risk.

However, another way of looking at this is that those at low risk are being asked to do a job which entails some risk., so they should be paid for the risk they are taking for the sake of providing a public good. And although it may be unlikely to influence so-called 'anti-vaxxers', it may influence a good portion of the 60% of American adults who responded in a March 2020 poll that they would either delay vaccination or didn’t know about vaccination. 33

I have previously argued that we should reconceive live organ donation and participation in risky research, including challenge studies, 34 as jobs where risk should be remunerated, much like we pay construction workers and other dangerous professions both for the job and for the risk involved. 35 36 While the risk profile for approved vaccinations means that it differs from these examples, it could be compared to a job such as social work as a further argument in favour of payment. People may legitimately be incentivised to take on risks, as the Nuffield Council recognises in its Intervention Ladder. 29

The advantage of payment for risk is that people are choosing voluntarily to take it on. As long as we are accurate in conveying the limitations in our confidence about the risks and benefits of a vaccine, then it is up to individuals to judge whether they are worth payment.

Of course, that is a big ask. It would require government to be transparent, explicit and comprehensive in disclosure of data, what should be inferred and the limitations on the data and confidence. This has often not been the case—one only has to remember the denial of the risks of bovine spongiform encephalopathy (BSE) at the height of the crisis by the British government, when in 1990 the Minister for Agriculture, Fisheries and Food, John Gummer proudly fed his 4-year-old daughter, Cordelia, a hamburger in front of the world’s media, declaring British beef safe. (Gummer was awarded a peerage in 2010 and is now Lord Deben.) 37

There is also a danger that payment might signal lack of confidence in safety. That is a real risk and one that I will address in the “payment in kind” section below.

But the basic ethical point (public acceptability aside) is that, if a vaccine is judged to be safe enough to be used without payment, then it is safe enough to be used with payment. 36 Payment itself does not make a vaccine riskier. If a vaccine is considered too risky to be administered to the population, then it should not be administered, no matter whether coercively, through incentives, or through some other policy.

A standard objection to payment for risk (whether it is risky research or live organ donation) is that it is coercive: it forces people to take risks against their better judgement. In Macklin’s words:

The reason for holding that it is ethically inappropriate to pay patients to be research subjects is that it is likely to be coercive, violating the ethical requirement that participation in research should be fully voluntary. 38

As I have previously argued, 39 this demonstrates deep conceptual confusion. Coercion exists when an option which is either desired or good is removed or made very unappealing. The standard example is a robber who demands “Your money or your life”. This removes the most desired and best option: your money and your life. The Australian “No Jab, No Pay”scheme arguably does constitute coercion as it removes an option that one is entitled to, that is, non-vaccination with the “Pay”. So too is the Italian scheme of fines coercive.

However, paying people is not coercive. Adding an option, like payment, without affecting the status quo is not coercive. If a person chooses that option, it is because they believe that overall their life will go better with it, in this case, with the vaccination and the payment. The gamble may not pay off: some risk might eventuate and then it wasn’t worth it. But that is life—and probability.

It is true that the value of the option might exercise force over our rational capacities, but that is no different from offering a lot of money to attract a favoured job applicant.

What can be problematic about offers is exploitation. Exploitation exists where one offers less than a fair deal and a person only accepts it because of vulnerability from background injustice.

There are two ways to prevent exploitation. First, we can correct any background injustice that might cause it. In this case, the person would have little reason to accept the offer. Second, we can pay a fair minimum price for risk, as when we pay construction workers danger money. Paradoxically, this requires paying more, rather than less. 40

But there is an important additional feature of vaccination. If a vaccine were deemed to be safe enough to offer on a voluntary basis without payment, it must be safe enough to incentivise with payment because the risks are reasonable. It may be that those who are poorer may be more inclined to take the money and the risk, but this applies to all risky or unpleasant jobs in a market economy. It is not necessarily exploitation if there are protections in place such as a minimum wage or a fair price is paid to take on risk.

So payment for vaccination which passes independent safety standards (and could reasonably be offered without payment) is not exploitation, if the payment is adequate.

Undue influence?

A related concern is undue influence. Undue influence means that because of the attractiveness of the offer, I can’t autonomously and rationally weigh up the risks and benefits. It is sometimes understood as “were it not for the money, he would not do it”.

But that formulation is too broad—were it not for the money, many people would not go to work. Rather what the concept of ‘undue influence’ intends to capture is that the offer, usually money, bedazzles a person so that he or she makes a mistake in weighing up the risks and benefits. Someone offers Jones a million dollars to take on a risk of 99.99% of dying in a dangerous experiment. He just focuses on the money and takes a deal which is unfair and unreasonable. However, taking such an offer might be rational. If Jones’ daughter is about to die without a million dollars and he values her life more than his own, it might be both autonomous and rational to take the deal.

Because we cannot get into people’s minds, it is difficult in practice to unravel whether undue influence is occurring—how can you differentiate it from a rational decision? In practice, if it would be acceptable to be vaccinated for nothing, it is acceptable to do it for money. Concerns about undue influence are best met by implementing procedures to minimise bias and irrational decision making, such as cooling off periods, information reframing, and so on.

There remains a lurking concern that a decision where payment is involved may not be fully autonomous or authentic. For example, racial and ethnic minorities are among the groups most gravely affected by COVID-19, but given concerns about systemic racism in research and medicine, these communities may have good reason to distrust the medical machine. Is it acceptable to use payment to get over those concerns?

All we can do practically to address concerns about autonomy and authenticity is to redouble efforts: to ensure we do know the risks and they are reasonable (and that the underpinning research is not itself subject to concerns about systemic racism), and try to foster trust with such public education campaigns. This can work alongside a payment scheme. People still need to understand what the facts are. They still need to make as autonomous and authentic a decision as possible.

Practical advantages

A payment model could also be superior to a mandatory model from a practical point of view. There may be considerable resistance to a mandatory model which may make it difficult, expensive and time-consuming to implement, with considerable invasion of liberty. In a payment model, people are doing what they want to do.

A payment model could also be very cheap, compared with the alternatives. The cost of the UK’s furlough scheme is estimated to reach £60 billion by its planned end in October, 41 and the economic shut down is likely to cost many billions more, as well as the estimated 200 000 lives expected to be lost as a result. 11 It would make economic sense to pay people quite a lot to incentivise them to vaccinate sooner rather than later—which, for example, would speed up their full return to work.

It may be that payment is only required to incentivise certain groups. For example, it may be that young people require incentivising because they are at lower risk from the disease itself. On the other hand, justice might require payment for all taking the risk. Although the elderly and those at higher risk have more to gain personally, they are also providing a service by being vaccinated and not using limited health resources. (There is an enormous backlog of patients in the NHS—another grave threat to public health.)

One particularly difficult case is paying parents to vaccinate their children. It is one thing to pay people to take on risk for themselves; it is quite another to pay them to enable their children to take on risks, particularly when the children have little to gain as they are at lowest risk. In part, the answer to this issue is determined by how safe the vaccine is and how confident we can be in that assessment. If it were safe, to a level that even a mandatory programme would be justified, it may be appropriate to instead incentivise parents to volunteer their children for vaccination. If safety is less certain, payment for risk in this group is the most problematic.

It is true that some mandatory vaccination programmes already fine parents for failure to vaccinate their children. However, in those cases vaccination is clearly in the child’s best interest, as the child receives the benefit of immunity to diseases such as measles, that pose a greater risk to that child than we currently believe COVID-19 does. Moreover, they are for vaccines that have been in place for many years and have a well-established safety profile.

A standard objection to paying people to do their duty, particularly civic duty, is that it undermines solidarity, trust, reciprocity and other community values. This is the argument given by Richard Titmuss for a voluntary blood donation scheme. 42

The UK does not pay donors for blood or blood products, but does purchase blood products from other countries, including Austria where donors are paid a “travel allowance” for plasma donation. In Australia, which runs a donor system, more than 50% of the plasma comes from paid donors in the USA. 43 Altruism is insufficient. Germany recently moved to paying for plasma donors. It does not appear to have undermined German society.

In the end, the policy we should adopt towards COVID-19 vaccination will depend on the precise risks and benefits of the vaccine (and our confidence in them), the state of the pandemic, the nature of the alternatives, and particularly the public appetite for a vaccine.

In the right circumstances, mandatory vaccination could be ethically justified, if the penalty is suitably proportionate.

Payment for vaccination, perhaps, has even more to be said for it.

For those attached to the gift of altruism, the vaccinated could be offered the opportunity to donate their fee back to the NHS (or similar health service provider). This combined “payment-donation” model would be a happy marriage of ethics and economics. It would give altruists a double chance to be altruistic: first by vaccinating and second by donating the fee. It would also couple self-interest with morality for free-riders (as they would have greater self-interest to do what is moral), and it would give those who face obstacles to vaccination an additional reason to overcome these.

Payment in kind

Of course, benefits can come in cash or kind. An alternative “payment” model is to pay those who vaccinate in kind. This could take the form of greater freedom to travel, opportunity to work or socialise. With some colleagues, I have given similar arguments in favour of immunity passports. 44

One attractive benefit would be the freedom to not wear a mask in public places if you carried a vaccination certificate, and not to socially distance. Currently, everyone has to wear a mask and practise social distancing. Relaxing this requirement for those who have been vaccinated (or otherwise have immunity) would be an attractive benefit. Moreover, it would help ameliorate the risks the unvaccinated would pose to others.

Payment in kind has one advantage over cash in that it might not send the signal that vaccination is perceived to be unsafe. A cash payment may paradoxically undermine vaccination uptake by introducing unwarranted suspicion (though this is an intuition that may need to be tested). Benefits in kind are less susceptible to this concern because they are directly linked to the benefit provided by the vaccine itself: the vaccinated person is no longer a threat to others.

Some might object that this represents a form of shaming the non-vaccinators (some of whom might be excluded from vaccination for health reasons), just as presenting those who evaded conscription with a white feather was a method of shaming perceived free-riders. But this could be managed through an education campaign about the justification for face covering requirements. There is a good reason to require the non-vaccinated to continue to wear masks and practice social distancing, regardless of whether their refusal is justified—they do represent a greater direct threat to others.

It is quite possible that some mixture of altruism, financial and non-financial benefits will obviate the need to introduce mandatory vaccination. It is better that people voluntarily choose on the basis of reasons to act well, rather than being forced to do so. Structuring the rewards and punishments in a just and fair way is one way of giving people reasons for action.

Mandatory vaccination can be ethically justified (see figure 3), but when risks are more uncertain, payment for vaccination (whether in cash or kind) may be an ethically superior option.

Acknowledgments

This piece builds on a previous piece I published on the JME blog, Good Reasons to Vaccinate: COVID19 Vaccine, Mandatory or Payment Model? [ https://blogs.bmj.com/medical-ethics/2020/07/29/good-reasons-to-vaccinate-covid19-vaccine-mandatory-or-payment-model/ ]. I would like to thank an anonymous reviewer for very many helpful and constructive comments. I would also like to thank Alberto Giubilini for his help.

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Supplementary materials

Press release

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.

Linked Articles

Response Persuasion, not coercion or incentivisation, is the best means of promoting COVID-19 vaccination Susan Pennings Xavier Symons Journal of Medical Ethics 2021; 47 709-711 Published Online First: 27 Jan 2021. doi: 10.1136/medethics-2020-107076

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Public attitudes toward COVID-19 vaccination: The role of vaccine attributes, incentives, and misinformation

Sarah Kreps 1 ,
Nabarun Dasgupta 2 ,
John S. Brownstein 3 , 4 ,
Yulin Hswen 5 &
Douglas L. Kriner ORCID: orcid.org/0000-0002-9353-2334 1

npj Vaccines volume 6 , Article number: 73 ( 2021 ) Cite this article

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While efficacious vaccines have been developed to inoculate against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; also known as COVID-19), public vaccine hesitancy could still undermine efforts to combat the pandemic. Employing a survey of 1096 adult Americans recruited via the Lucid platform, we examined the relationships between vaccine attributes, proposed policy interventions such as financial incentives, and misinformation on public vaccination preferences. Higher degrees of vaccine efficacy significantly increased individuals’ willingness to receive a COVID-19 vaccine, while a high incidence of minor side effects, a co-pay, and Emergency Use Authorization to fast-track the vaccine decreased willingness. The vaccine manufacturer had no influence on public willingness to vaccinate. We also found no evidence that belief in misinformation about COVID-19 treatments was positively associated with vaccine hesitancy. The findings have implications for public health strategies intending to increase levels of community vaccination.

Measuring the impact of COVID-19 vaccine misinformation on vaccination intent in the UK and USA

a good thesis statement for vaccinations

Vaccine hesitancy and monetary incentives

Providing normative information increases intentions to accept a COVID-19 vaccine

Introduction.

In less than a year, an array of vaccines was developed to bring an end to the SARS-CoV-2 pandemic. As impressive as the speed of development was the efficacy of vaccines such as Moderna and Pfizer, which are over 90%. Despite the growing availability and efficacy, however, vaccine hesitancy remains a potential impediment to widespread community uptake. While previous surveys indicate that overall levels of vaccine acceptance may be around 70% in the United States 1 , the case of Israel may offer a cautionary tale about self-reported preferences and vaccination in practice. Prospective studies 2 of vaccine acceptance in Israel showed that about 75% of the Israeli population would vaccinate, but Israel’s initial vaccination surge stalled around 42%. The government, which then augmented its vaccination efforts with incentive programs, attributed unexpected resistance to online misinformation 3 .

Research on vaccine hesitancy in the context of viruses such as influenza and measles, mumps, and rubella, suggests that misinformation surrounding vaccines is prevalent 4 , 5 . Emerging research on COVID-19 vaccine preferences, however, points to vaccine attributes as dominant determinants of attitudes toward vaccination. Higher efficacy is associated with greater likelihood of vaccinating 6 , 7 , whereas an FDA Emergency Use Authorization 6 or politicized approval timing 8 is associated with more hesitancy. Whether COVID-19 misinformation contributes to vaccine preferences or whether these attributes or policy interventions such as incentives play a larger role has not been studied. Further, while previous research has focused on a set of attributes that was relevant at one particular point in time, the evidence and context about the available vaccines has continued to shift in ways that could shape public willingness to accept the vaccine. For example, governments, employers, and economists have begun to think about or even devise ways to incentivize monetarily COVID-19 vaccine uptake, but researchers have not yet studied whether paying people to receive the COVID-19 vaccine would actually affect likely behavior. As supply problems wane and hesitancy becomes a limiting factor, understanding whether financial incentives can overcome hesitancy becomes a crucial question for public health. Further, as new vaccines such as Johnson and Johnson are authorized, knowing whether the vaccine manufacturer name elicits or deters interest in individuals is also important, as are the corresponding efficacy rates of different vaccines and the extent to which those affect vaccine preferences. The purpose of this study is to examine how information about vaccine attributes such as efficacy rates, the incidence of side effects, the nature of the governmental approval process, identity of the manufacturers, and policy interventions, including economic incentives, affect intention to vaccinate, and to examine the association between belief in an important category of misinformation—false claims concerning COVID-19 treatments—and willingness to vaccinate.

General characteristics of study population

Table 1 presents sample demographics, which largely reflect those of the US population as a whole. Of the 1335 US adults recruited for the study, a convenience sample of 1100 participants consented to begin the survey, and 1096 completed the full questionnaire. The sample was 51% female; 75% white; and had a median age of 43 with an interquartile range of 31–58. Comparisons of the sample demographics to those of other prominent social science surveys and U.S. Census figures are shown in Supplementary Table 1 .

Vaccination preferences

Each subject was asked to evaluate a series of seven hypothetical vaccines. For each hypothetical vaccine, our conjoint experiment randomly assigned values of five different vaccine attributes—efficacy, the incidence of minor side effects, government approval process, manufacturer, and cost/financial inducement. Descriptions of each attribute and the specific levels used in the experiment are summarized in Table 2 . After seeing the profile of each vaccine, the subject was asked whether she would choose to receive the vaccine described, or whether she would choose not to be vaccinated. Finally, subjects were asked to indicate how likely they would be to take the vaccine on a seven-point likert scale.

Across all choice sets, in 4419 cases (58%) subjects said they would choose the vaccine described in the profile rather than not being vaccinated. As shown in Fig. 1 , several characteristics of the vaccine significantly influenced willingness to vaccinate.

Circles present the estimated effect of each attribute level on the probability of a subject accepting vaccination from the attribute’s baseline level. Horizontal lines through points indicate 95% confidence intervals. Points without error bars denote the baseline value for each attribute. The average marginal component effects (AMCEs) are the regression coefficients reported in model 1 of Table 3 .

Efficacy had the largest effect on individual vaccine preferences. An efficacy rate of 90% increased uptake by about 20% relative to the baseline at 50% efficacy. Even a high incidence of minor side effects (1 in 2) had only a modest negative effect (about 5%) on willingness to vaccinate. Whether the vaccine went through full FDA approval or received an Emergency Use Authorization (EUA), an authority that allows the Food and Drug Administration mechanisms to accelerate the availability and use of treatments or medicines during medical emergencies 9 , significantly influenced willingness to vaccinate. An EUA decreased the likelihood of vaccination by 7% compared to a full FDA authorization; such a decline would translate into about 23 million Americans. While a $20 co-pay reduced the likelihood of vaccination relative to a no-cost baseline, financial incentives did not increase willingness to vaccinate. Lastly, the manufacturer had no effect on vaccination attitudes, despite the public pause of the AstraZeneca trial and prominence of Johnson & Johnson as a household name (our experiment was fielded before the pause in the administration of the Johnson & Johnson shot in the United States).

Model 2 of Table 3 presents an expanded model specification to investigate the association between misinformation and willingness to vaccinate. The primary additional independent variable of interest is a misinformation index that captures the extent to which each subject believes or rejects eight claims (five false; three true) about COVID-19 treatments. Additional analyses using alternate operationalizations of the misinformation index yield substantively similar results (Supplementary Table 4 ). This model also includes a number of demographic control variables, including indicators for political partisanship, gender, educational attainment, age, and race/ethnicity, all of which are also associated with belief in misinformation about the vaccine (Supplementary Table 2 ). Finally, the model also controls for subjects’ health insurance status, past experience vaccinating against seasonal influenza, attitudes toward the pharmaceutical industry, and beliefs about vaccine safety generally.

Greater levels of belief in misinformation about COVID-19 treatments were not associated with greater vaccine hesitancy. Instead, the relevant coefficient is positive and statistically significant, indicating that, all else being equal, individuals who scored higher on our index of misinformation about COVID-19 treatments were more willing to vaccinate than those who were less susceptible to believing false claims.

Strong beliefs that vaccines are safe generally was positively associated with willingness to accept a COVID-19 vaccine, as were past histories of frequent influenza vaccination and favorable attitudes toward the pharmaceutical industry. Women and older subjects were significantly less likely to report willingness to vaccinate than men and younger subjects, all else equal. Education was positively associated with willingness to vaccinate.

This research offers a comprehensive examination of attitudes toward COVID-19 vaccination, particularly the role of vaccine attributes, potential policy interventions, and misinformation. Several previous studies have analyzed the effects of vaccine characteristics on willingness to vaccinate, but the modal approach is to gauge willingness to accept a generic COVID-19 vaccine 10 , 11 . Large volumes of research show, however, that vaccine preferences hinge on specific vaccine attributes. Recent research considering the influence of attributes such as efficacy, side effects, and country of origin take a step toward understanding how properties affect individuals’ intentions to vaccinate 6 , 7 , 8 , 12 , 13 , but evidence about the attributes of actual vaccines, debates about how to promote vaccination within the population, and questions about the influence of misinformation have moved quickly 14 .

Our conjoint experiment therefore examined the influence of five vaccine attributes on vaccination willingness. The first category of attributes involved aspects of the vaccine itself. Since efficacy is one of the most common determinants of vaccine acceptance, we considered different levels of efficacy, 50%, 70%, and 90%, levels that are common in the literature 7 , 15 . Evidence from Phase III trials suggests that even the 90% efficacy level in our design, which is well above the 50% threshold from the FDA Guidance for minimal effectiveness for Emergency Use Authorization 16 , has been exceeded by both Pfizer’s and Moderna’s vaccines 17 , 18 . The 70% efficacy threshold is closer to the initial reports of the efficacy of the Johnson & Johnson vaccine, whose efficacy varied across regions 19 . Our analysis suggests that efficacy levels associated with recent mRNA vaccine trials increases public vaccine uptake by 20% over a baseline of a vaccine with 50% efficacy. A 70% efficacy rate increases public willingness to vaccinate by 13% over a baseline vaccine with 50% efficacy.

An additional set of epidemiological attributes consisted of the frequency of minor side effects. While severe side effects were plausible going into early clinical trials, evidence clearly suggests that minor side effects are more common, ranging from 10% to 100% of people vaccinated depending on the number of doses and the dose group (25–250 mcg) 20 . Since the 100 mcg dose was supported in Phase III trials 21 , we include the highest adverse event probability—approximating 60% as 1 in 2—and 1 in 10 as the lowest likelihood, approximating the number of people who experienced mild arthralgia 20 . Our findings suggest that a the prevalence of minor side effects associated with recent trials (i.e. a 1 in 2 chance), intention to vaccinate decreased by about 5% versus a 1 in 10 chance of minor side effects baseline. However, at a 25% rate of minor side effects, respondents did not indicate any lower likelihood of vaccination compared to the 10% baseline. Public communications about how to reduce well-known side effects, such as pain at the injection site, could contribute to improved acceptance of the vaccine, as it is unlikely that development of vaccine-related minor side effects will change.

We then considered the effect of EUA versus full FDA approval. The influenza H1N1 virus brought the process of EUA into public discourse 22 , and the COVID-19 virus has again raised the debate about whether and how to use EUA. Compared to recent studies also employing conjoint experimental designs that showed just a 3% decline in support conditional on EUA 6 , we found decreases in support of more than twice that with an EUA compared to full FDA approval. Statements made by the Trump administration promising an intensely rapid roll-out or isolated adverse events from vaccination in the UK may have exacerbated concerns about EUA versus full approval 8 , 23 , 24 , 25 . This negative effect is even greater among some subsets of the population. As shown in additional analyses reported in the Supplementary Information (Supplementary Fig. 5 ), the negative effects are greatest among those who believe vaccines are generally safe. Among those who believe vaccines generally are extremely safe, the EUA decreased willingness to vaccinate by 11%, all else equal. This suggests that outreach campaigns seeking to assure those troubled by the authorization process used for currently available vaccines should target their efforts on those who are generally predisposed to believe vaccines are safe.

Next, we compared receptiveness as a function of the manufacturer: Moderna, Pfizer, Johnson and Johnson, and AstraZeneca, all firms at advanced stages of vaccine development. Vaccine manufacturers in the US have not yet attempted to use trade names to differentiate their vaccines, instead relying on the association with manufacturer reputation. In other countries, vaccine brand names have been more intentionally publicized, such as Bharat Biotech’s Covaxin in India and Gamaleya Research Institute of Epidemiology and Microbiology Sputnik V in Russia. We found that manufacturer names had no impact on willingness to vaccinate. As with hepatitis and H. influenzae vaccines 26 , 27 , interchangeability has been an active topic of debate with coronavirus mRNA vaccines which require a second shot for full immunity. Our research suggests that at least as far as public receptiveness goes, interchangeability would not introduce concerns. We found no significant differences in vaccination uptake across any of the manufacturer treatments. Future research should investigate if a manufacturer preference develops as new evidence about efficacy and side effects becomes available, particularly depending on whether future booster shots, if needed, are deemed interchangeable with the initial vaccination.

Taking up the question of how cost and financial incentives shape behavior, we looked at paying and being paid to vaccinate. While existing research suggests that individuals are often willing to pay for vaccines 28 , 29 , some economists have proposed that the government pay individuals up to $1,000 to take the COVID-19 vaccine 30 . However, because a cost of $300 billion to vaccinate the population may be prohibitive, we posed a more modest $100 incentive. We also compared this with a $10 incentive, which previous studies suggest is sufficient for actions that do not require individuals to change behavior on a sustained basis 31 . While having to pay a $20 co-pay for the vaccine did deter individuals, the additional economic incentives had no positive effect although they did not discourage vaccination 32 . Consistent with past research 31 , 33 , further analysis shows that the negative effect of the $20 co-pay was concentrated among low-income earners (Supplementary Fig. 7 ). Financial incentives failed to increase vaccination willingness across income levels.

Our study also yields important insights into the relationship between one prominent category of COVID-19 misinformation and vaccination preferences. We find that susceptibility to misinformation about COVID-19 treatments—based on whether individuals can distinguish between factual and false information about efforts to combat COVID-19—is considerable. A quarter of subjects scored no higher on our misinformation index than random guessing or uniform abstention/unsure responses (for the full distribution, see Supplementary Fig. 2 ). However, subjects who scored higher on our misinformation index did not exhibit greater vaccination hesitancy. These subjects actually were more likely to believe in vaccine safety more generally and to accept a COVID-19 vaccine, all else being equal. These results run counter to recent findings of public opinion in France where greater conspiracy beliefs were negatively correlated with willingness to vaccinate against COVID-19 34 and in Korea where greater misinformation exposure and belief were negatively correlated with taking preventative actions 35 . Nevertheless, the results are robust to alternate operationalizations of belief in misinformation (i.e., constructing the index only using false claims, or measuring misinformation beliefs as the number of false claims believed: see Supplementary Table 4 ).

We recommend further study to understand the observed positive relationship between beliefs in COVID-19 misinformation about fake treatments and willingness to receive the COVID-19 vaccine. To be clear, we do not posit a causal relationship between the two. Rather, we suspect that belief in misinformation may be correlated with an omitted factor related to concerns about contracting COVID-19. For example, those who believe COVID-19 misinformation may have a higher perception of risk of COVID-19, and therefore be more willing to take a vaccine, all else equal 36 . Additional analyses reported in the Supplementary Information (Supplementary Fig. 6 ) show that the negative effect of an EUA on willingness to vaccinate was concentrated among those who scored low on the misinformation index. An EUA had little effect on the vaccination preferences of subjects most susceptible to misinformation. This pattern is consistent with the possibility that these subjects were more concerned with the disease and therefore more likely to vaccinate, regardless of the process through which the vaccine was brought to market.

We also observe that skepticism toward vaccines in general does not correlate perfectly with skepticism toward the COVID-19 vaccine. Therefore, it is important not to conflate people who are wary of the COVID-19 vaccine and those who are anti-vaccination, as even medically informed individuals may be hesitant because of the speed at which the COVID-19 vaccine was developed. For example, older people are more likely to believe vaccines are safe but less willing to receive the COVID-19 vaccine in our survey, perhaps following the high rates of vaccine skepticism among medical staff expressing concerns regarding the safety of a rapidly-developed vaccine 2 . This inverse relationship between age and willingness to vaccinate is also surprising. Most opinion surveys find older adults are more likely to vaccinate than younger adults 37 . However, most of these survey questions ask about willingness to take a generic vaccine. Two prior studies, both recruiting subjects from the Lucid platform and employing conjoint experiments to examine the effects of vaccine attributes on public willingness to vaccinate, also find greater vaccine hesitancy among older Americans 6 , 7 . Future research could explore whether these divergent results are a product of the characteristics of the sample or of the methodological design in which subjects have much more information about the vaccines when indicating their vaccination preferences.

An important limitation of our study is that it necessarily offers a snapshot in time, specifically prior to both the election and vaccine roll-out. We recommend further study to understand more how vaccine perceptions evolve both in terms of the perceived political ownership of the vaccine—now that President Biden is in office—and as evidence has emerged from the millions of people who have been vaccinated. Similarly, researchers should consider analyzing vaccine preferences in the context of online vaccine controversies that have been framed in terms of patient autonomy and right to refuse 38 , 39 . Vaccination mandates may evoke feelings of powerlessness, which may be exacerbated by misinformation about the vaccines themselves. Further, researchers should more fully consider how individual attributes such as political ideology and race intersect with vaccine preferences. Our study registered increased vaccine hesitancy among Blacks, but did not find that skepticism was directly related to misinformation. Perceptions and realities of race-based maltreatment could also be moderating factors worth exploring in future analyses 40 , 41 .

Overall, we found that the most important factor influencing vaccine preferences is vaccine efficacy, consistent with a number of previous studies about attitudes toward a range of vaccines 6 , 42 , 43 . Other attributes offer potential cautionary flags and opportunities for public outreach. The prospect of a 50% likelihood of mild side effects, consistent with the evidence about current COVID-19 vaccines being employed, dampens likelihood of uptake. Public health officials should reinforce the relatively mild nature of the side effects—pain at the injection site and fatigue being the most common 44 —and especially the temporary nature of these effects to assuage public concerns. Additionally, in considering policy interventions, public health authorities should recognize that a $20 co-pay will likely discourage uptake while financial incentives are unlikely to have a significant positive effect. Lastly, belief in misinformation about COVID-19 does not appear to be a strong predictor of vaccine hesitancy; belief in misinformation and willingness to vaccinate were positively correlated in our data. Future research should explore the possibility that exposure to and belief in misinformation is correlated with other factors associated with vaccine preferences.

Survey sample and procedures

This study was approved by the Cornell Institutional Review Board for Human Participant Research (protocol ID 2004009569). We conducted the study on October 29–30, 2020, prior to vaccine approval, which means we captured sentiments prospectively rather than based on information emerging from an ongoing vaccination campaign. We recruited a sample of 1096 adult Americans via the Lucid platform, which uses quota sampling to produce samples matched to the demographics of the U.S. population on age, gender, ethnicity, and geographic region. Research has shown that experimental effects observed in Lucid samples largely mirror those found using probability-based samples 45 . Supplementary Table 1 presents the demographics of our sample and comparisons to both the U.S. Census American Community Survey and the demographics of prominent social science surveys.

After providing informed consent on the first screen of the online survey, participants turned to a choice-based conjoint experiment that varied five attributes of the COVID-19 vaccine. Conjoint analyses are often used in marketing to research how different aspects of a product or service affect consumer choice. We build on public health studies that have analyzed the influence of vaccine characteristics on uptake within the population 42 , 46 .

Conjoint experiment

We first designed a choice-based conjoint experiment that allowed us to evaluate the relative influence of a range of vaccine attributes on respondents’ vaccine preferences. We examined five attributes summarized in Table 2 . Past research has shown that the first two attributes, efficacy and the incidence of side effects, are significant drivers of public preferences on a range of vaccines 47 , 48 , 49 , including COVID-19 6 , 7 , 13 , 50 . In this study, we increased the expected incidence of minor side effects from previous research 6 to reflect emerging evidence from Phase III trials. The third attribute, whether the vaccine received full FDA approval or an EUA, examines whether the speed of the approval process affects public vaccination preferences 6 . The fourth attribute, the manufacturer of the vaccine, allows us to examine whether the highly public pause in the AstraZeneca trial following an adverse event, and the significant differences in brand familiarity between smaller and less broadly known companies like Moderna and household name Johnson & Johnson affects public willingness to vaccinate. The fifth attribute examines the influence of a policy tool—offsetting the costs of vaccination or even incentivizing it financially—on public willingness to vaccinate.

Attribute levels and attribute order were randomly assigned across participants. A sample choice set is presented in Supplementary Fig. 1 . After viewing each profile individually, subjects were asked: “If you had to choose, would you choose to get this vaccine, or would you choose not to be vaccinated?” Subjects then made a binary choice, responding either that they “would choose to get this vaccine” or that they “would choose not to be vaccinated.” This is the dependent variable for the regression analyses in Table 3 . After making a binary choice to take the vaccine or not be vaccinated, we also asked subjects “how likely or unlikely would you be to get the vaccine described above?” Subjects indicated their vaccination preference on a seven-point scale ranging from “extremely likely” to “extremely unlikely.” Additional analyses using this ordinal dependent variable reported in Supplementary Table 3 yield substantively similar results to those presented in Table 3 .

To determine the effect of each attribute-level on willingness to vaccinate, we followed Hainmueller, Hopkins, and Yamamoto and employed an ordinary least squares (OLS) regression with standard errors clustered on respondent to estimate the average marginal component effects (AMCEs) for each attribute 51 . The AMCE represents the average difference in a subject choosing a vaccine when comparing two different attribute values—for example, 50% efficacy vs. 90% efficacy—averaged across all possible combinations of the other vaccine attribute values. The AMCEs are nonparametrically identified under a modest set of assumptions, many of which (such as randomization of attribute levels) are guaranteed by design. Model 1 in Table 3 estimates the AMCEs for each attribute. These AMCEs are illustrated in Fig. 1 .

Analyzing additional correlates of vaccine acceptance

To explore the association between respondents’ embrace of misinformation about COVID-19 treatments and vaccination willingness, the survey included an additional question battery. To measure the extent of belief in COVID-19 misinformation, we constructed a list of both accurate and inaccurate headlines about the coronavirus. We focused on treatments, relying on the World Health Organization’s list of myths, such as “Hand dryers are effective in killing the new coronavirus” and true headlines such as “Avoiding shaking hands can help limit the spread of the new coronavirus 52 .” Complete wording for each claim is provided in Supplementary Appendix 1 . Individuals read three true headlines and five myths, and then responded whether they believed each headline was true or false, or whether they were unsure. We coded responses to each headline so that an incorrect accuracy assessment yielded a 1; a correct accuracy assessment a -1; and a response of unsure was coded as 0. From this, we created an additive index of belief in misinformation that ranged from -8 to 8. The distribution of the misinformation index is presented in Supplementary Fig. 2 . A possible limitation of this measure is that because the survey was conducted online, some individuals could have searched for the answers to the questions before responding. However, the median misinformation index score for subjects in the top quartile in terms of time spent taking the survey was identical to the median for all other respondents. This may suggest that systematic searching for correct answers is unlikely.

To ensure that any association observed between belief in misinformation and willingness to vaccinate is not an artifact of how we operationalized susceptibility to misinformation, we also constructed two alternate measures of belief in misinformation. These measures are described in detail in the Supplementary Information (see Supplementary Figs. 3 and 4 ). Additional regression analyses using these alternate measures of misinformation beliefs yield substantively similar results (see Supplementary Table 4 ). Additional analyses examining whether belief in misinformation moderates the effect of efficacy and an FDA EUA on vaccine acceptance are presented in Supplementary Fig. 6 .

Finally, model 2 of Table 3 includes a range of additional control variables. Following past research, it includes a number of demographic variables, including indicator variables identifying subjects who identify as Democrats or Republicans; an indicator variable identifying females; a continuous variable measuring age (alternate analyses employing a categorical variable yield substantively similar results); an eight-point measure of educational attainment; and indicator variables identifying subjects who self-identify as Black or Latinx. Following previous research 6 , the model also controlled for three additional factors often associated with willingness to vaccinate: an indicator variable identifying whether each subject had health insurance; a variable measuring past frequency of influenza vaccination on a four-point scale ranging from “never” to “every year”; beliefs about the general safety of vaccines measured on a four-point scale ranging from “not at all safe” to “extremely safe”; and a measure of attitudes toward the pharmaceutical industry ranging from “very positive” to “very negative.”

Reporting summary

Further information on research design is available in the Nature Research Reporting Summary linked to this article.

Data availability

All data and statistical code to reproduce the tables and figures in the manuscript and Supplementary Information are published at the Harvard Dataverse via this link: 10.7910/DVN/ZYU6CO.

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S.K. and D.K. would like to thank the Cornell Atkinson Center for Sustainability for financial support.

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Kreps, S., Dasgupta, N., Brownstein, J.S. et al. Public attitudes toward COVID-19 vaccination: The role of vaccine attributes, incentives, and misinformation. npj Vaccines 6 , 73 (2021). https://doi.org/10.1038/s41541-021-00335-2

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Attitudes towards covid-19 vaccination: literature review and attitudes of individuals who delayed vaccination.

Sydney Hornberger '22 , DePauw University

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This thesis examines attitudes towards and ethics of receiving one of the fastest vaccines ever developed— the COVID-19 vaccine. The Food and Drug Administrations (FDA) in the U.S. has granted either Emergency Use Authorization or full approval to three vaccines: the Pfizer-BioNTech, Johnson & Johnson, and Moderna-NIAID vaccines. However, although the FDA approved and the Center for Disease Control and Prevention (CDC) recommends getting the vaccines, that does not necessarily mean people have an ethical responsibility or a positive attitude towards getting vaccinated against COVID-19; this current paper explores both of these ideas as related to COVID-19 vaccination. First, it surveys sources highlighting the utility of vaccines to control infectious diseases and pandemics. Next, it questions whether getting vaccinated against any disease, and specifically COVID-19, is the ethical action to take. Then, there is a literature review of research into attitudes towards the COVID-19 vaccine, determining the most prevalent attitudes across all people and within specific demographics such as women, people belonging to certain political and religious groups, racial and ethnic minorities, and children. Finally, the results of a study conducted at DePauw University to investigate attitudes, attitude changes, and motivations of recently vaccinated individuals are reported in order to elucidate certain factors that may be useful to understand vaccine decision making.

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Hornberger, Sydney '22, "Attitudes Towards COVID-19 Vaccination: Literature Review and Attitudes of Individuals Who Delayed Vaccination" (2022). Honor Scholar Theses . 201, Scholarly and Creative Work from DePauw University. https://scholarship.depauw.edu/studentresearch/201

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Attitudes on voluntary and mandatory vaccination against COVID-19: Evidence from Germany

Roles Conceptualization, Formal analysis, Writing – original draft, Writing – review & editing

Affiliation DIW Berlin / SOEP, Berlin, Germany

* E-mail: [email protected] (CSP); [email protected] (CS)

Affiliation Karlsruhe Institute of Technology, Karlsruhe, Germany

Affiliations DIW Berlin / SOEP, Berlin, Germany, Freie Universität Berlin, Berlin, Germany

Daniel Graeber,
Christoph Schmidt-Petri,
Carsten Schröder

Published: May 10, 2021
https://doi.org/10.1371/journal.pone.0248372
Reader Comments

Several vaccines against COVID-19 have now been developed and are already being rolled out around the world. The decision whether or not to get vaccinated has so far been left to the individual citizens. However, there are good reasons, both in theory as well as in practice, to believe that the willingness to get vaccinated might not be sufficiently high to achieve herd immunity. A policy of mandatory vaccination could ensure high levels of vaccination coverage, but its legitimacy is doubtful. We investigate the willingness to get vaccinated and the reasons for an acceptance (or rejection) of a policy of mandatory vaccination against COVID-19 in June and July 2020 in Germany based on a representative real time survey, a random sub-sample (SOEP-CoV) of the German Socio-Economic Panel (SOEP). Our results show that about 70 percent of adults in Germany would voluntarily get vaccinated against the coronavirus if a vaccine without side effects was available. About half of residents of Germany are in favor, and half against, a policy of mandatory vaccination. The approval rate for mandatory vaccination is significantly higher among those who would get vaccinated voluntarily (around 60 percent) than among those who would not get vaccinated voluntarily (27 percent). The individual willingness to get vaccinated and acceptance of a policy of mandatory vaccination correlates systematically with socio-demographic and psychological characteristics of the respondents. We conclude that as far as people’s declared intentions are concerned, herd immunity could be reached without a policy of mandatory vaccination, but that such a policy might be found acceptable too, were it to become necessary.

Citation: Graeber D, Schmidt-Petri C, Schröder C (2021) Attitudes on voluntary and mandatory vaccination against COVID-19: Evidence from Germany. PLoS ONE 16(5): e0248372. https://doi.org/10.1371/journal.pone.0248372

Editor: Valerio Capraro, Middlesex University, UNITED KINGDOM

Received: October 19, 2020; Accepted: February 25, 2021; Published: May 10, 2021

Copyright: © 2021 Graeber et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Our analyses rely on the German Socio-Economic Panel (SOEP), an independent scientific data infrastructure established in 1984. We, as users, cannot send the data to the journal and make them publicly available, as this is against SOEP's statutes (and most likely against the statutes of all providers of micro data). However, this should not be a hurdle, as researchers from scientific institutions around the globe can access the data (free of costs) once they have signed a user contract. The scientific use file of the SOEP with anonymous microdata is made available free of charge to universities and research institutes for research and teaching purposes. The direct use of SOEP data is subject to the provisions of German data protection law. Therefore, signing a data distribution contract is the single precondition for working with SOEP data. The data distribution contract can be requested with a form which can be downloaded from: http://www.diw.de/documents/dokumentenarchiv/17/diw_01.c.88926.de/soep_application_contract.pdf .

Funding: The data collection of the SOEP-CoV Study was financially supported by the German Federal Ministry of Education and Research. We acknowledge support by the KIT-Publication Fund of the Karlsruhe Institute of Technology. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Great efforts have been made worldwide to develop a vaccine against COVID-19. When we first drafted this article, in October 2020, 35 different potential vaccines were in clinical trials and 145 were still in the pre-clinical stage. In February 2021, several vaccines have been approved in many countries and are being rolled out, 74 are in clinical trials, and 182 are in the pre-clinical stage [ 1 ].

These developments are very encouraging, as a wide availability of vaccines is seen by many as a prerequisite for a return to a “normal” pre-COVID-19 type of social and economic life. With the growing availability of vaccines comes the hope that coercive measures such as restrictions on international trade, contact restrictions, and travel bans, etc., which cause enormous economic and social costs, may soon be removed and will not need to be reimplemented.

Of course, any vaccine is only an effective contribution to a return to normal life if a sufficiently high number of people are actually vaccinated, yielding herd immunity. If so, vaccination secures a public good: protection from COVID-19 for everyone. From a microeconomic perspective, this raises a well-known problem, free-riding: If the vaccination is freely available but not obligatory, then citizens’ individual decisions determine the extent to which this public good is made available. In order to make that decision, they will weigh their own costs and benefits. These costs include the time sacrificed, physical unpleasantness, possible side effects of a vaccination, etc. The benefits to a particular individual are primarily, but not necessarily exclusively, the reduction in risk to that person’s own health or material well-being. From a welfare perspective, if individuals do not take into account the positive externalities on third parties that their own vaccination triggers, there will be an undersupply of the public good. Following [ 2 , 3 ], individuals’ utility function may also include other-regarding preferences and hence yield a direct benefit from contributions to a public good. In our context, people could therefore benefit from a ‘warm glow of vaccinating’, because by vaccinating themselves they also reduce the risks of others. But even so there is certainly no guarantee that the social optimum will be reached [ 4 ] or that a sufficiently high number of people will freely choose to get vaccinated.

It is frequently argued that vaccination should be made mandatory because of the free-rider problem [ 5 ]: While vaccinated individuals have incurred private costs in terms of discomfort or money and receive the private benefit of a reduced risk of getting the disease, the major collective benefit, the reduced incidence of disease, is public. If enough other people produce the public benefit, and the circulation of the virus decreases accordingly, an individual might rationally decide to free-ride on others’ decisions. A policy of mandatory vaccination would prevent this.

[ 6 ] argue that such a policy would not be necessary: “If vaccinations are perfect, then if one is vaccinated he or she does not care whether others are vaccinated, so there is no longer any public good problem” ([ 6 ], p. 70). Hence there would not be a case in favor of mandatory vaccination, as under such a policy, individuals who would have favored not to be vaccinated are made worse off, while those who anyway would get vaccinated are not better off.

However, by definition, ‘perfect’ vaccination means that everyone vaccinated is perfectly immune [ 6 ]. In the current situation, it can neither be taken for granted that a perfect vaccination is being or will be provided soon, nor that everyone who wants to also will have the possibility to be vaccinated (both financially and in terms of health). If perfect vaccination is not feasible, however, mandatory vaccination is not dominated by a laissez faire solution [ 6 ].

Extensions of this theoretical public good analysis emphasize the relevance of behavioral aspects not typically considered in classical models. The empirical literature also highlights a number of factors that matter for vaccine uptake. For instance [ 7 ], show that social norms matter for an individual’s willingness to get a vaccination and that such norms can suppress vaccine uptake even in the presence of frequent disease outbreaks. Further [ 8 ], show that the design of public vaccination policies should also take intergroup interactions into account. Other-regarding preferences can explain voluntary vaccination uptake, as argued by [ 9 ]. For example [ 10 ], show that the presence of individuals who cannot get vaccinated, like babies and the elderly, increases the willingness to get vaccinated. The static model in [ 6 ] also does not reflect interactive processes [ 9 , 11 ]. show that vaccination is the individually best response until a certain vaccination rate is reached in the population and becomes a social dilemma only from this vaccination rate until herd immunity is maximized. Communicating the social benefits of vaccination can have positive effects, particularly when this protects vulnerable groups, but it can also invite free-riding [ 12 ]. Those people who cannot get vaccinated themselves for medical reasons are particularly vulnerable: they cannot protect themselves even if they wanted to and, hence, depend on their fellow citizens to protect them by preventing the spread of the virus through their vaccination. Children, too, need to be considered separately. Since they cannot give informed consent to a voluntary vaccination themselves, they might have to be protected from their parents (who might be unwilling to get them vaccinated) in case of particularly serious diseases (see [ 13 , 14 ]).

There is, in summary, hope that the public goods problem may be overcome, as social and behavioral science offers a wide array of potential policy options to influence people’s perceptions and reactions to the pandemic (for an extensive up-to-date overview, see [ 15 ]). It is not clear, however, how the research on well-established vaccines carries over to the current pandemic, and recent developments seem to indicate that the willingness to get vaccinated against the novel coronavirus is currently rather low. We therefore chose to investigate two fundamental questions at the opposite extremes of the spectrum of policy options: would a sufficient number of people voluntarily undergo vaccination to achieve herd immunity? Or would a mandatory vaccination against COVID-19 be acceptable to achieve herd immunity?

A legal duty to be vaccinated against COVID-19 could be an alternative to other coercive measures if one assumes that a high-risk, unregulated, laissez faire approach is not a realistic policy option: it seems irresponsible to lift all restrictions because the virus would soon spread through the entire population. Coercive measures of some kind therefore seem inevitable. Mandatory vaccination could be preferable to other coercive measures, provided the interference with bodily integrity would be considered less socially costly in the long run than the effects of prolonged lockdowns. Emotions run high where vaccination policies are concerned, but because mandatory vaccination might become a realistic scenario, it is worth investigating what the general population thinks about such a policy.

It is important to emphasize that a legal duty to vaccinate against COVID-19 would not imply a legal (or even moral) duty to vaccinate against other diseases. The novel coronavirus is a special case in many respects: In contrast to influenza, for example, the population does not have a background immunity from past infections. In addition, many infected people do not show symptoms (a recent meta-study estimates this to be one in six infected [ 16 ]) and, hence, cannot protect others from being infected through voluntary self-quarantining. Thus, people with COVID-19 represent a much higher risk of infection for others than, for example, people who come down with influenza, assuming that these would normally stay at home. Therefore, a vaccination against COVID-19 is much more important from the social perspective than e.g. a vaccination against influenza: not for self-protection, but to protect other people from unintentional infection. Although classic liberal positions (cf. [ 17 ]) would reject a paternalist legal obligation to protect oneself through vaccination, they plausibly would favor a policy of mandatory vaccination in the case of COVID-19 to protect others from being harmed. In modern philosophical discussions, even some libertarians are in favor of mandatory vaccination against serious diseases for similar reasons (see [ 18 ] and for an overview [ 19 ]).

Though there are philosophical reasons supporting a policy of mandatory vaccination, we want to emphasize that we are not advocating it as a concrete policy option for Germany at this moment. Our aim is to understand whether the general public would consider such a policy acceptable, or which sections of the population, and why. To this end, we study the willingness to get vaccinated and the acceptance of a policy of mandatory vaccination against COVID-19 in June and July 2020 in Germany. We use unique real time survey data from a sub-sample (SOEP-CoV) of the German Socio-Economic Panel (SOEP, see [ 20 ]). A set of questions about vaccination was part of the later stages of SOEP-CoV, an ongoing research project initiated in April 2020. This so-called ‘vaccination module’ included questions on the willingness to get vaccinated voluntarily and the acceptance of a policy of mandatory vaccination against COVID-19. In addition, individuals could indicate reasons for their preference regarding the second question. Using the rich data of the SOEP, pre-pandemic income, education, household context, personality, political preferences etc., which can be directly linked with SOEP-CoV, we are able to provide a detailed picture on who intends to get vaccinated and who does not.

The most important result of our study is that about 70 percent of adults in Germany would get vaccinated voluntarily against COVID-19 if a vaccine without significant side effects was available. Further, about half of adults in Germany are in favor, and half against, a policy of mandatory vaccination against COVID-19. The approval rate for mandatory vaccination is significantly higher among those who would get vaccinated voluntarily (around 60 percent) than among those who would not get vaccinated voluntarily (27 percent). However, 22 percent of the individuals would disapprove of both a voluntary and a mandatory vaccination and 8 percent can be characterized as ‘passengers’ (they are not willing to get vaccinated but do support a policy of mandatory vaccination, but they might not all be ‘free-riders’ in the standard sense). In this group, surprisingly, 86 percent state that, without a mandatory vaccination, too few individuals would get vaccinated and about 87 percent indicate that most people underestimate how dangerous COVID-19 is. In general, the willingness to get vaccinated is significantly lower for female, younger, and less educated respondents as well as those with lower income. A policy of mandatory vaccination is rejected with higher probability by women and favored by older people and those living in the eastern federal states.

Data, measures, and methods

Data: soep and soep-cov.

The German Socio-economic Panel (SOEP) is among the largest and longest-running representative panel surveys worldwide and is recognized for maintaining the highest standards of data quality and research ethics [ 20 ]. In 2020, the survey covers about 30,000 adults in 20,000 households. Since the same individuals and households participate in the study every year, life courses of the respondents can be tracked and intertemporal analyses can be carried out at the individual and at the household level. The data contain information on the respondents’ household situation, education, labor market outcomes, and health, among others (see [ 20 , 21 ]).

To better understand the effects of the corona pandemic, a special survey called SOEP-CoV was conducted within the framework of the SOEP, which consisted of a random sample of about 6,700 SOEP respondents, (see [ 21 , 22 ]). SOEP-CoV was surveyed in nine staggered tranches from early April to the end of July 2020 and collected data on the following topics: a) Prevalence, health behavior, and health inequality; b) Labor market and gainful employment; c) Social life, networks, and mobility; d) Mental health and well-being; and e) Social cohesion. Over time, some new question modules were introduced within these five thematic complexes. These included the ‘vaccination module’ (see questionnaires available under www.soep-cov.de/Methodik/ ).

Measures: Preferences toward vaccination against COVID-19

The ‘vaccination module’ went into the field with tranches 7 to 9, in June and July 2020, and covered a total of 851 persons aged 19 years and older. At that moment, major research efforts were being undertaken, but it was not clear whether any vaccine would actually be found. The module hence starts with a question on the hypothetical willingness to get vaccinated against COVID-19:

“Let us assume that a vaccine against the novel coronavirus that is shown to have no significant side effects is found. Would you get vaccinated?” The response categories are ’Yes’, ’No’, and ‘no answer’. The module contains a further question about mandatory vaccination with the same response categories:
“Would you be in favor of a policy of mandatory vaccination against the coronavirus?” In addition, the interviewees were asked about their reasons for or against a policy of mandatory vaccination. For this purpose, a filter was used to adapt the arguments according to the respondents’ answers to question (B). The arguments given were as follows:

Argument 1: Others’ willingness to get vaccinated without mandatory vaccination

Against mandatory vaccination: “Enough people would get vaccinated even without a policy of mandatory vaccination.”
In favor of mandatory vaccination: “Only with a policy of mandatory vaccination would enough people get vaccinated.”

Argument 2: Misperception of risks

Against mandatory vaccination: “Most people overestimate the dangerousness of the virus.”
In favor of mandatory vaccination: “Most people underestimate the dangerousness of the virus.”

Argument 3: Legitimacy of a policy of mandatory vaccinations in general

Against mandatory vaccination: “A policy of mandatory vaccination is never permissible, even in the case of very dangerous diseases.”
In favor of mandatory vaccination: “A policy of mandatory vaccinations would make sense also for less dangerous diseases.”

Argument 4: Other reasons (without listing these reasons explicitly)

The first three arguments are of particular relevance for political decision-making. Although there is quite a lot of research on the reasons people have not to get vaccinated themselves, there is much less research on what people think about policies of mandatory vaccinations, and up to present–at least to our knowledge–none on the application to the special case of the novel coronavirus. As the reasons for the individual decision need not carry over to the policy assessment, and given the previously discussed particularities of the coronavirus, we focused on factors that are both of theoretical importance and under discussion in the general public. It would be interesting, for instance, if many people did not have the intention to get vaccinated themselves, yet believed that enough other people would get vaccinated so that mandatory vaccination would not be required. Similarly, it would be surprising if people wanted to get vaccinated yet believed that others overestimated the dangerousness of the virus. Finally, we wanted to see whether people considered mandatory vaccinations potentially legitimate at all.

Sample selection, weighting, and item non-response

Since SOEP-CoV is a random sample from the SOEP population, the SOEP-CoV data 2020 can be linked with the regular SOEP data of previous years. Thus, attitudes toward vaccination against COVID-19 that were collected during the pandemic can be linked to the characteristics of the respondents before the outbreak of the pandemic (e.g., income or educational level). Since these characteristics were collected before the pandemic, they can be considered unaffected by the pandemic event and, hence, exogenous ( S1 File provides definitions of all dependent and independent variables used in the empirical analyses).

The response rate in the vaccination module was high. Altogether, only 4.58 percent of the 851 respondents did not answer the question about voluntary vaccination and 3.41 percent did not answer the question about mandatory vaccination. Of those who supported (objected to) mandatory vaccination, 0.26 (1.82) percent did not provide at least one motive in the follow-up question. Hence, bias from item non-response should be small and we did not correct for it. As the focal variables are coded dichotomously (yes = 1; no = 0), there was no need to remove outliers in them from the database.

To derive population-wide estimates, the SOEP-CoV data is equipped with frequency weights. The weighting of SOEP-CoV follows the standard weighting used in SOEP [ 23 , 24 ]. Based on the SOEP household weights, weights for all persons in the participating households were generated via a marginal adjustment step and corrected for selection effects. Furthermore, the data were corrected for the fact that some SOEP subsamples were excluded from the SOEP-CoV study from the outset. To address potential selection effects and adjust frequency weights accordingly, we followed the two-step procedure recommended in [ 25 ]:

Step 1: Estimation of a logistic regression model where the dependent variable is a dummy variable indicating whether respondents belong to the working sample of tranches 7 to 9 (dummy is equal to one) or not (dummy is zero). All variables included in the following analyses serve as explanatory variables.
Step 2: If at least one analysis variable shows a significant (i.e., p -value below 0.05) and at the same time meaningful effect (i.e., coefficient above 0.01) with respect to the assignment to the analysis population, a correction of the SOEP-CoV weights is performed by multiplying the frequency weights by the inverse estimated probability. In other words, multiplying the SOEP-CoV weights belonging to the analysis set by the inverse predicted probability yields the sought adjusted weight that can be used to calculate population statistics. In the present case, an adjustment using the following variables is indicated: Extraversion and whether respondents live in a household in which at least one household member was tested for COVID-19. Overall, selection on observables is very minor. Unless otherwise stated, our results are weighted with the adjusted probability weights.

Statistical framework

Since the vaccination questions are answered once by each respondent, our empirical strategy is between-person. Uni- and bivariate results for our focal variable, attitudes toward vaccination, are presented as weighted means or percentages. Assessments of differences in attitudes or characteristics between-groups rely on two-tailed t-tests, with statistical significance evaluated at p <0.01, p <0.05, and p <0.10 using the survey weights explained above. Our empirical strategy involves multiple between-group tests. This raises the question of whether a correction is necessary for multiple hypotheses testing. We do not implement such a correction because we seek to compare a certain attitude or characteristic between groups and not to draw, at the end of the test series, a concluding summary of all tests results.

Willingness to get vaccinated and attitudes toward a policy of mandatory vaccination

For the questions on voluntary vaccination (A) and mandatory vaccination (B), four groups in the population may be distinguished:

Anti-vaccination: interviewees who would not get vaccinated voluntarily against the coronavirus and who also oppose a policy of mandatory vaccination.
Anti-duty: interviewees who would get vaccinated voluntarily but oppose a policy of mandatory vaccination.
Passengers: interviewees who would not get vaccinated voluntarily but are in favor of mandatory vaccination. We refer to this group as ‘passengers’ because they apparently want to see the public good of herd immunity provided by mandatory vaccination, yet would not voluntarily contribute to this good. Some of these passengers might be free-riders in the standard sense, trying to benefit from the decisions of others while not voluntarily contributing themselves, while others might not be able to get vaccinated for medical reasons. If mandatory vaccination were introduced, the first group, but not the second, would also get vaccinated, of course. Neither group would actually free-ride, but the first might initially have wanted to.
Pro-vaccination: interviewees who would get vaccinated voluntarily and are also in favor of mandatory vaccination.

Overall, 70 percent of adults in Germany would voluntarily get vaccinated against the coronavirus, provided a vaccine without significant side effects was available ( Table 1 : groups 2 and 4). This value corresponds exactly to the results of [ 26 ]. From May till September 2020, the COVID-19 snapshot monitoring (COSMO) at the University of Erfurt showed relatively constant values of between 60 and 66 percent; it was only in April that it showed an exceptionally high value of 79 percent, and it has now decreased further (cf. [ 27 ], p. 76; an overview of previous studies on the willingness to get vaccinated in Germany is provided in S2 File .). Overall, these studies paint a consistent picture, with a slight decline in the willingness in the second half of 2020.

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https://doi.org/10.1371/journal.pone.0248372.t001

Approximately half of the interviewees are against, and half are in favor of, a policy of mandatory vaccination (against: 51%, groups 1 and 2, in favor: 49%, groups 3 and 4). These values, too, coincide almost exactly with those of the COSMO monitoring since May 2020 (cf. [ 27 ], p. 78), which in April showed an approval rate for mandatory vaccination of 73 percent, but later discontinued this question (till July 2020, and it has been decreasing since; see S2 File ). The agreement with a policy of mandatory vaccination is clearly higher, namely almost 60 percent (41/(41+29) = 0.59) among those who would get vaccinated voluntarily than with those who would not let themselves be vaccinated voluntarily, i.e. approximately 27 percent (8/(8+22) = 0.27).

Attitudes toward a policy of mandatory vaccination

The four groups differ noticeably in how they assess the arguments presented to them. This is shown in Table 2 , which gives the group-specific approval rate for each argument in combination with the p-values of t-tests in S3.1 Table in S3 File .

https://doi.org/10.1371/journal.pone.0248372.t002

Argument 1.

The groups differ markedly in how likely they think it is that others will get vaccinated. Among the two groups that are against a policy of mandatory vaccination, 56 percent of the ‘anti-vaccination’ group (who would not get vaccinated voluntarily) think that their fellow citizens would get vaccinated sufficiently frequently such that mandatory vaccinations would not be necessary. Almost 80 percent of the ‘anti-duty’ group (the members of which would get vaccinated voluntarily) think the same. Among the two groups that are in favor of mandatory vaccination, 85 percent of the ‘passengers’ (who would not voluntarily get vaccinated) think that the others would not voluntarily get vaccinated either, as do slightly more than 90 percent of the ‘pro-vaccination’ group (who would also get vaccinated voluntarily).

Argument 2.

These results run in parallel with the assessment of the dangerousness of the virus. Even though the analysis is not causal, we can see that about 50 percent of the ‘anti-vaccination’ group and 30 percent of the ‘anti-duty’ group think that most people overestimate the dangerousness of SARS-CoV-2. Exactly the opposite, that most people underestimate the dangerousness, is believed by nearly 90 percent of the ‘passenger’ group and by slightly more than 80 percent of the ‘pro-vaccination’ group. Summarizing the numbers differently, one could say that groups 2 and 4, who would voluntarily get vaccinated, probably have similar opinions about whether their fellow citizens correctly assess the danger posed by the virus. About 80 percent of the members of the ‘pro-vaccination’ group think that most people underestimate the danger. Of the members of the ‘anti-duty’ group, we only know with certainty that 30 percent of them believe that most people overestimate the danger–we do not know, however, how the remaining 70 percent are divided between ’underestimate’ and ’correctly estimate’. The difference between the corresponding values for groups 1 and 3 is significantly higher.

Looking at arguments 1 and 2, we may conclude that there is a high level of disagreement among the population about the dangerousness of the virus. This disagreement probably explains why people have such different attitudes toward getting vaccinated and toward the necessity (or not) of a policy of mandatory vaccination.

The position of the group of the ‘passengers’ is hard to understand. On the one hand, they favor a policy of mandatory vaccination, presumably because, as they do believe, the dangerousness of the virus is often underestimated. On the other hand, they probably assume that they themselves do not underestimate that dangerousness, but nevertheless would not get vaccinated voluntarily. One reason for this could be their medical condition: they might be willing but unable to get vaccinated for medical reasons. If so, they would not be trying to free-ride. It is unclear, however, how much weight the appeal to such a hypothetical medical contraindication should have, given that at the time of the interviews, no vaccine was even available. Some, but not all, of the ‘passengers’ are probably free-riders in the standard sense.

Argument 3.

Approximately 40 percent of both the ‘anti-vaccination’ group and the ‘anti-duty’ group agree with the statement that a mandatory vaccination is never permissible, not even with very dangerous diseases. Since these two groups reject mandatory vaccination against COVID-19, this means that for the remaining 60 percent of the group, mandatory vaccination may well be permissible–but apparently only for diseases that they would have to consider as even more dangerous than COVID-19. Conversely, well over 60 percent of the ‘passenger’ group and just over 70 percent of the ‘pro-vaccination’ group agree with the statement that a policy of mandatory vaccination would also make sense for less dangerous diseases. In combination with the results for argument 2, these two groups could therefore believe that their fellow citizens also underestimate the danger of such other diseases. It is interesting to note that, overall, people in Germany estimate the probability that the novel coronavirus will cause a life-threatening disease within the next twelve months to be high (cf. [ 20 ]). This probability is around 25 percent across our four groups. In group 1 it is 20 percent, in group 2 around 27 percent, in group 3 it is 30 percent and in group 4 it is 25 percent (see Table 3 ).

https://doi.org/10.1371/journal.pone.0248372.t003

Other reasons (which were not further broken down in the questionnaire for capacity reasons) are important primarily among those respondents who would not themselves get vaccinated and also oppose mandatory vaccination. Although questions (A) and (B) explicitly assume that a vaccine would not have any significant side effects, this could be due to a deeper skepticism about vaccination, which we hope to be able to explore in future research (on ’vaccine denialism’ see [ 28 ]).

Characteristics of the ‘anti-vaccination’, ‘anti-duty’, ‘passenger’, and ‘pro-vaccination’ groups

Description of the individual characteristics of the groups..

We would like to know in more detail who is in favor of a policy of mandatory vaccination against COVID-19 and who is opposing it, as well as what the socio-economic characteristics of those who would get vaccinated and of those who would not are. Table 3 shows how the four groups defined above differ across various socio-demographic characteristics (measured before the pandemic), personality (measured before the pandemic), health (before and during the pandemic), and political orientation (measured before the pandemic). Statistical t-tests for the significance of differences in characteristics between groups are shown in S3.2 Table in S3 File assuming equal variances across groups. S3.3 Table in S3 File provides supporting evidence: tests for equality of variance across groups provides support for this assumption in about 90% of the cases, and as S3.4 Table in S3 File . shows, relaxing the equality of variances assumption does not change our conclusions.

Socio-demographic characteristics . Almost 60 percent of the ‘anti-vaccination’ group are female, they are on average 48 years old, 12 percent of them have a university degree and their monthly net household income in 2019 averaged just under EUR 2,800. Around 27 percent have children under 16 and around 17 percent live in the eastern German states. ‘Passengers’ do not differ in their characteristics statistically significantly from this group. The members of the ‘anti-duty’ group, by contrast, are much more likely to be male and more often have a university degree. In comparison to the ‘anti-vaccination’ group, the members of the ‘pro-vaccination’ group are also more often male and older, and are also more likely to have a university degree. In particular, older interviewees are more likely to be in groups that favor mandatory vaccination and persons with a university education in groups comprising those who would get vaccinated voluntarily.

Personality traits . SOEP collects the personality traits of the respondents using a battery of questions that measure the five dimensions of the so-called ’Big Five’ [ 29 ]. The Big Five are the five most important groups of character traits in personality research: ’openness’, ’conscientiousness’, ’extraversion (sociability)’, ’tolerance’, and ’neuroticism’. Furthermore, risk attitude is surveyed. We see that members of the ‘anti-vaccination’ group tend to be more sociable but less open than the other groups. Their willingness to take risks is similar to that of the members of the ‘anti-duty’ and of the ‘pro-vaccination’ groups, but is significantly higher than that of ‘passengers’. Members of the ‘anti-duty’ group are particularly unsociable compared to the other groups, but open to new experiences. The ‘passengers’ are, like the members of the ‘pro-vaccination’ group, less neurotic. They are particularly tolerable and the least willing to take risks of the four groups.

Health . As far as the health of those surveyed is concerned, statistically significant differences are only evident in the number of illnesses: Members of the ‘anti-vaccination’ group have significantly fewer risk diseases than ‘passengers’ and members of the ‘pro-vaccination’ group. ‘Anti-duty’ members, on the other hand, have significantly fewer diseases than the ‘passengers’. Thus, overall, it may be said that those who refuse a policy of mandatory vaccination have fewer risk diseases at the time of the survey. There are no differences between the groups in terms of whether a member of the respondent’s household has already undergone a test for an infection with corona. It should be noted, however, that the number of cases of those tested for an infection is comparatively small.

Political orientation . As far as the political orientation of the respondents is concerned, no systematic significant differences between the four groups are identified. Only the members of the ‘anti-vaccination’ group seem to be positioned somewhat more to the right in the party spectrum than the members of the ‘anti-duty’ group.

Multivariate description of the characteristics of the four groups.

The differences and similarities with regard to group composition described above always refer to a single characteristic, i.e. they are univariate. Additionally, the relationships between individual characteristics of the respondents–after taking other characteristics into account–and their attitude toward mandatory or voluntary vaccination are explained below using a multivariate model (logistic estimation; see Eq ( 1 )). The dependent variable is either an indicator that describes the respondent’s own willingness to get vaccinated voluntarily (value 1 = yes; 0 = no; Table 4 ) or an indicator (value 1 = yes; 0 = no) that describes whether the respondents favors a policy of mandatory vaccination ( Table 5 ). As our interest is the explanation of data structures, we do not use survey weights in the multivariate analysis.

https://doi.org/10.1371/journal.pone.0248372.t004

https://doi.org/10.1371/journal.pone.0248372.t005

With regard to the willingness to voluntarily get vaccinated ( Table 4 ), some significant differences in socio-demographic characteristics are observed. If all other characteristics are kept constant, the willingness to vaccinate is about 10 percentage points lower in women than in men. It is positively associated with age (0.4 percentage points per year of life), education (13 percentage points if respondents have a university degree compared to the other education categories), and household income (2.5 percentage points per 1,000 euros). The personality traits of the Big Five do not correlate with the respondents’ willingness to vaccinate; only openness is slightly positively associated with the willingness to vaccinate. In the health block, there is also only one significant variable that correlates with the willingness to get vaccinated: The higher the respondents estimate the probability that the virus could trigger a life-threatening disease in them, the more willing they are to be vaccinated.

A policy of mandatory vaccination ( Table 5 ) is also rejected with higher probability by women, but favored by older people and those living in the eastern federal states, ceteris paribus . Approval is negatively associated with neuroticism, i.e. emotional instability, and positively associated with the subjective probability of contracting life-threatening COVID-19.

The tables presenting the logit estimations include an initial model diagnostic: the Pseudo- R 2 . In S4 File , we present two additional model diagnostics: First, the linktest for both logit models does not find any evidence for model misspecifications. Second, a receiver operator characteristic (ROC) analysis provides evidence that the predictive power of our two models is acceptable. In addition, to assess multicollinearity, we have computed variance inflation factors (VIF) in S5 File . As a rule of thumb, a variable whose VIF values exceeds 10 may merit further investigation. In both regressions, the VIF of none of the explanatory variable exceeds 7.7 and the average VIF over all variables is below 2.1. It should also be noted that the two separate logit models do not model correlation and heteroscedasticity between the two outcomes (vaccinate voluntarily or obligatorily). Hence, in S6 File , as a robustness check, we have estimated a multivariate probit model using Stata’s mvprobit command that relies on simulated maximum likelihood [ 30 ]. S6.1-S6.6 Tables in S6 File compare the coefficients of the multivariate probit with the two separate models. Overall, there are some changes in the magnitude of the coefficients, but no changes in the signs of the regression coefficients or significance levels.

It is possible that respondents who did not give an answer about their vaccination preferences–for example, because they are still undecided–would decide to vaccinate or support mandatory vaccination after an adequate vaccination campaign. In a robustness check, we followed this argument by assigning respondents who refused to answer the question about voluntary or mandatory vaccination to the ‘yes’ category and repeated the logit estimation. This does not change our results (see S7.1 and S7.2 Tables in S7 File , S8 File provides our Stata code, which prepares the data and conducts all the statistical analyses, as well as the outputs of the multivariate estimations).

Finally, Table 6 provides a statistical comparison of the marginal effects from the model on willingness to get vaccinated ( Table 4 ) and attitudes toward mandatory vaccinations ( Table 5 ). We find no significant differences in marginal effects between the two models except for two variables: tertiary education and eastern federal states. The marginal effect for tertiary education is significantly larger for the willingness to get vaccinated model while the opposite is true for eastern federal states.

https://doi.org/10.1371/journal.pone.0248372.t006

Politicians must make decisions which are based on incomplete information yet have far-reaching consequences for public health, personal freedom, and economic prosperity. It seems that many citizens are prepared to behave responsibly in the sense that they are prepared to endure a ‘little sting’ for the good of all: a vast majority of the German population (70 percent) state that they would get vaccinated as soon as a vaccine against COVID-19 was available. This means that under favorable conditions, a legal duty to get vaccinated to achieve herd immunity might not be necessary. It should, however, be noted that the question was asked in a stylized context: Potential side effects or ineffectiveness of the then hypothetical vaccine were assumed away. Though there is no reason to believe the vaccines currently being administered are more problematic in this respect than any other vaccines in use, neither can strictly be guaranteed in reality. In addition, the time required for a vaccination, the process of the vaccination itself (i.e. the injection), bureaucratic administration (e.g. making an appointment with the family doctor) or any necessary co-payment should de facto reduce the willingness to get vaccinated. Furthermore, at the time of writing, not only is it still unclear how quickly a vaccine can even be produced in the quantity required and administered to enough people, it is also unclear how long its effect will last. It is not even clear what percentage of the population would have to be vaccinated to achieve herd immunity, as this also depends on individual behavior and legal (or ethical) norms which are likely to continue to change (e.g. an explicit or implicit obligation to wear a mask of a specific variety in public transport or a testing obligation for people returning from trips abroad) [ 31 , 32 ]. Hence, a sufficiently high willingness to get vaccinated in the ‘best case’ scenario investigated here is an idealization and in any case only one relevant factor among many.

We observed there to be gender differences in the willingness to get vaccinated: women are less willing to get vaccinated, and also less willing to support a policy of mandatory vaccination. This is surprising, given that men are generally less likely to engage in preventive behavior [ 33 ] and women have been shown to be more willing to engage in preventive behavior in the pandemic, for instance by wearing face masks when recommended [ 34 ], and they also seem to be more compliant with other measures in general [ 35 ]. However, men are also more severely affected by the coronavirus [ 36 ] and women generally more skeptical about vaccinations, especially against COVID-19 [ 37 ]. We don’t know whether our interviewees frame their decision to get vaccinated or not as a situation of a social dilemma, but if so, previous results on gender differences in cooperation suggest men and women might have to be addressed differently to influence their decisions [ 38 , 39 ]. We also observed that income and education increase the willingness to get vaccinated voluntarily. It has also been shown recently that the willingness to pay for a vaccine against Covid-19 is positively impacted by, among other variables, income [ 40 ].

A mandatory vaccination would almost certainly achieve herd immunity against COVID-19, since all those for whom there is no medical contraindication would also get vaccinated. About half of the respondents approve and disapprove, respectively, of such a mandatory vaccination policy. In this context, the strong disagreement among the participants of the study regarding the dangerousness of the virus is particularly striking. Many of those who reject a policy of mandatory vaccination assume the dangerousness of the virus is being overestimated by others, while those who approve of a policy of mandatory vaccination seem to believe the exact opposite. This is highly problematic: at most one of the two groups can be right. Plausibly, the interviewees themselves differ in how dangerous they think the virus is. This yields a concrete and important policy recommendation (see also [ 40 , 41 ]): we need more reliable data on the dangerousness of SARS-CoV-2 and to communicate this data more clearly to the general public. Though the ‘knowledge-deficit’ explanation of low vaccine uptake might not work for well-established vaccines [ 42 ], we have found evidence that this might be different for COVID-19.

We are not recommending a policy of mandatory vaccination in this paper, but merely investigating the attitudes of people towards it. A policy of mandatory vaccination would be an extreme solution to solve the potential problem of low vaccine uptake, and a lot may be said in favor of less extreme policies (as outlined in [ 15 ], for instance). Vaccination could also be made mandatory only for certain groups of people (e.g. nurses, physicians, physiotherapists, people working in confined spaces, people travelling on public transport etc.), or only after time has conclusively shown that not enough people actually get vaccinated. It might also turn out that people are unwilling to take the second dose of a two-dose vaccine, or not accept refresher doses, which would further complicate the situation and might require subtle intertemporal strategy choice. Before making any vaccination mandatory, people could also be paid or incentivized in other ways to accept it [ 43 ]. If, as we hope, people take the external effects of their action into account, and a sufficiently high number of people get vaccinated as a result, mandatory vaccination won’t be necessary.

This article investigates the willingness to get vaccinated and the acceptance of a policy of mandatory vaccination against COVID-19 in June and July 2020 in Germany. Our first main result is that a large majority of about 70 percent of adults in Germany would voluntarily get vaccinated against the novel coronavirus if a vaccine without side effects was available. Our second result is that about half of this population is in favor of, and half against, a policy of mandatory vaccination. Our third main result is that the individual willingness to get vaccinated and acceptance of a policy of mandatory vaccination correlates systematically with several socio-demographics (gender, age, education, income) but, overall, not with psychological characteristics of the respondents.

When interpreting the results from our survey, it should be noted that preferences were elicited in an ideal-typical situation: a vaccine which is effective and free of side effects is immediately available for the entire population at zero cost. Future research will have to show how actual vaccination behavior differs in real-life situations that deviate from this ideal-typical situation.

Supporting information

S1 file. variable definitions..

https://doi.org/10.1371/journal.pone.0248372.s001

S2 File. Comparison with further studies in Germany.

https://doi.org/10.1371/journal.pone.0248372.s002

S3 File. Complementary estimation results.

https://doi.org/10.1371/journal.pone.0248372.s003

S4 File. Additional diagnostics for the logit models.

https://doi.org/10.1371/journal.pone.0248372.s004

S5 File. Multicollinearity across explanatory variables.

https://doi.org/10.1371/journal.pone.0248372.s005

S6 File. Functional form assumptions and simultaneity.

https://doi.org/10.1371/journal.pone.0248372.s006

S7 File. Imputation.

https://doi.org/10.1371/journal.pone.0248372.s007

S8 File. Stata code.

https://doi.org/10.1371/journal.pone.0248372.s008

Acknowledgments

We thank Thomas Rieger for his outstanding research assistance.

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Masked children behind protective screens in a classroom

3 reasons for making COVID-19 vaccination mandatory for children

Associate professor of Philosophy and Core Member of the Rotman Institute of Philosophy, Western University

British Academy Postdoctoral Fellow, University of Oxford

Disclosure statement

Lisa Forsberg receives funding from the British Academy.

Anthony Skelton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

University of Oxford provides funding as a member of The Conversation UK.

Western University provides funding as a member of The Conversation CA-FR.

Western University provides funding as a member of The Conversation CA.

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On May 5, Health Canada approved a COVID-19 vaccine for use in children aged 12-15 years . The United States Food and Drug Administration quickly followed suit , and other countries are likely to do the same. Similar approvals for younger children are on the horizon .

This is very welcome news. It will not be possible to achieve full protection against COVID-19 at the population level unless most adolescents and children are vaccinated. However, factors such as vaccine hesitancy and mistaken beliefs about the risks COVID-19 poses to children may make this a challenging goal.

One tool that may serve to encourage vaccination uptake is vaccine mandates.

As philosophical researchers, we offer three ethical arguments in favour of making COVID-19 vaccination mandatory for children, based on our research . We contend it would be ethically permissible for governments to impose a sanction (such as a fine or exclusion from social environments or activities) on those who fail to vaccinate their children.

Risk of harm to children

A child receiving an injection in his arm from a health-care worker

Argument one : if there is an easy, low-cost way for parents or guardians to avoid exposing children in their care to substantial risk of harm and death, they ought to do so.

COVID-19 presents a substantial risk of harm — including long-term health complications such as organ damage, long COVID , or multisystem inflammatory syndrome (MIS-C) and death — to at least some proportion of children. We have limited knowledge about how large the at-risk group is and who is in it, and about the extent to which these conditions will be treatable.

If the COVID-19 vaccine is as safe and effective as other standard childhood vaccinations (or similarly safe as, it seems , most COVID-19 vaccines are for adults), it would provide parents and guardians with an easy, low-cost way to avoid exposing their children to an infection that may cause them serious harm or death.

Governments have an obligation to protect children from parents or guardians who might expose children in their care to easily avoidable risk of harm and death. Therefore, the state ought, in principle and in the absence of decisive countervailing reasons, to mandate that parents vaccinate their children against COVID-19.

We accept that the state protects children in other contexts by imposing obligations on adults to adopt easy, low-cost ways of avoiding significant harm and death, for example, by using car seats and seat belts for their children when driving.

Risk of harm to others

Young people waiting outdoors in a socially distanced lineup

Argument two : If, by vaccinating their children, parents and guardians can avoid imposing a significant risk of harm and death on others in an easy, low-cost way, they ought to vaccinate their children.

The threat to all of us from COVID-19 is significant. The risk unvaccinated children pose is especially great. Children contribute to the spread of the virus through social mixing, often in large groups (for example, in classrooms ). Moreover, the longer children remain unvaccinated, the more opportunity exists for a new, more potent variant of COVID-19 to emerge and threaten us all.

A safe, effective COVID-19 vaccine would provide parents and guardians with an easy, low-cost way to avoid imposing the significant risk of harm or death associated with COVID-19 on others.

The state is required to adopt measures to protect populations from exposure to risk of harm and death that might be avoided easily and at low cost. Therefore, the state ought (again in principle and in the absence of decisive countervailing reasons) to mandate that parents vaccinate their children.

We accept that the state protects populations with low-cost and easy avoidance of risk of harm and death in other contexts by, for example, imposing speed limits, limits on alcohol consumption and vision requirements for driving.

We also already accept that the state imposes obligations on parents to take measures to prevent their children from posing risks to others in many contexts. Childhood vaccinations are already mandatory in some liberal democracies , and most liberal democracies mandate that children attend school to provide them with a civic education, and prohibit children from carrying weapons, for similar reasons.

Children’s well-being

Empty classroom with chairs up on student desks

Argument three : One very compelling reason we have to end the pandemic and to mandate vaccination relates to children’s well-being. We must protect children from the mental and physical effects of lockdown and other restrictions, or effects of insufficient restrictions, such as school closures due to infection spread.

Restrictions and the effects of spreading infection lead to decreased opportunities for the pursuit of well-being. Impacts on education alone are considerable, especially amongst the least well off.

But most important of all we want children to thrive. The third argument for mandating the vaccination of children turns on unique features of children’s well-being . Children’s well-being may have different elements than adults’. For example, adults may be focused on values like authentic happiness and rational desires. This may not be true of (especially young) children.

While happiness and the satisfaction of desires matter to children’s well-being, these might not be all that matters. Other so-called “objective goods ” may play a significant role in children’s well-being. These include loving and supportive relationships, various forms of play, learning and intellectual development.

Ending the pandemic is essential to enabling children to enjoy the so-called “ goods of childhood ,” including valuable relationships with friends and extended family (especially older adults), various forms of unstructured play, exploration and intellectual development, and to pursue them in a carefree way in the absence of unavoidable worries about risk.

Childhood is a relatively short period in an individual’s life. It is important for preparing children to meet the challenges of adulthood. But it is also a time in which to savour particular kinds of goods in a unique way. An effective way to secure this for all children is to mandate their vaccination.

We believe these three arguments are compelling reasons for vaccinating children. We hold that they offer a strong case for considering mandating vaccination for children. However, even if there are decisive counter-arguments for not mandating vaccination in some contexts, we maintain that our arguments provide parents or guardians with conclusive reasons to vaccinate their children.

Vaccination
Mandatory vaccination
Coronavirus
Childhood vaccination
COVID-19 risk
COVID-19 vaccines
COVID-19 ethics

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Good reasons to vaccinate: mandatory or payment for risk?

Affiliations.

1 Faculty of Philosophy, University of Oxford, Oxford, UK [email protected].
2 Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
3 Melbourne Law School, University of Melbourne, Melbourne, Victoria, Australia.
PMID: 33154088
PMCID: PMC7848060
DOI: 10.1136/medethics-2020-106821

Keywords: behaviour modification; coercion; philosophical ethics; public health ethics; technology/risk assessment.

COVID-19 / prevention & control*
Dissent and Disputes*
Health Policy*
Mandatory Programs / ethics*
Motivation / ethics*
Patient Acceptance of Health Care*
Public Health / ethics
Vaccination / ethics*

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How to Write a Thesis Statement–Examples

What is a thesis statement? A thesis statement summarizes the main idea of a paper or an essay. Similar to the statement of the problem in research, it prepares the reader for what is to come and ties together the evidence and examples that are presented and the arguments and claims that are made later.

A good thesis statement can provoke thought, arouse interest, and is always followed up by exactly what it promises—if the focus or direction of your essay changes over time, you should go back to your statement and adapt it as well so that it clearly reflects what you are explaining or discussing.

Where does the thesis statement go in my paper?

Your thesis statement should be placed near the end of your introduction—after you have given the reader some background and before you delve into the specific evidence or arguments that support your statement.

these statement example, books on a shelf

Can you give me a thesis statement template?

Depending on the type of essay you are writing, your thesis statement will look different. The important thing is that your statement is specific and clearly states the main idea you want to get across. In the following, we will discuss different types of statements, show you a simple 4-step process for writing an effective thesis statement, and finish off with some not-so-good and good thesis statement examples.

Types of Thesis Statements

Depending on whether your paper is analytical, expository, or argumentative, your statement has a slightly different purpose.

Analytical thesis statements

An analytical paper breaks down an issue or an idea into its components, evaluates the pieces, and presents an evaluation of this breakdown to the reader. Such papers can analyze art, music, literature, current or historical events, political ideas, or scientific research. An analytical thesis statement is therefore often the result of such an analysis of, for example, some literary work (“Heathcliff is meant to be seen as a hero rather than a horrible person”) or a process (“the main challenge recruiters face is the balance between selecting the best candidates and hiring them before they are snatched up by competitors”), or even the latest research (“starving yourself will increase your lifespan, according to science”). In the rest of the paper, you then need to explain how you did the analysis that led you to the stated result and how you arrived at your conclusion, by presenting data and evidence.

Expository thesis statements

An expository (explanatory) paper explains something to the audience, such as a historical development, a current phenomenon, or the effect of political intervention. A typical explanatory thesis statement is therefore often a “topic statement” rather than a claim or actual thesis. An expository essay could, for example, explain “where human rights came from and how they changed the world,” or “how students make career choices.” The rest of the paper then needs to present the reader with all the relevant information on the topic, covering all sides and aspects rather than one specific viewpoint.

Argumentative thesis statements

An argumentative paper makes a clear and potentially very subjective claim and follows up with a justification based on evidence. The claim could be an opinion, a policy proposal, an evaluation, or an interpretation. The goal of the argumentative paper is to convince the audience that the author’s claim is true. A thesis statement for such a paper could be that “every student should be required to take a gap year after high school to gain some life experience”, or that “vaccines should be mandatory”. Argumentative thesis statements can be bold, assertive, and one-sided—you have the rest of the paper to convince the reader that you have good reasons to think that way and that maybe they should think like that, too.

How to Write a Thesis Statement Step-by-Step

If you are not quite sure how you get from a topic to a thesis statement, then follow this simple process—but make sure you know what type of essay you are supposed to write and adapt the steps to the kind of statement you need.

First , you will have to select a topic . This might have been done for you already if you are writing an essay as part of a class. If not, then make sure you don’t start too general—narrow the subject down to a specific aspect that you can cover in an essay.

Second , ask yourself a question about your topic, one that you are personally interested in or one that you think your readers might find relevant or interesting. Here, you have to consider whether you are going to explain something to the reader (expository essay) or if you want to put out your own, potentially controversial, opinion and then argue for it in the rest of your (argumentative) essay.

Third , answer the question you raised for yourself, based on the material you have already sifted through and are planning to present to the reader or the opinion you have already formed on the topic. If your opinion changes while working on your essay, which happens quite often, then make sure you come back to this process and adapt your statement.

Fourth and last, reword the answer to your question into a concise statement . You want the reader to know exactly what is coming, and you also want to make it sound as interesting as possible so that they decide to keep reading.

Let’s look at this example process to give you a better idea of how to get from your topic to your statement. Note that this is the development of a thesis statement for an argumentative essay .

Choose a specific topic: Covid-19 vaccines

Narrow it down to a specific aspect: opposition to Covid-19 vaccines

Ask a question: Should vaccination against Covid-19 be mandatory?
Answer the question for yourself, by sorting through the available evidence/arguments:

Yes: vaccination protects other, more vulnerable people; vaccination reduces the spread of the disease; herd immunity will allow societies to go back to normal…

No: vaccines can have side-effects in some people; the vaccines have been developed too fast and there might be unknown risks; the government should stay out of personal decisions on people’s health…

Form your opinion and reword it into your thesis statement that represents a very short summary of the key points you base your claim on:

While there is some hesitancy around vaccinations against Covid-19, most of the presented arguments revolve around unfounded fears and the individual freedom to make one’s own decisions. Since that freedom is offset by the benefits of mass vaccination, governments should make vaccines mandatory to help societies get back to normal.

This is a good argumentative thesis statement example because it does not just present a fact that everybody knows and agrees on, but a claim that is debatable and needs to be backed up by data and arguments, which you will do in the rest of your essay. You can introduce whatever evidence and arguments you deem necessary in the following—but make sure that all your points lead back to your core claim and support your opinion. This example also answers the question “how long should a thesis statement be?” One or two sentences are generally enough. If your statement is longer, make sure you are not using vague, empty expressions or more words than necessary .

Good and Bad Thesis Statement Examples

Not-so-good thesis statement : Everyone should get vaccinated against Covid-19.

Problem: The statement does not specify why that might be relevant or why people might not want to do it—this is too vague to spark anyone’s interest.

Good : Since the risks of the currently available Covid-19 vaccines are minimal and societal interests outweigh individual freedom, governments should make Covid-19 vaccination mandatory.

Not-so-good thesis statement : Binge drinking is bad for your health.

Problem: This is a very broad statement that everyone can agree on and nobody needs to read an article on. You need to specify why anyone would not think that way.

Good : Binge drinking has become a trend among college students. While some argue that it might be better for your health than regular consumption of low amounts of alcohol, science says otherwise.

Not-so-good thesis statement : Learning an instrument can develop a child’s cognitive abilities.

Problem: This is a very weak statement—”can” develop doesn’t tell us whether that is what happens in every child, what kind of effects of music education on cognition we can expect, and whether that has or should have any practical implications.

Good thesis statement : Music education has many surprising benefits on children’s overall development, including effects on language acquisition, coordination, problem-solving, and even social skills.

You could now present all the evidence on the specific effects of music education on children’s specific abilities in the rest of your (expository) essay. You could also turn this into an argumentative essay, by adding your own opinion to your statement:

Good thesis statement : Considering the many surprising benefits that music education has on children’s overall development, every child should be given the opportunity to learn an instrument as part of their public school education.

Not-so-good thesis statement : Outer space exploration is a waste of money.

Problem: While this is a clear statement of your personal opinion that people could potentially disagree with (which is good for an argumentative thesis statement), it lacks context and does not really tell the reader what to expect from your essay.

Good thesis statement : Instead of wasting money on exploring outer space, people like Elon Musk should use their wealth to solve poverty, hunger, global warming, and other issues we are facing on this earth.

Get Professional Thesis Editing Services

Now that you know how to write the perfect thesis statement for your essay, you might be interested in our free grammar checker , the Wordvice AI Proofreader. And after drafting your academic papers, be sure to get proofreading that includes manuscript editing , thesis editing , or dissertation editing services before submitting your work to journals for publication.

We have many more articles for you on all aspects of academic writing , tips and tricks on how to avoid common grammar mistakes , and resources on how to strengthen your writing style in general.

Persuasive Essay Guide

Persuasive Essay About Covid19

How to Write a Persuasive Essay About Covid19 | Examples & Tips

11 min read

Steps to Write a Persuasive Essay About Covid-19

Here are the steps to help you write a persuasive essay on this topic, along with an example essay:

Step 1: Choose a Specific Thesis Statement

Your thesis statement should clearly state your position on a specific aspect of COVID-19. It should be debatable and clear. For example:

Step 2: Research and Gather Information

Collect reliable and up-to-date information from reputable sources to support your thesis statement. This may include statistics, expert opinions, and scientific studies. For instance:

COVID-19 vaccination effectiveness data
Information on vaccine mandates in different countries
Expert statements from health organizations like the WHO or CDC

Step 3: Outline Your Essay

Create a clear and organized outline to structure your essay. A persuasive essay typically follows this structure:

Introduction
Background Information
Body Paragraphs (with supporting evidence)
Counterarguments (addressing opposing views)

Step 4: Write the Introduction

In the introduction, grab your reader's attention and present your thesis statement. For example:

Step 5: Provide Background Information

Offer context and background information to help your readers understand the issue better. For instance:

Step 6: Develop Body Paragraphs

Each body paragraph should present a single point or piece of evidence that supports your thesis statement. Use clear topic sentences, evidence, and analysis. Here's an example:

Step 7: Address Counterarguments

Acknowledge opposing viewpoints and refute them with strong counterarguments. This demonstrates that you've considered different perspectives. For example:

Step 8: Write the Conclusion

Summarize your main points and restate your thesis statement in the conclusion. End with a strong call to action or thought-provoking statement. For instance:

Step 9: Revise and Proofread

Edit your essay for clarity, coherence, grammar, and spelling errors. Ensure that your argument flows logically.

Step 10: Cite Your Sources

Include proper citations and a bibliography page to give credit to your sources.

Remember to adjust your approach and arguments based on your target audience and the specific angle you want to take in your persuasive essay about COVID-19.

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Examples of Persuasive Essay About Covid19

When writing a persuasive essay about the Covid-19 pandemic, it’s important to consider how you want to present your argument. To help you get started, here are some example essays for you to read:

Check out some more PDF examples below:

Persuasive Essay About Covid-19 Pandemic

Sample Of Persuasive Essay About Covid-19

Persuasive Essay About Covid-19 In The Philippines - Example

If you're in search of a compelling persuasive essay on business, don't miss out on our “ persuasive essay about business ” blog!

Examples of Persuasive Essay About Covid-19 Vaccine

Covid19 vaccines are one of the ways to prevent the spread of Covid-19, but they have been a source of controversy. Different sides argue about the benefits or dangers of the new vaccines. Whatever your point of view is, writing a persuasive essay about it is a good way of organizing your thoughts and persuading others.

A persuasive essay about the Covid-19 vaccine could consider the benefits of getting vaccinated as well as the potential side effects.

Below are some examples of persuasive essays on getting vaccinated for Covid-19.

Covid19 Vaccine Persuasive Essay

Persuasive Essay on Covid Vaccines

Interested in thought-provoking discussions on abortion? Read our persuasive essay about abortion blog to eplore arguments!

Examples of Persuasive Essay About Covid-19 Integration

Covid19 has drastically changed the way people interact in schools, markets, and workplaces. In short, it has affected all aspects of life. However, people have started to learn to live with Covid19.

Writing a persuasive essay about it shouldn't be stressful. Read the sample essay below to get idea for your own essay about Covid19 integration.

Persuasive Essay About Working From Home During Covid19

Searching for the topic of Online Education? Our persuasive essay about online education is a must-read.

Examples of Argumentative Essay About Covid 19

Covid-19 has been an ever-evolving issue, with new developments and discoveries being made on a daily basis.

Writing an argumentative essay about such an issue is both interesting and challenging. It allows you to evaluate different aspects of the pandemic, as well as consider potential solutions.

Here are some examples of argumentative essays on Covid19.

Argumentative Essay About Covid19 Sample

Argumentative Essay About Covid19 With Introduction Body and Conclusion

Looking for a persuasive take on the topic of smoking? You'll find it all related arguments in out Persuasive Essay About Smoking blog!

Examples of Persuasive Speeches About Covid-19

Do you need to prepare a speech about Covid19 and need examples? We have them for you!

Persuasive speeches about Covid-19 can provide the audience with valuable insights on how to best handle the pandemic. They can be used to advocate for specific changes in policies or simply raise awareness about the virus.

Check out some examples of persuasive speeches on Covid-19:

Persuasive Speech About Covid-19 Example

Persuasive Speech About Vaccine For Covid-19

You can also read persuasive essay examples on other topics to master your persuasive techniques!

Tips to Write a Persuasive Essay About Covid-19

Writing a persuasive essay about COVID-19 requires a thoughtful approach to present your arguments effectively.

Here are some tips to help you craft a compelling persuasive essay on this topic:

Choose a Specific Angle

Start by narrowing down your focus. COVID-19 is a broad topic, so selecting a specific aspect or issue related to it will make your essay more persuasive and manageable. For example, you could focus on vaccination, public health measures, the economic impact, or misinformation.

Provide Credible Sources

Support your arguments with credible sources such as scientific studies, government reports, and reputable news outlets. Reliable sources enhance the credibility of your essay.

Use Persuasive Language

Employ persuasive techniques, such as ethos (establishing credibility), pathos (appealing to emotions), and logos (using logic and evidence). Use vivid examples and anecdotes to make your points relatable.

Organize Your Essay

Structure your essay involves creating a persuasive essay outline and establishing a logical flow from one point to the next. Each paragraph should focus on a single point, and transitions between paragraphs should be smooth and logical.

Emphasize Benefits

Highlight the benefits of your proposed actions or viewpoints. Explain how your suggestions can improve public health, safety, or well-being. Make it clear why your audience should support your position.

Use Visuals -H3

Incorporate graphs, charts, and statistics when applicable. Visual aids can reinforce your arguments and make complex data more accessible to your readers.

Call to Action

End your essay with a strong call to action. Encourage your readers to take a specific step or consider your viewpoint. Make it clear what you want them to do or think after reading your essay.

Revise and Edit

Proofread your essay for grammar, spelling, and clarity. Make sure your arguments are well-structured and that your writing flows smoothly.

Seek Feedback

Have someone else read your essay to get feedback. They may offer valuable insights and help you identify areas where your persuasive techniques can be improved.

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Common Topics for a Persuasive Essay on COVID-19

Here are some persuasive essay topics on COVID-19:

The Importance of Vaccination Mandates for COVID-19 Control
Balancing Public Health and Personal Freedom During a Pandemic
The Economic Impact of Lockdowns vs. Public Health Benefits
The Role of Misinformation in Fueling Vaccine Hesitancy
Remote Learning vs. In-Person Education: What's Best for Students?
The Ethics of Vaccine Distribution: Prioritizing Vulnerable Populations
The Mental Health Crisis Amidst the COVID-19 Pandemic
The Long-Term Effects of COVID-19 on Healthcare Systems
Global Cooperation vs. Vaccine Nationalism in Fighting the Pandemic
The Future of Telemedicine: Expanding Healthcare Access Post-COVID-19

In search of more inspiring topics for your next persuasive essay? Our persuasive essay topics blog has plenty of ideas!

To sum it up,

You have read good sample essays and got some helpful tips. You now have the tools you needed to write a persuasive essay about Covid-19. So don't let the doubts stop you, start writing!

If you need professional writing help, don't worry! We've got that for you as well.

MyPerfectWords.com is a professional persuasive essay writing service that can help you craft an excellent persuasive essay on Covid-19. Our experienced essay writer will create a well-structured, insightful paper in no time!

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Frequently Asked Questions

Are there any ethical considerations when writing a persuasive essay about covid-19.

Yes, there are ethical considerations when writing a persuasive essay about COVID-19. It's essential to ensure the information is accurate, not contribute to misinformation, and be sensitive to the pandemic's impact on individuals and communities. Additionally, respecting diverse viewpoints and emphasizing public health benefits can promote ethical communication.

What impact does COVID-19 have on society?

The impact of COVID-19 on society is far-reaching. It has led to job and economic losses, an increase in stress and mental health disorders, and changes in education systems. It has also had a negative effect on social interactions, as people have been asked to limit their contact with others.

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How to write a vaccination research paper fast.

March 25, 2021

If you have just received your first vaccination research paper assignment, you probably don’t know what to do or where to start. This is probably why you are reading this blog, after all. Every semester, we receive hundreds of pleas for help from students in high school and college. They are struggling with writing an excellent vaccination research paper. In fact, many of these students are worrying that they might fail the class unless they get a top grade on their essay.

This is why we have decided to write this article. You will find information on how to write a paper about vaccination research. You will also get a list of interesting topics that should work great in 2022 (we also have COVID-19 vaccine topics there). Last, but not least, we will show you how to get a great example and give you a quick guide for writing a five-paragraph essay about vaccines.

Some Excellent Vaccination Research Topics

The best vaccination research paper outline, getting an example for your vaccine research paper, quick guide to write a vaccination paper, need more help.

Before you even start doing any research on vaccination, you should pick the topic of your paper. Truth be told, over 50% of all students pick the wrong topic. The problem is that you will most likely be tempted to choose a topic that’s very popular. The downside to this is that these same topics have probably already been chosen by some of your classmates. To make sure your paper is worthy of a top grade (and to make sure it stands out from the crowd), you need to find an original topic. The topic shouldn’t be too general, nor should it be too narrow. It should be about something of interest today. Also, you must find a topic that you have plenty of information about (to avoid spending days upon days writing the essay). To help you out, we have put together a short list of vaccination research topics:

The history of the vaccine
Are vaccines 100% effective?
Common side effects of Covid vaccination
Natural immunity versus vaccine immunity
Mandatory Covid vaccination
The impact of vaccination
How does a vaccine work?
Discuss the HPV vaccine
Write a vaccination position paper on influenza
Vaccination in African countries
ARN-based vaccines
The evolution of vaccination for Covid 19
Arguments against vaccination
Latest Ebola vaccination research
Arguments for vaccination
Should vaccination be mandatory for children?
Discussing the anti-vaccination stance
The effects of multiple vaccines
Links between Polio vaccines and the development of cancer
Do vaccines cause Autism?
Is vaccination research bad?

Check out our nursing research topics . You’ll surely like them.

Now that you have some interesting vaccination research paper topics to pick from, it’s time to talk about the vaccination research paper outline. It is very important to know how to structure your paper properly. The truth is that failing to do so will get you penalized quite badly. Let’s discuss the proper vaccine research paper outline in just two minutes

No matter what topic you choose (including coronavirus vaccination), you can safely use the five paragraph essay. Here is how such an essay would look like:

An introduction – first paragraph.
Body paragraph – second paragraph
Body paragraph – third paragraph
Body paragraph – fourth paragraph
A conclusion – fifth paragraph

It is definitely not difficult to write such a paper. However, we will provide you with a quick guide shortly. But first, let’s talk about getting you a good example; an example you can follow.

Let’s face it: finding good examples for a vaccine research paper can be difficult. Nowadays, the Internet is full of useless or poorly written content. In other words, you simply cannot trust anything you find online. Yes, it’s true that you may get a few hints on some website. Maybe get some interesting tips and ideas from online forums or blogs. However you will not be able to get a perfect example simply by searching on Google for it.

And no, reading vaccination research articles is not enough. You need a great example; an example you can actually use. The best way to get such a sample is to get in touch with us. Our professional academic writers can write a sample for you in no time. And the best part is that the example will be written from scratch just for you. We can even write an example paper about the vaccine for coronavirus, if you need one. You can, of course, use some parts of our sample in your own essay. After all, our sample will be 100 percent original.

It’s not enough to research a certain vaccination research term or to watch a few videos on YouTube. Writing an academic paper about vaccination can take days, even weeks if you don’t have anyone to help you. To make things a bit easier for you, we have put together a quick guide that you should follow. It outlines the basic steps you need to take to write the paper in record time. Here goes:

The first part of your paper is the introduction . In this section, you will have to provide a bit of background information about the topic. If you are talking about the coronavirus vaccine, it’s a great idea to talk about how it appeared, where it appeared, and what its peculiarities are. Also, remember to include the thesis statement towards the beginning of the intro.
Write three body paragraphs . Of course, you can write more, but 3 is the minimum for the five paragraph essay. Each body paragraph in your vaccination paper will discuss one single main idea or talking point. It’s a good idea to begin the paragraph with the statement and then use the rest of the paragraph to support it. Don’t forget to cite and reference works or students you use to support the statement.
Write a conclusion . This conclusion is the part where you basically wrap everything up and write the call to action. Provide a short summary of the most important ideas and show your readers how your research or analysis supports your thesis statement. If you want to include a call to action (for example, “my research shows that more research is needed to establish the exact cause of side effects A, B and C”), do so at the end of the conclusion.
Edit your vaccination essay . It’s very important to make sure that it is written logically and that the information is presented in an unbiased, objective way. Also, make sure you use connector sentences to transition from one paragraph to the next.
Proofread and then proofread some more . Did you know that over 80% of students lose points due to minor mistakes, grammar errors or simple typos? Why would you want to lose points when it takes you just 10 minutes to proofread your work?

We realize that writing a vaccination argumentative essay is not easy. We know that even finding a great topic can take hours of research. And the sad truth is that most students simply can’t rely on their professors for clarifications or any kind of help. Professors are too busy, so don’t expect any help. The great news is that our professional writer service with seasoned ENL writers, professional editors and expert proofreaders can help you with anything you need. Here are some examples of what we do for students each and every day:

Our writers can write a vaccination research paper in no time, even overnight. Instead of submitting the essay late and getting penalized, get in touch with us.
We can create a vaccination research paper outline for you, so all you have left to do is fill each section with great content.
Our experts can put together a new list of vaccination research paper topics just for you. This means you can pick any topic you like, knowing it will be unique.
We can edit and proofread your essay. In fact, our editors and proofreaders have extensive experience proofing academic papers about vaccination.
We can put you in touch with a medical expert, in case you need in-depth, well-researched medical information. It can make the difference between a B and an A+.
We can write you a paper about the coronavirus vaccine. Our experts are up to date with the latest news and information about the COVID-19 virus.
You can get tips and advice on how to improve your academic writing skills. One of our professional writers can take a look at your paper and suggest some improvements.

Bottom line, if you are tasked with writing a vaccine research paper and want to make sure your essay is worthy of a top grade, you should get assistance from a team of experts. We are here to help at any time of day or night. Get in touch with us now!

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COMMENTS

The Benefits of Vaccinations: An Argumentative Essay Example
Thesis Statement: Research shows that the benefits of vaccination outweigh the risks because vaccines can prevent serious illness and disease in individuals, vaccinations can also prevent widespread outbreaks of diseases in populations and the side effect of vaccinations, though occasionally serious, are vary rare. Don't use plagiarized sources.
Vaccine Confidence, Coverage, and Hesitancy Worldwide: A Literature
Vaccine Confidence, Coverage, and Hesitancy Worldwide Hammond 2 many of the unvaccinated are a result of rising vaccine hesitancy of parents in conjunction with the anti-vaccination movement. Vaccine hesitancy is defined as "a delay in acceptance or refusal of vaccines despite availability" (Macdonald, 2015, p. 34).
Good reasons to vaccinate: mandatory or payment for risk?
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 ...
How to Write a Thesis Statement
Step 1: Start with a question. You should come up with an initial thesis, sometimes called a working thesis, early in the writing process. As soon as you've decided on your essay topic, you need to work out what you want to say about it—a clear thesis will give your essay direction and structure.
Simply put: Vaccination saves lives
A recent economic analysis of 10 vaccines for 94 low- and middle-income countries estimated that an investment of $34 billion for the immunization programs resulted in savings of $586 billion in reducing costs of illness and $1.53 trillion when broader economic benefits were included ( 5 ). The only human disease ever eradicated, smallpox, was ...
A Vaccine a Day to Keep the Doctor Away: A Research Essay on Vaccinations
An additional aspect of vaccines many parents are troubled with is the increase in suggested vaccines for young children. "Today, the CDC recommends that children receive vaccines for 10 diseases — plus the flu vaccine — by age 6, which can mean up to 37 separate shots. That compares to five vaccines for the same age group in 1995 ...
Public attitudes toward COVID-19 vaccination: The role of vaccine
While efficacious vaccines have been developed to inoculate against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; also known as COVID-19), public vaccine hesitancy could still ...
The Perception and Attitudes toward COVID-19 Vaccines: A Cross
Vaccine hesitancy is a major threat to the success of COVID-19 vaccination programs. The present cross-sectional online survey of adult Poles (n = 1020) expressing a willingness to receive the COVID-19 vaccine was conducted between February and March 2021 and aimed to assess (i) the general trust in different types of vaccines, (ii) the level of acceptance of the COVID-19 vaccines already in ...
"Attitudes Towards COVID-19 Vaccination: Literature Review and Attitude
This thesis examines attitudes towards and ethics of receiving one of the fastest vaccines ever developed— the COVID-19 vaccine. The Food and Drug Administrations (FDA) in the U.S. has granted either Emergency Use Authorization or full approval to three vaccines: the Pfizer-BioNTech, Johnson & Johnson, and Moderna-NIAID vaccines. However, although the FDA approved and the Center for Disease ...
COVID-19 vaccine rollout: Examining COVID-19 vaccination perceptions
vaccination decisions, especially within the context of COVID-19 vaccines. Vaccination decision making has considered the known apprehensions that vaccination carries, but not as broadly as uncertainty around the virus and consequently the vaccine. This thesis aims to explore nurses' decision-making around COVID-19 vaccination, with
PDF Developing a Thesis Statement for a Paper
What makes a good thesis statement? A good thesis statement is specific and takes a clear position on a debatable topic. Your thesis statement needs to be backed up by ... Example: Vaccinations for kids are important for many reasons. Step 5: Revise the answer so that it is specific, takes a position, and lets
Attitudes on voluntary and mandatory vaccination against COVID-19
Several vaccines against COVID-19 have now been developed and are already being rolled out around the world. The decision whether or not to get vaccinated has so far been left to the individual citizens. However, there are good reasons, both in theory as well as in practice, to believe that the willingness to get vaccinated might not be sufficiently high to achieve herd immunity. A policy of ...
Argumentative Essay About Vaccines
I work in the medical field and am familiar with vaccinations. People are free to be pro-vaccination or anti-vaccination. I thought this would be a good controversial topic to discuss. Preview/Thesis Statement: Today I will present to you three reasons why the Federal Government should make vaccinations mandatory. Body Transition:
An Ethical Anaylsis of the Arguments Both For and Against COVID-19
Background. Since the development of the first U.S. Food and Drug Administration-approved vaccine for the prevention of serious disease and death associated with the SARS-CoV-2 virus, health care workers have been expected to comply with mandatory immunization requirements or face potential termination of employment and censure by their state medical boards.
Vaccinations Thesis Statement
Free Google Slides theme and PowerPoint template. There is a lot of information about vaccines and, sadly also a lot of misinformation. It is in health worker's hands to select only proven information and share it in a clear, understandable way that makes people who don't understand the subject feel safer and more open to get their shot.
3 reasons for making COVID-19 vaccination mandatory for children
Full population-level protection against COVID-19 will require most adolescents and children to be vaccinated. There are ethical arguments for encouraging vaccination uptake through vaccine mandates.
Good reasons to vaccinate: mandatory or payment for risk?
Abstract. 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.
How to Write a Thesis Statement-Examples
Let's look at this example process to give you a better idea of how to get from your topic to your statement. Note that this is the development of a thesis statement for an argumentative essay. Choose a specific topic: Covid-19 vaccines. Narrow it down to a specific aspect: opposition to Covid-19 vaccines. Ask a question: Should vaccination ...
Persuasive Essay About Covid19
Step 1: Choose a Specific Thesis Statement. Your thesis statement should clearly state your position on a specific aspect of COVID-19. It should be debatable and clear. For example: Thesis Statement: "COVID-19 vaccination mandates are necessary for public health and safety."
Refusal of Vaccination: A Test to Balance Societal and Individual
Risks and Benefits of Vaccination. The factual bases for vaccine refusal have largely been scientifically refuted. There is no scientific support for the notion that vaccines overwhelm the infant immune system. 18 Most additives in vaccines are safe in the absence of anaphylaxis to a component ingredient. 19 No reputable study has suggested a link between autism and any vaccine. 20
Vaccination Research Paper
Let's face it: finding good examples for a vaccine research paper can be difficult. Nowadays, the Internet is full of useless or poorly written content. ... Also, remember to include the thesis statement towards the beginning of the intro. Write three body paragraphs. Of course, you can write more, but 3 is the minimum for the five paragraph ...
PDF The Controversy of Vaccines
law which will decrease the amount of parents deciding against vaccination. Thesis/Problem Statement In this thesis, I will investigate the basis and prevalence of the controversies surrounding vaccines and examine the data and claims based on this data that brings forth the controversy of vaccines.
The Anti-vaccination Movement: A Regression in Modern Medicine
This paper evaluates and reviews the origins of the anti-vaccination movement, the reasons behind the recent strengthening of the movement, role of the internet in the spread of anti-vaccination ideas, and the repercussions in terms of public health and safety. Keywords: vaccination, mmr vaccine, measles outbreak, virus, anti-vaccine movement.

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Introduction

Ethics of mandatory COVID-19 vaccination

Grave threat to public health

Vaccine is safe and effective

Better than the alternatives

Conscription in war

Pre-existing mandatory vaccination

Coercion is proportionate

Better than coercion? Payment for risk

Undue influence?

Practical advantages

Payment in kind

Acknowledgments

Supplementary materials

Linked Articles

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Public attitudes toward COVID-19 vaccination: The role of vaccine attributes, incentives, and misinformation

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Measuring the impact of COVID-19 vaccine misinformation on vaccination intent in the UK and USA

Vaccine hesitancy and monetary incentives

Providing normative information increases intentions to accept a COVID-19 vaccine

General characteristics of study population

Vaccination preferences

Survey sample and procedures

Conjoint experiment

Analyzing additional correlates of vaccine acceptance

Reporting summary

Data availability

Acknowledgements

Author information

Contributions

Corresponding author

Ethics declarations

Additional information

Supplementary information

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Author Corner

Attitudes on voluntary and mandatory vaccination against COVID-19: Evidence from Germany

Introduction

Data, measures, and methods

Measures: Preferences toward vaccination against COVID-19

Sample selection, weighting, and item non-response

Statistical framework

Willingness to get vaccinated and attitudes toward a policy of mandatory vaccination

Attitudes toward a policy of mandatory vaccination

Argument 1.

Argument 2.

Argument 3.

Characteristics of the ‘anti-vaccination’, ‘anti-duty’, ‘passenger’, and ‘pro-vaccination’ groups

Multivariate description of the characteristics of the four groups.

Supporting information

S2 File. Comparison with further studies in Germany.

S3 File. Complementary estimation results.

S4 File. Additional diagnostics for the logit models.

S5 File. Multicollinearity across explanatory variables.

S6 File. Functional form assumptions and simultaneity.

S7 File. Imputation.

S8 File. Stata code.

Acknowledgments

3 reasons for making COVID-19 vaccination mandatory for children

Disclosure statement

Risk of harm to children

Risk of harm to others

Children’s well-being