Virginia State Health Commis­sioner, Dr. Norman Oliver, told a local news station in August 2020 that he planned to mandate COVID-19 immunizations for Virginians once a vaccine becomes available to the public. The follow­ing day, the Governor, Ralph Northam, pulled rank on the Commissioner and announced there would be no vaccine mandate after all. The Health Department walked back the Commissioner’s earlier comments while the Governor’s Office issued a statement focusing on vaccine accessibility and fair distribution, not a mandate. 

Virginia law, nevertheless, does empower the Commissioner to is­sue a vaccine mandate under certain conditions. Virginia has a religious exemption for vaccines generally, but not if the state declares an “emergency or epidemic of any dis­ease of public health importance for which a vaccine exists.” In the emergency situation, the only ex­emption would be for serious medi­cal reasons, i.e. the vaccine would be detrimental to the health of the recipient, as certified by a physician. 

State legislators have been pushing to update the Virginia law to include a religious exemption in an emergency declaration.

The contentious discussions in Virginia raise broader questions about vaccine mandates and ex­emptions.

It can be helpful to distin­guish local vaccine mandates from universal ones. 

A local mandate means an immunization is required for services or employment, insisting, for example, that children be vac­cinated prior to admission to the local school, or workers in a hos­pital system be compliant with Centers for Disease Control im­munization schedules as a condi­tion for employment. 

A universal mandate, mean­while, involves a demand that all residents of a particular geo­graphical area, such as a town­ship, county, state or country be immunized.

Generally speaking, vaccina­tions should not be universally mandated, considering the unique manner in which a vaccine can impose itself upon the inner workings of the human body, and in consideration of the potentially complex set of risks that may ac­crue. 

Especially for newly-devel­oped vaccines with uncertain pro­files of efficacy, adverse events, and long-term consequences, universal mandates are ethically problematic. 

Only in the face of a highly virulent and deadly pathogen, with few or no alternative treatments available — and it would be doubtful whether any vaccine for COVID-19 could ever qualify in this way — might a broader, universal-type man­date become justifiable.

Even in such high risk situa­tions, however, only a "soft universal mandate" would be justifiable, one that allowed for at least three exemp­tions to be liberally available to the populace: a conscience exemption, a religious exemption, and as noted earlier, a medical exemption. These exceptions provide the basis for ap­propriate "opt outs" to occur, and for basic human freedoms to be duly safeguarded.

A local vaccine mandate to en­sure the safety of a school or work environment can be acceptable, and not unduly coercive, in part because no one is compelled to seek employ­ment in the field of healthcare, nor to be educated in one specific school setting. Also, exemptions are often­times available within schools or cer­tain healthcare settings.

How would a religious exemp­tion differ from a conscience exemp­tion?

A religious exemption would apply if the teachings of the faith of the individual to be vaccinated held that vaccines in general were immoral and contrary to God's will, as might be the case for members of the Christian Science Church founded by Mary Baker Eddy. Since there is no Catholic teaching that the reception of vaccines, including those that rely on fetal cell lines from abortions that happened long ago, is sinful, Catho­lics cannot claim a religious exemp­tion from the requirement of immu­nization.

A conscience exemption, mean-while, would refer to the situa­tion in which an individual in con­science believed that it was immoral to be vaccinated. 

Some individuals might claim a conscience exemption if they were convinced, even following extensive safety and efficacy testing, that the risks of being inoculated outweighed the potential benefits. 

It is Catholic teaching that one must follow one's informed judgment of conscience even if one is in error because the conscience is our last best judgment about what is right or wrong. 

Some Catholics might claim a conscience exemption out of a mis­taken but sincerely held conviction that vaccinations themselves are al­ways wrong, or that it is always im­moral to receive vaccines made out of cell lines from abortions when that is the only option available.

Some states and jurisdictions do not distinguish between religious and conscience exemptions. They only make available a religious exemption, by which they often intend to include and subsume under the same heading the exercise of conscientious objec­tion.

In sum, state-sponsored or leg­islative coercion through a universal vaccine mandate raises ethical con­cerns, especially when appropriate exemptions are unavailable. 

Health officials should instead seek to educate those under their authority, through careful and patient explanation, about the importance of receiving a vaccine, so they might freely choose to do so on their own initiative.

 Copyright © 2020, The National Catholic Bioethics Center, Philadelphia, PA. All rights reserved.