A plea for mandatory vaccination – now after all?

"We are committed to good health communication and evidence-based decision-making, and so far we have rejected mandatory vaccination," explains Cornelia Betsch, Professor of Health Communication at the University of Erfurt and head of the COSMO team.

However, the current situation is also leading us to reassess this issue. We have put the reasons for and against mandatory vaccination in the context of the current situation and are now pleading for the introduction of a general mandatory vaccination to be examined as soon as possible."

Despite the currently increasing willingness to vaccinate among first-time vaccinators, it is currently not foreseeable that the vaccination rates required by the Robert Koch Institute (RKI) for the future control of the SARS-CoV-2 virus can be achieved with the measures taken so far to increase the willingness to vaccinate, according to the paper now presented. The scientists first list the advantages and disadvantages of mandatory vaccination:

Advantages of mandatory vaccination:

• Mandatory vaccination is social and strengthens the common good.
• Mandatory vaccination can be effective.
• Mandatory vaccination against COVID is currently accepted.
• Mandatory vaccination can have a positive impact on society.
• Mandatory vaccination can strengthen trust.

Disadvantages of mandatory vaccination:

• Mandatory vaccination does not exempt people from being informed.
• Mandatory vaccination can have psychological side effects.
• A target group-specific mandatory vaccination could have a negative impact on the overall vaccination rate.
• Mandatory vaccination could make people "vaccine lazy".
• Mandatory vaccination needs accompanying measures to strengthen acceptance.

Up to now, for the latter reasons, the scientists from psychology and health communication had not generally recommended mandatory vaccination – not only with regard to Corona – but had rather pleaded for an informed, evidence-based vaccination decision. "However, due to the expected high health and societal costs and burdens that the absence of mandatory vaccination and thus too low vaccination rates entail, we now recommend that consultations on the design, implementation, legal basis and mitigation of possible consequences be started immediately," says Cornelia Betsch. The recommendation is that an interdisciplinary team of experts, including social and behavioural scientists as well as citizens, should be consulted.

Background:
In 8 to 9 out of 10 infections, at least one person is involved who has not been vaccinated – either as the infected person, as the infected person or usually both. The infection figures are very high, especially in regions of Germany where the vaccination rate is low. The willingness to vaccinate of those who have not yet been vaccinated is also lower in these parts of Germany than in regions with already high vaccination rates (see COSMO #56). Although the willingness to vaccinate is currently increasing minimally even among the unvaccinated, more than half of the currently unvaccinated are "definitely not" willing to be vaccinated (COSMO #56). "Even if all previously unvaccinated people were to be vaccinated immediately, it would currently take too long to effectively break the fourth wave," the paper states. Other measures would be necessary here and even after the fourth wave, a high vaccination rate would be necessary to prevent further waves.

Politicians from many parties publicly spoke out against mandatory vaccination early in the pandemic and may perceive a change of heart now as a breaking of promises. "However, many aspects of the pandemic have changed. Adjusting one's stance shows strength and can also increase lost confidence," the paper continues. According to the COSMO study, people who have already been vaccinated currently still have a higher level of trust in politics than people who have not been vaccinated. However, slow action in the face of rapidly increasing numbers of cases also decreases their trust (COSMO #56). "The introduction of an effective infection protection measure could therefore repair the damaged trust among this large group, the majority."

Cornelia Betsch is quite self-reflective: "Many of the research papers from our working group have so far also supported a negative stance on mandatory vaccination. For example, we have written critical statements on mandatory measles vaccination and have also been critical of possible mandatory vaccination in the Corona pandemic so far. As a substantive main argument against mandatory vaccination, we have also listed the psychological side effects of mandatory vaccination: namely, that mandatory vaccination can lead to 'defiant behaviour' among people who refuse vaccinations and thus also have a negative impact on other (voluntary) vaccination decisions. In any case, however, we pursue with great conviction the goal of good health education and the support of informed, autonomous and science-based decision-making. However, the current situation – high number of cases, too low vaccination rate, high percentage of people who do not want to be vaccinated – also lead us to a re-evaluation, which is why we put reasons for and against mandatory vaccination in the context of the current situation in this paper, in order to make them available to the public discussion and decision-makers. All previous, mostly digital campaigns – #ärmelhoch, #impfenschützt, #allesindenarm – could not contribute to a sufficient increase in the willingness to vaccinate, despite the calls of famous people, informative videos by Youtubers and information material in many languages. Even temporary low-entry offers through vaccination centres, vaccination buses, mobile vaccination teams and vaccination campaigns in unusual places may have ensured that a plateau was reached more quickly, but not a sufficient increase in the vaccination rate."

Therefore, the scientists around Cornelia Betsch now consider the restriction of individual freedom of choice associated with mandatory vaccination "justified" for the above-mentioned reasons: Nevertheless, even mandatory vaccination does not exempt from the necessity of good and reliable information. Mass communication approaches (e.g. information on websites) should be supplemented by interpersonal communication approaches. In mass communication, not only government channels and government-related spokespersons should be used. Recommendations, information and calls for vaccination must reach all levels of society. Therefore, according to the scientists, the media should educate more about misinformation, regularly communicate and explain new recommendations and focus on the disease. Hundreds of people die every day and reports about the fates of the bereaved and doctors/nurses are still rare. The focus of many press reports is on controversial thinkers (Querdenker) and reports about undesirable side effects of vaccinations. This shifts the focus away from the disease and the dramatic extent of the actual catastrophe recedes into the background.