On May 5, Health Canada approved a COVID-19 vaccine for use in children aged 12-15 years. The United States Food and Drug Administration quickly followed suit, and other countries are likely to do the same. Similar approvals for younger children are on the horizon.
This is very welcome news. It will not be possible to achieve full protection against COVID-19 at the population level unless most adolescents and children are vaccinated. However, factors such as vaccine hesitancy and mistaken beliefs about the risks COVID-19 poses to children may make this a challenging goal.
One tool that may serve to encourage vaccination uptake is vaccine mandates.
As philosophical researchers, we offer three ethical arguments in favour of making COVID-19 vaccination mandatory for children, based on our research. We contend it would be ethically permissible for governments to impose a sanction (such as a fine or exclusion from social environments or activities) on those who fail to vaccinate their children.
Risk of harm to children
Argument one: if there is an easy, low-cost way for parents or guardians to avoid exposing children in their care to substantial risk of harm and death, they ought to do so.
COVID-19 presents a substantial risk of harm — including long-term health complications such as organ damage, long COVID, or multisystem inflammatory syndrome (MIS-C) and death — to at least some proportion of children. We have limited knowledge about how large the at-risk group is and who is in it, and about the extent to which these conditions will be treatable.
If the COVID-19 vaccine is as safe and effective as other standard childhood vaccinations (or similarly safe as, it seems, most COVID-19 vaccines are for adults), it would provide parents and guardians with an easy, low-cost way to avoid exposing their children to an infection that may cause them serious harm or death.
Governments have an obligation to protect children from parents or guardians who might expose children in their care to easily avoidable risk of harm and death. Therefore, the state ought, in principle and in the absence of decisive countervailing reasons, to mandate that parents vaccinate their children against COVID-19.
We accept that the state protects children in other contexts by imposing obligations on adults to adopt easy, low-cost ways of avoiding significant harm and death, for example, by using car seats and seat belts for their children when driving.
Risk of harm to others
Argument two: If, by vaccinating their children, parents and guardians can avoid imposing a significant risk of harm and death on others in an easy, low-cost way, they ought to vaccinate their children.
The threat to all of us from COVID-19 is significant. The risk unvaccinated children pose is especially great. Children contribute to the spread of the virus through social mixing, often in large groups (for example, in classrooms). Moreover, the longer children remain unvaccinated, the more opportunity exists for a new, more potent variant of COVID-19 to emerge and threaten us all.
A safe, effective COVID-19 vaccine would provide parents and guardians with an easy, low-cost way to avoid imposing the significant risk of harm or death associated with COVID-19 on others.
The state is required to adopt measures to protect populations from exposure to risk of harm and death that might be avoided easily and at low cost. Therefore, the state ought (again in principle and in the absence of decisive countervailing reasons) to mandate that parents vaccinate their children.
We accept that the state protects populations with low-cost and easy avoidance of risk of harm and death in other contexts by, for example, imposing speed limits, limits on alcohol consumption and vision requirements for driving.
We also already accept that the state imposes obligations on parents to take measures to prevent their children from posing risks to others in many contexts. Childhood vaccinations are already mandatory in some liberal democracies, and most liberal democracies mandate that children attend school to provide them with a civic education, and prohibit children from carrying weapons, for similar reasons.
Argument three: One very compelling reason we have to end the pandemic and to mandate vaccination relates to children’s well-being. We must protect children from the mental and physical effects of lockdown and other restrictions, or effects of insufficient restrictions, such as school closures due to infection spread.
Restrictions and the effects of spreading infection lead to decreased opportunities for the pursuit of well-being. Impacts on education alone are considerable, especially amongst the least well off.
But most important of all we want children to thrive. The third argument for mandating the vaccination of children turns on unique features of children’s well-being. Children’s well-being may have different elements than adults’. For example, adults may be focused on values like authentic happiness and rational desires. This may not be true of (especially young) children.
While happiness and the satisfaction of desires matter to children’s well-being, these might not be all that matters. Other so-called “objective goods” may play a significant role in children’s well-being. These include loving and supportive relationships, various forms of play, learning and intellectual development.
Ending the pandemic is essential to enabling children to enjoy the so-called “goods of childhood,” including valuable relationships with friends and extended family (especially older adults), various forms of unstructured play, exploration and intellectual development, and to pursue them in a carefree way in the absence of unavoidable worries about risk.
Childhood is a relatively short period in an individual’s life. It is important for preparing children to meet the challenges of adulthood. But it is also a time in which to savour particular kinds of goods in a unique way. An effective way to secure this for all children is to mandate their vaccination.
We believe these three arguments are compelling reasons for vaccinating children. We hold that they offer a strong case for considering mandating vaccination for children. However, even if there are decisive counter-arguments for not mandating vaccination in some contexts, we maintain that our arguments provide parents or guardians with conclusive reasons to vaccinate their children.
Anthony Skelton, Associate professor of Philosophy and Core Member of the Rotman Institute of Philosophy, Western University and Lisa Forsberg, British Academy Postdoctoral Fellow, University of Oxford