By Iñigo de Miguel Beriain.

The debate about coercive vaccination is gaining intensity in most Western countries. One of the arguments that have been put forward in recent days in support of coercive vaccination has been that of the ‘seat belt analogy (SBA)’, originally proposed by Giubilini and Savulescu. This argument states that, since the situation posed by vaccines is analogous to that of seat belts, we should proceed to implement coercive vaccination policies on the basis of this historical experience with seat belts.

In my opinion, this argument is not convincing, because 1) not all arguments in favour of mandatory seat belts are as convincing as they seem at first glance and 2) although there are some strong reasons in favour of mandatory seat belt wear, they are not as sound when applied in the case of vaccines. This is due to the fact that the analogy between vaccines and seat belts is not as strong as its apologists believe it to be.

Let us start by analysing the real moral consistency of seat belt-use coercive policies. These might be justified first on the basis of the savings they provide to public health systems. However, this justification is not solid. Mainly, because citizens are not always required to follow certain behaviours or lifestyles in order to defend the interests of the society where they live. We usually do not overtax people because of their bad habits. Taxes related to a lack of adherence to treatments or an unhealthy lifestyle have never been implemented.

Furthermore, forcing someone to vaccinate for these purposes would open the door to more general restrictions on individual autonomy: If we force you to get vaccinated to optimize the use of public resources in times of scarcity, why couldn’t we use the same argument to force you to undergo a Covid-curing treatment once it is available? Moreover, if healthcare resources are always scarce, why should this obligation be implemented only in times of pandemic? As can be seen, the reasoning can give rise to serious problems in terms of respect for patient autonomy.

Second, seat belt-use coercive policies are often based on a paternalistic attitude: we protect drivers and passengers even though they are not willing to protect themselves. The problem, in this case, is that paternalism was a more acceptable attitude in all areas of life in the 1980s, when seat belts were made compulsory, but circumstances have changed since then in the realm of health care.

Today, the paradigm ruling physician–patient relations is that of informed consent. This evolution should not be forgotten when drawing analogies between seat belts and vaccines, at the risk of falling into unacceptable paradoxes. Of course, Giubilini and Savulescu would probably reply to this argument by saying that paternalism should at least be respected if we are thinking about children’s interests. However, this is only true if risk analysis works the same in the case of the seat belts and that of the vaccines.

This is not really the case. It is, indeed, undeniable that, in both cases – vaccination and seat belts – the risks are usually outweighed by the benefits. The main difference, however, is that, in the case of seat belts, this is not only true at the level of big data – a whole population – but also at the level of the concrete individual. In the case of vaccines, on the contrary, it is certain that their imposition will improve the situation in terms of the population (in that fewer people will die or have serious sequelae), but this is not necessarily the truth for each individual (for certain individuals, it is possible that not being vaccinated would be preferable).

Another essential difference is that both the possible effects of vaccines and the course of a disease in a particular patient can at least be intuited a priori, something that does not happen with traffic incidents. Thus, the circumstances are not at all the same in both scenarios.

Let us now concentrate on the idea that both seat belts and vaccines should be compulsory because they help to protect third parties’ lives. Here the problem is that the analogy forgets that, in the case of seat belts, the benefit to third parties does not depend upon what others do: if one wears a seat belt, it should prevent them from being thrown against the front seat occupants, regardless of what the other occupants in the vehicle do. In the case of vaccines, however, effective protection of those third parties will only be achieved if a lot of people get vaccinated. Thus, this clearly creates a substantial difference: vaccines require collective actions that seat belts do not. Furthermore, seat belts are the only reasonable option we have to protect third parties from a hit. In the case of virus transmission, instead, there are multiple ways to achieve this goal. Finally, it is clear that the strength of the argument depends upon the capability of the vaccines to substantially impede the dissemination of the virus: if vaccines do not provide substantial sterilising immunity, then coercive vaccination will not prevent harm to others.

Author: Iñigo de Miguel Beriain

Affiliations: University of the Basque Country/Ikerbasque. Basque Foundation for Science. Panelfit project

Competing interests: None

Social media accounts of post author: @idemiguelb