Vaccine Mandates and Bodily Autonomy
Here`s a topic that's likely always going to be important
Now, we all know that vaccine mandates were controversial after Edward Jenner discovered the first smallpox vaccine in 1796. We know that there have been protests, defacing of iconic monuments, and even polio vaccination workers in Nigeria, Afghanistan, and Pakistan have been shot. That said; why? There isn't so much strife around other, more basic healthcare interventions. Even medications that we take on an everyday basis can have side effects. Aspirin is not without the risk of side effects, when used in COVID-19 patients for instance. Paracetomal and ibuprofen, when taken inappropriately (either intentionally or accidentally), may result in poisoning and various other side effects. Even antidepressants can cause side effects if stopped suddenly; and can cause particular risks during pregnancy. The point being that there is no such thing as a 0% chance of side effects, or other risk, in any medication or medical procedure. Therefore the fact that there is so much emotion around vaccines (in my own view) tells us that the concept of vaccination taps into something slightly deeper and more emotive than vaccines as a medical procedure.
Of course there are many factors contributing to hesitancy but the key one that's relevant to mandates is bodily autonomy. So first question; what do I mean by bodily autonomy? It can be described as a set of practices that centre the patient in all decision -making. Put simply, it's the right to do as you wish with your body. How you present it, take care of it, ingest into it (be that food, medication, or anything else). It means being well-informed about the benefits and potential risks of any medication or procedure you accept. It also means being given the time, space and empathy by caregivers to ask questions and raise concerns, no matter how large or small the concerns, unusual or common the concerns might be. Quite simply, it can just mean reassurance. It can simply mean knowing there is someone supporting you as you are advocating for yourself as a patient.
One's body belongs to oneself. It's a central principle of medicine. According to the website of the World Health Organization, it’s essentially under the umbrella term of “human rights”. It can't be isolated from other rights such as education, participation, food, housing, water, and information. For that reason, for bodily autonomy issues and by extension, vaccine hesitancy to be addressed, a holistic approach needs to be taken where all human rights are considered. It's multi-tiered. What that means is; if one right is violated, that leads to mistrust in relevant institutions. If one right has been violated; it's not unreasonable that other rights could be violated by them too. If governmental institutions are restricting reproductive rights (which I'll discuss further in the next paragraph); people are liable to mistrust their motivations for encouraging vaccination too.
With this, it can be detrimental to patient provider trust if it is compromised in any way. If it's compromised on a larger scale, this can be detrimental to national or even global vaccination coverage. The removal of autonomy doesn't necessarily need to relate to vaccination itself. Bodily autonomy can be violated in multiple ways. To see the impact of this, one only needs consider the case of the Roe vs Wade overturn in the US last year which overturned a landmark 1973 decision that made abortion a right and removed legislative restrictions to accessing it. One can't discuss bodily autonomy without discussing this landmark event. With it, regulations have returned and many abortion opponents are now investigating how to limit or ban international travel for abortions. This caused outrage among abortion proponents; sparking outrage across various social media platforms, protests and so on.
What does this tell us about bodily autonomy? Well, it's clear that bodily autonomy also means being able to make decisions concerning one's own life and healthcare. Without it, one can potentially become resentful; as accepting or rejecting medication or treatment just once can have a long term impact on the patient's life. However, being subjected to involuntary care long term can negatively impact many if not all aspects of the patient's life. Many patients, I think, realise this intuitively; and The World Health Organization website briefly details the story of what can result from involuntary care long-term;
Alexandra M Schuster from the United Kingdom was diagnosed with a mental illness when she was seven. “Throughout my childhood and adolescence, I had no say in my own recovery: my own ideas of what would work well for me were often dismissed,” says Alexandra. “This lack of autonomy eroded my already-low self-esteem and worsened my mental illness.”
By the age of nineteen, Alexandra says she was a shell of an individual. “Years of being forced into specific care pathways and bubble-wrapped by caring adults had shattered my confidence. I barely believed I was capable of making basic decisions, let alone helping myself.”
Of course, the specifics vary from person to person. However, being subjected to short term or long term care involuntarily can also contribute to disillusionment with healthcare professionals, authorities, or institutions.
It is therefore clear that any event or multiple events, such as the above, that elevates distrust of governmental or other institutions feeds into vaccine hesitancy. It doesn't necessarily even need to be related to vaccines as we've seen. The examples highlighted really illustrate how vaccine hesitancy needs to be considered not as a single issue in a vacuum; but as a framework of interlinked issues. I believe that this is a more accurate
It's been really thoroughly discussed in the media in recent years; and for good reason. It`s important because we haven't always had it; especially marginalised groups such as ethnic minorities and women. Some people still fight for bodily autonomy and other freedoms on a daily basis; and when you fight for something for so long and you perceive that it is now being taken away; that can result in significant emotional distress. At the very least, that can be one element of the issue. Also, bodily autonomy is much more personal than autonomy as a broader concept. For that reason, there`s added nuance when it comes to bodily autonomy, depending on the individual's circumstances, what experiences they've had, among many other factors.
For example; if someone has multiple experiences where their bodily autonomy has been violated in several ways. This can mean that any situation that might cause their autonomy to be violated again can evoke a lot of emotion. This is where vaccines come in. A common argument against vaccines, and particularly vaccine mandates, is that they violate bodily autonomy. That is, some vaccine hesitant people feel that they are deprived of the right to choose.
The next question that naturally follows, I believe, is how do we address the perceived loss of bodily autonomy that some vaccine hesitant/resistant patients experience?
Of course, not everyone has the same experience.
That said, to discuss this, I'm going to reiterate a principle that's universally true- actions have consequences. I don't think that's controversial to say. It's simply cause-and-effect.
Nobody is going to drag vaccine hesitant/resistant individuals to vaccination clinics. I believe we have to remain consistent here; bodily autonomy is a central pillar of medicine. So with that said; they're absolutely free to choose not to vaccinate, or to delay one or more vaccines. People are absolutely free to have questions about vaccines; as they are with any medication or procedure. .However if they do make that decision they may be restricted from leisure areas like cinemas, restaurants, and they may be required to take other precautions or work from home.
An article published on the conversation.com in August 2020 addresses this well. It is absolutely reasonable that people should have bodily autonomy and it's been discussed in detail here. That said, if one wants to benefit from public health measures one also has a responsibility to maintain public health (it's right in the name - public health). If that's not by vaccinating it could be by remaining at home, masking, regular antigen testing and so on. If not, the principle of having the right to freedom loses value. Actions have consequences, and rights resulting in responsibilities fall under this broader principle. Framing one`s response to bodily autonomy arguments like this can help reduce the perceived loss of bodily autonomy in the other party. This is because “actions have consequences” re-frames the above restrictions more accurately. That is, they are the result of a principle that is universally true; and not necessarily an act of coercion or control.
Now of course, there's a difference between restricting their entry to leisure areas and restricting entry to essential areas like hospitals, schools etc; and that's a different discussion entirely. So, the response to the question “should unvaccinated or undervaccinated patients be restricted entry to public areas?” - possibly some but not others. It's not a binary “yes or no” answer, as is the case with most complicated questions. If it were, there wouldn't be so much emotion and therefore so much dialogue around this topic. There's nuance to the topic. It's important to acknowledge that because it allows us to present an accurate picture of what vaccine hesitancy actually is. When we do that, we have a solid foundation to work as a society to address complex issues like this.
Related to this; one way to do this is for the public and health authorities to clarify what our expectations of each other are. To illustrate this, I'm going to quote a phrase I learned about a decade ago in secondary school ( high school if you're based in the US). I've never forgotten this phrase and I think it's hugely relevant here - rights come with responsibilities. In terms of establishing expectations; expectations; not only communication is needed; but high quality communication. This is the same principle with any friendship or relationship; mistrust can grow if there is reduced communication, or no communication at all over a long period of time. If one scales that up from one individual relationship to the level of an entire population of people; it can be seen how hesitancy became such a widespread issue.
How, then, do you improve communication? One way is to reframe the discussion such that both parties are equal stakeholders. A 2021 paper by Jotterand and colleagues addresses the concept that the public broadly is a central stakeholder in maintaining and advancing public health via research and discovery. The paper emphasises that although physicians and public health authorities are the primary stakeholders in PH research the public as key secondary stakeholders, have the right to not only engage in; but drive the direction of research and discovery. The authors propose” the beginning a bi-directional conversation between researchers and the public that will outline the rights and responsibilities of the public. Specifically, such dialogue, and an ensuing document, will provide the basis to empower (rights) and engage the public (responsibilities) in the conduct of biomedical research.” Therefore, reframing the roles of both stakeholders in a discussion can help to change the dynamic in a more positive way. As a result; this can help both individuals feel heard and produce more effective communication and better solutions.
Few things unite people more than having a common goal. Be it two people, or a larger group, working towards aspirations allows people to synergize with each other. So, then, how do we apply this to discussion on vaccine mandates and bodily autonomy? The first step is to clarify the goal. What motivates and drives all parties involved? In this case, I`d argue that it`s the health and wellbeing of themselves and the people they care about. The majority of people globally work throughout the day to ensure the welfare of their loved ones. Therefore, regardless of ethnicity, gender, life experiences, socioeconomic status etc; this is a key way to start a conversation so that everyone is debating from a position where they can relate to each other; rather than a place of wanting to be right or “win”.
The other element of having common goals is that they remind people of shared values. Shared goals based on shared values is a much stronger way to build trust than either alone. For this reason, values-based approaches to addressing hesitancy have shown promise. I wrote about a good example of this here, but I`ll describe it briefly. Fremantle is a community in Western Australia known for their “natural living” lifestyle. They engage in homebirth, growing vegetables, cloth nappies, and so on. It won't be surprising that rejecting vaccinations is a component of this. In 2015, political scientist Katie Atwell from the University of Western Australia conducted an “I immunise” campaign. This involved displaying posters of of members of the Freomantle community around the area with positive messaging about immunisation ie. “I use cloth nappies, I eat wholefoods, and I immunise.” There was also an “I immunise” website they could visit for further information about community members' stories.
In my view, this was effective for several reasons. First of all, it supported vaccination in line with the values of the community. Due to this, the community still felt they had freedom to practise their eco-friendly lifestyle. Their autonomy wasn't being taken away, or even reduced. They could feel that their decision was self-directed, rather than feeling instructed by a health professional who did not practise the same lifestyle as them and those who they couldn't relate to. That`s a huge reason. Related to this, the second reason I believe this was more effective than other approaches was that it made vaccination a social norm among their community. They weren't going to be isolated or rejected from their community if they decided to vaccinate. In sum, the messaging was encouraging, and not forceful. Once again, this gives a sense of control and autonomy
It should be clear at this point that bodily autonomy is multifactorial (as is every aspect of life). It is hugely rooted in the broader principle of freedom. Freedom always comes with responsibilities regardless of how liberal one is. That said, it is only one drop in the ocean of vaccine hesitancy. Thanks for reading