Novak Djokovic, the world’s top-ranking tennis player at the start of 2022, was looking forward to the Australian Open, held [that] January. He had won it in each of the past three years. One more victory would have given him a record 21 major titles, breaking a three-way tie with Roger Federer and Rafael Nadal. The Australian government, however, [then required] incoming visitors to show proof of vaccination, and Djokovic had previously refused to reveal his vaccination status, calling it “a private matter and an inappropriate inquiry”.
The family of Dale Weeks would disagree. Weeks, 78, was a patient being treated for sepsis at a small hospital in rural Iowa, but the treatment was not proving effective. The hospital sought to transfer him to a larger hospital where he could have surgery, but the surge in Covid-19 patients, almost all of them unvaccinated, meant there were no spare beds. It took 15 days for Weeks to obtain a transfer and by then it was too late.
Weeks was just one of the many victims of the unvaccinated. His daughter said, “The thing that bothers me the most is people’s selfish decision not to get vaccinated and the failure to see how this affects a greater group of people. That’s the part that’s really difficult to swallow.”
Around the time Weeks died, in December 2021, Rob Davidson, an emergency room physician in Michigan, wrote an essay for the New York Times that provided a vivid picture of life in a hospital that had consistently been at or near capacity for several weeks. The overwhelming majority of patients had Covid-19, and 98% of those needing acute critical care were unvaccinated.
What happened to Weeks was happening at Davidson’s hospital, too: those in need of more specialised treatment could not be transferred to a larger facility because nearly every hospital in the region was already full or close to it. Davidson is unable to view the choice not to get vaccinated as a private matter. “It forces patients with ruptured appendixes and broken bones to wait for hours in my emergency department; it postpones surgeries for countless other people and burns out doctors and nurses.”
That is one reason vaccination is not a private matter; the other is that vaccinated people are less likely to spread the virus to others. That is because, first, they are less likely to get infected and, second, if they do get infected, their illness is likely to be less severe (which is why the patients needing acute critical care are, as Davidson indicated, overwhelmingly unvaccinated). Vaccinated people typically have a high load of the virus in their body for a shorter period than unvaccinated people, decreasing the amount of time in which it could spread to others.
Personal Choice
The Australian Open is held in Melbourne, the capital of the state of Victoria, which happens to be the first jurisdiction in the world to have made it compulsory to wear a seat belt in a car. The legislation was attacked as a violation of individual freedom, but Victorians accepted it because it saved lives. Now, most of the world has similar legislation. I can’t recall when I last heard someone demanding the freedom to drive without wearing a seat belt.
Instead, we are now hearing demands for the freedom to be unvaccinated against the virus that causes Covid-19. Before Djokovic became the public face of unvaccinated athletes, Brady Ellison, a member of the US Olympic archery team, said his decision not to get vaccinated before the Tokyo Olympics was “100% a personal choice”, insisting that “anyone that says otherwise is taking away people’s freedoms”. The oddity here is that laws requiring us to wear seat belts really do quite straightforwardly infringe on the freedom of the individual, whereas laws requiring people to be vaccinated if they are going to be in places where they could infect other people are restricting one kind of freedom in order to protect the freedom of others to go about their business safely.
Don’t misunderstand me. I strongly support laws requiring drivers and passengers in cars to wear seat belts. In the US, such laws are estimated to have saved about 370,000 lives and to have prevented many more serious injuries. Nevertheless, these laws are paternalistic. They coerce us to do something for our own good. They violate John Stuart Mill’s famous principle: “The only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others.” The fact that the coercion is for the individual’s own good is “not a sufficient warrant”.
There is a lot to be said for this principle, especially when it is used to oppose laws against victimless crimes such as homosexual relations between consenting adults, or physician aid in dying, when these acts were illegal. But Mill had more confidence in the ability of members of “civilised” communities to make rational choices about their own interests than we can justifiably have today.
Before seat belts were made compulsory, governments ran campaigns to educate people about the risks of not wearing them. These campaigns had some effect, but the number of people who wore seat belts came nowhere near the 90% or more who wear them in the US today (with similar or higher figures in many other countries where not wearing them is an offence).
The reason is that we are not good at protecting ourselves against very small risks of disaster. Each time we get into a car, the chance that we will be involved in an accident serious enough to cause injury, if we are not wearing a seat belt, is very small. Nevertheless, given the negligible cost of wearing a belt, a reasonable calculation of one’s own interests shows it is irrational not to wear one. Car-crash survivors who were hurt because they were not wearing seat belts recognise and regret their irrationality – but only when it is too late, as it always is for those who were killed while sitting on their belts.
We are now seeing a similar situation with vaccination. Brytney Cobia gave the following account of her experiences working as a doctor in Birmingham, Alabama: “I’m admitting young healthy people to the hospital with very serious Covid infections. One of the last things they do before they’re intubated is beg me for the vaccine. I hold their hand and tell them that I’m sorry, but it’s too late.
A few days later, when I call time of death, I hug their family members and I tell them the best way to honour their loved one is to go get vaccinated and encourage everyone they know to do the same. They cry. And they tell me they didn’t know. They thought it was a hoax. They thought it was political. They thought, because they had a certain blood type or a certain skin colour, they wouldn’t get as sick. They thought it was ‘just the flu’. But they were wrong. And they wish they could go back. But they can’t.”
The same reason justifies making vaccination against Covid-19 mandatory: otherwise, too many people make decisions they later regret. One would have to be monstrously callous to say: “It’s their own fault, let them die.”
In any case, as we have already seen, in the Covid era, making vaccination mandatory doesn’t violate Mill’s “harm to others” principle. Unvaccinated Olympic athletes impose risks on others, just as speeding down a busy street does. The only “personal choice” Ellison should have had was to get vaccinated or stay home. In a pandemic, that applies to everyone. If you are willing to stay at home, indefinitely, and not be physically close to anyone else who is not similarly isolated, fine, you should not be forced to get vaccinated. But if you are not prepared to do that, you are increasing the risk to others.
For the situation Davidson described, and that Weeks’ children believe led to their father’s death, a different solution is available, one that respects the decisions of those who choose not to be vaccinated but requires them to bear the consequences of their choice. Hospitals that are at or near capacity should warn the populations they serve that, after a certain date – far enough in the future to allow ample time for people to get fully vaccinated – they will give vaccinated patients priority over unvaccinated patients with Covid-19.
After the announced date, when both a vaccinated and an unvaccinated patient with Covid-19 need the last available bed in the intensive care unit, the vaccinated patient should get it. If the last ICU bed is given to an unvaccinated patient because at the time there is no one else who needs it, and subsequently a vaccinated patient with a greater or equal need for the facility arrives, the bed should be reallocated to the vaccinated patient. The unvaccinated patient, or the family of that patient, may object, but if the move is in accord with a previously announced policy, and everyone had the opportunity to be vaccinated before the policy took effect, people must take responsibility for their own choices, especially when they have been warned that their choice could harm others, and have been told they will be lower priority for treatment for that reason.
Extra strain on staff
Hospitals with sufficient capacity should, of course, continue to treat unvaccinated Covid-19 patients as best they can. Despite the extra strain this puts on hospital staff, everyone should have sufficient compassion to try to save lives, even when those whose lives need saving have made foolish, selfish choices.
Exceptions should be made for those few patients for whom vaccination is contraindicated on medical grounds, but not for those who claim to have religious grounds for exemption. No major religion rejects vaccination, and if some people choose to interpret their religious beliefs as requiring them to avoid vaccination, then they, and not others, should bear the consequences.
Such a policy is likely to increase vaccination rates, which will benefit the unvaccinated as well as the vaccinated, and save lives, just as vaccine mandates have saved lives by increasing the number of vaccinated people. But even if the policy does not persuade more people to get vaccinated, at least fewer people would die from health conditions over which they have no control because others who regard vaccination as a “personal choice”, and selfishly rejected it, are using scarce resources needed to save lives.
Djokovic travelled to Melbourne to play in the Australian Open, claiming he had medical grounds for an exemption from the requirement to be vaccinated. The Australian Minister for Immigration rejected his grounds for exemption and ordered him deported, saying his presence in the country posed a risk to public health. In a marathon five-set final match, Nadal triumphed over Daniil Medvedev and became the first person ever to win 21 grand slam titles. l
Reprinted with permission from Ethics in the Real World: 90 Essays on Things That Matter, by Pete Singer (Text Publishing, RRP $30, available now).
