{"id":4766,"date":"2026-04-01T08:17:55","date_gmt":"2026-04-01T07:17:55","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=4766"},"modified":"2026-04-01T08:17:55","modified_gmt":"2026-04-01T07:17:55","slug":"is-it-unfair-discrimination-to-treat-the-unvaccinated-differently","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2026\/04\/01\/is-it-unfair-discrimination-to-treat-the-unvaccinated-differently\/","title":{"rendered":"Is it unfair discrimination to treat the unvaccinated differently?"},"content":{"rendered":"

By Lydia Tsiakiri and Andreas Albertsen<\/p>\n

Six years ago, the WHO officially declared the COVID-19 outbreak to be a pandemic. This declaration triggered lockdowns, rapid vaccine development, and a wide range of emergency public health measures. Yet the pandemic also revealed how unprepared societies were to address its practical and ethical aspects. On the practical side, health systems worldwide faced acute resource shortages. On the ethical side, there was little consensus about the moral principles and values that should guide policy responses. As governments introduced measures such as vaccine mandates, questions about fairness, justification, and discrimination quickly moved to the centre of the public debate.<\/p>\n

The criteria for distribution of scarce healthcare resources, such as ICU beds and ventilators, were widely debated. In this context, our article focuses on one of them, namely personal responsibility for remaining unvaccinated. Specifically, we ask whether treating people differently based on vaccination status \u2013 by restricting access to care, imposing fines, or limiting their access to public places \u2013 amounts to wrongful discrimination.<\/p>\n

The idea that personal responsibility should influence how resources are allocated reflects the sentiments endorsed by luck egalitarianism. Luck egalitarianism argues that society should aim to alleviate and resolve inequalities arising from factors beyond individuals\u2019 control. By contrast, inequalities that reflect personal priorities should be considered less problematic. Applied to the pandemic, this reasoning might suggest that the unvaccinated should be given lower priority or suffer financial burdens because they chose to remain unvaccinated. However, disadvantaging the unvaccinated could also be seen as a form of discrimination, and possibly wrongful discrimination. Our paper, therefore, addresses two central questions: whether this practice is directly or indirectly discriminatory, and whether it is wrongfully so. To answer these questions, we assess how the policies in question align with prevailing accounts of direct, indirect, and wrongful discrimination.<\/p>\n

Direct discrimination involves disadvantageous differential treatment based on a particular characteristic. Policies that imposed financial penalties on the unvaccinated, restricted their access to public places, or deprioritised them for healthcare clearly fit this definition; they explicitly treated individuals differently because of their vaccination status.<\/p>\n

But such policies may also raise concerns about indirect discrimination. This form of discrimination occurs when an allegedly neutral policy disproportionately affects certain groups. Empirical research during the COVID-19 pandemic in Europe and the United States showed that people who refused vaccination or remained undecided were often members of more socioeconomically disadvantaged groups or groups with particular racial or ethnic backgrounds. Given these findings, our paper argues that policies targeting the unvaccinated might also have amounted to indirect discrimination against people from lower socioeconomic backgrounds and certain ethnic or racial communities.<\/p>\n

The key question, however, is whether these cases of differential treatment also constitute a form of wrongful discrimination. Philosophers have offered different accounts of what makes discrimination wrongful. Some locate the wrongness of discrimination in the harm it causes, while others focus on restrictions on freedom or expressed disrespect. From a harm-based perspective, these policies are indeed found to put the discriminatee in a worse-off position than if the instance of discrimination had not taken place. Yet, before concluding that such policies constitute harmful discrimination, we should also consider mitigating factors, such as individual responsibility for remaining unvaccinated and their broader public health effects. From a freedom-based perspective, taking one\u2019s vaccination status into account could be seen as restricting individuals\u2019 freedom to decide who they are and how to live. However, if people\u2019s choice to remain unvaccinated could threaten the healthcare system\u2019s ability to care for the most vulnerable by endangering its overall capacity, the above conclusion becomes less straightforward. Finally, from a respect-based perspective, the respective policies do not appear to build on problematic mental states about the discriminatees\u2019 inferior moral worth, nor do they fail to respect individuals\u2019 autonomy or personal deliberation about the issue. Nevertheless, it is difficult to avoid the concern that these measures may still convey a demeaning message toward those who remained unvaccinated.<\/p>\n

Overall, our analysis suggests that policies sensitive to individuals\u2019 vaccination status align with common understandings of both direct and indirect discrimination. However, whether this discrimination is wrongful depends on how we understand the wrongness of discrimination and on the extent to which vaccination status reflects free and informed choice. In several influential accounts, such policies can be justified, especially when individuals\u2019 responsibility and the broader public health consequences are also considered. Concerns about indirect discrimination are particularly pressing, given that vaccine hesitancy often overlaps with socioeconomic disadvantage and racial inequality. This also suggests that these policies sit uneasily with luck egalitarian views, which can only justify targeting those who are genuinely responsible for their situation. The upshot is not that such policies are clearly permissible or impermissible, but that their moral status is conditional and depends on both normative assumptions and empirical circumstances. In any event, these tensions highlight the need for clearer and firmer ethical guidance before the next pandemic unfolds.<\/p>\n

Paper Title: <\/strong>No jab, no access? Is differential treatment based on vaccination (wrongfully) discriminatory?<\/a><\/p>\n

Author(s)<\/strong>: Lydia Tsiakiri (1-3) and Andreas Albertsen (4-5)<\/p>\n

Affiliation<\/strong>:<\/p>\n

    \n
  1. Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore<\/li>\n
  2. Centre for the Experimental-Philosophical Study of Discrimination (CEPDISC), Aarhus University, Aarhus, Denmark<\/li>\n
  3. Department of Political Science, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark<\/li>\n
  4. Centre for the Experimental-Philosophical Study of Discrimination (CEPDISC), Aarhus University, Aarhus, Denmark<\/li>\n
  5. Department of Political Science, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark<\/li>\n<\/ol>\n

    Conflicts of Interest<\/strong>: None to declare<\/p>\n

    Social Media<\/strong>:\u00a0Lydia Tsiakiri: (LinkedIn<\/a>, X<\/a>, Bluesky<\/a>); Andreas Albertsen (LinkedIn<\/a>, X<\/a>, Bluesky<\/a>)<\/p>\n","protected":false},"excerpt":{"rendered":"

    By Lydia Tsiakiri and Andreas Albertsen Six years ago, the WHO officially declared the COVID-19 outbreak to be a pandemic. This declaration triggered lockdowns, rapid vaccine development, and a wide range of emergency public health measures. Yet the pandemic also revealed how unprepared societies were to address its practical and ethical aspects. On the practical […]<\/p>\n

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