The Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
The Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK.
J Med Ethics. 2022 Jun;48(6):371-377. doi: 10.1136/medethics-2021-107956. Epub 2022 Mar 7.
COVID-19 vaccine requirements have generated significant debate. Here, we argue that, on the evidence available, such policies should have recognised proof of natural immunity as a sufficient basis for exemption to vaccination requirements. We begin by distinguishing our argument from two implausible claims about natural immunity: (1) natural immunity is superior to 'artificial' vaccine-induced immunity simply because it is 'natural' and (2) it is better to acquire immunity through natural infection than via vaccination. We then briefly survey the evidence base for the comparison between naturally acquired immunity and vaccine-induced immunity. While we clearly cannot settle the scientific debates on this point, we suggest that we lack clear and convincing scientific evidence that vaccine-induced immunity has a significantly higher protective effect than natural immunity. Since vaccine requirements represent a substantial infringement of individual liberty, as well as imposing other significant costs, they can only be justified if they are necessary for achieving a proportionate public health benefit. Without compelling evidence for the superiority of vaccine-induced immunity, it cannot be deemed necessary to require vaccination for those with natural immunity. Subjecting them to vaccine mandates is therefore not justified. We conclude by defending the standard of proof that this argument from necessity invokes, and address other pragmatic and practical considerations that may speak against natural immunity exemptions.
新冠病毒疫苗接种要求引发了广泛的争议。在此,我们认为,现有证据表明,此类政策应承认自然免疫的证明是接种要求豁免的充分依据。我们首先将我们的观点与关于自然免疫的两个不太可信的说法区分开来:(1) 自然免疫优于“人为”疫苗诱导的免疫,仅仅因为它是“自然的”;(2) 通过自然感染获得免疫比通过接种疫苗更好。然后,我们简要回顾了自然获得的免疫与疫苗诱导的免疫之间比较的证据基础。虽然我们显然无法解决这一问题的科学争论,但我们认为,我们缺乏明确和令人信服的科学证据表明,疫苗诱导的免疫具有比自然免疫更高的保护效果。由于疫苗接种要求对个人自由构成了重大侵犯,并且还带来了其他重大成本,因此只有在它们对于实现相称的公共卫生效益是必要的情况下,才能证明其是合理的。如果没有关于疫苗诱导的免疫具有更高优越性的令人信服的证据,就不能认为有必要要求具有自然免疫力的人接种疫苗。因此,对他们实施疫苗接种要求是不合理的。最后,我们通过捍卫这一必要性论点所援引的证明标准来结束讨论,并讨论可能不利于自然免疫豁免的其他实际和实际考虑因素。