For all the talk on how its important for everyone to get vaccinated, not a single country has so far made the COVID vaccine mandatory for adults. Some states are making it mandatory for college students but none are planning to enforce it for other groups of adults. Even China isn't making them mandatory despite them having little respect for human rights otherwise and no courts to limit the power of the government.

So where does this reluctance come from? At least in the US such a law would be constitutional so the decision not to go ahead with such a mandate is purely political.

Update from August: good news, look like the mandates are coming after all, though mostly for public employees

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    When you write "some states", do you mean some U.S. states or some countries?
    – gerrit
    Commented Jun 11, 2021 at 8:29
  • @gerrit I mean some states in the US or some states/subdivisions in other nations. I.e. Scotland in the UK or Bavaria in Germany. Commented Jun 11, 2021 at 16:57
  • Comments are not for extended discussion; this conversation about anecdotes regarding vaccine hesitance has been moved to chat.
    – Philipp
    Commented Jun 13, 2021 at 13:17

14 Answers 14


Forced medical treatment is a very sensitive topic and is widely considered a grave violation of medical ethics, and is only applied in extreme cases of mental illness, etc.

See https://en.wikipedia.org/wiki/Involuntary_treatment


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    "is only applied in extreme cases of mental illness, etc" is a bit of an exaggeration–it's common in the US to have mandatory vaccine requirements for students to attend school (though the criteria for exemptions vary depending on the state from "my personal beliefs are opposed to vaccines" to "no exemptions except for extremely compelling medical reasons with proof") or to serve in the armed forces. Commented Jun 11, 2021 at 2:43
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    @ZachLipton The armed forces is the interesting one. Unlike many countries, the US does not currently have compulsory military service. But it does still have registration. If the draft were to start again, then plenty of medical stuff (vaccines included) may effectively be required for those drafted. Not likely any time soon (I hope). Commented Jun 11, 2021 at 3:01
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    @ZachLipton That's to attend particular types of schools, not all types of schools. They can still be homeschooled, at the least, and not have any vaccination requirements. When we're talking forced medical treatment, we mean "you don't have any choice or alternative", not "you can deny this, but you may then have fewer options available in other areas of your life". Commented Jun 11, 2021 at 7:55
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    !? Why does "I don't want other people to have a say in what I do with my body" religious? Just because there's no governmental rule on something doesn't mean the only other reason for it can be religious. Commented Jun 12, 2021 at 21:03
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    @Vaelus: Bodily autonomy is hardly “religious” — it’s seen as a principle or right in many different approaches to ethical philosophy, both religious and secular. The fact it’s not a legally-guaranteed right doesn’t make it religious. Commented Jun 13, 2021 at 15:57

For one thing, as long as the approval is "experimental" or "provisional" or similar, there are many who will object on that basis, citing problems with other drugs (not necessarily vaccines) which turned out to have problems not discovered in the earliest stages of testing and distribution, like Thalidomide.

In addition, generally speaking, vaccines are not required (at least in the US) for adults, though commonly required (with religious & other exemptions possible) for children attending school - effectively requiring them for children because school attendance is required (though some exemptions there as well for home-schooling or other options, depending on local & state laws).

In general, the US does not force anyone, to do anything - mandatory schooling, for minors, being one of the few exceptions, along with Selective Service (aka "draft registration"). If you want to vote, you can, but you don't have to vote (unlike some countries). If you want to get a passport, you can, but you don't have to (and no mandatory state or national ID card). Even filing taxes: As I understand it, if you manage to live without earning any money (dependent of someone else) you never even have to file taxes. Medical insurance is, sort of, required, but actually doing anything medical is not.

As an interesting (to me, at least) example, take jury duty. Generally speaking in the US, jury duty is tied to voting registration. It actually doesn't have to be, but it is a practical solution to registering people for that purpose since they show interest by being involved in the system (i.e., they want to be able to vote), and in the US you are simply not required to register your residence and other information with the authorities. (You do need to have a Social Security Number, but that is normally assigned at birth and unless you do some related action (like pay taxes) the authorities may not know where you currently live.) Contrast this to some other places, such as Germany. As of 1978, West Germany did not have jury trials. But it did have required registration with the local police. That came into play with the hijacking trial of LOT 165 which had a jury trial in the US Court for Berlin. The jury pool was drawn from local police registration records - something which would not, could not, be done in the US, because aside from privacy issues, the US simply doesn't have that level of requirements for its citizens.

COVID-19 is a serious disease, but not necessarily more serious than the many other diseases that have vaccines available and widely distributed but not required.

There are many other medical and political issues surrounding this specific disease and the available vaccines for it. My answer would apply to any vaccine, for any disease, based on current practices, at least in the US.

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    Interesting to think about children's vaccinations being effectively required through schooling. This creates a soft waiting period for newer vaccines, ending after the age when children begin attending school. Commented Jun 10, 2021 at 21:10
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    In general, the US does not force anyone, to do anything... which you then follow with a long and still incomplete list of exceptions. The US is not a libertarian utopia by any stretch of the imagination.
    – user5526
    Commented Jun 10, 2021 at 23:25
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    @BenCrowell Actually, I gave two exceptions (1 = vaccine in school is part of "school", 2 = register for Selective Service). The others were things required in many other countries but not the US - e.g., voting, national ID card, etc. Commented Jun 10, 2021 at 23:53
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    @BenCrowell Only the Sith deal in absolutes... freedoms like speech/2nd have limitations and statements like "the US doesn't require" also has limitations. No one serious claims the US is 100% "freedom" and that claim wasn't made here to my reading...
    – WernerCD
    Commented Jun 11, 2021 at 1:56
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    @Barmar Actually in many places in the US (not sure if it is "all"), the jury pool is pulled from registered voters. Registering to vote is not mandatory. I know people who (I think foolishly) never registered to vote in order to avoid jury duty. I have served a number of times and found that generally (there was one exception) the courts made great efforts to make it a good experience for the jurors. But it certainly isn't always that way, and for some people it can be a true financial hardship if they are on a jury for several days. Commented Jun 11, 2021 at 14:20

To add a mostly epidemiological argument:

The primary political goal of mass vaccination is to reach herd immunity, i.e., to make so many people immune (be it due to vaccination or having survived the disease) that the virus cannot spread anymore because one person infects less than one person on average. If an infectious disease has a basic reproduction number R₀, the proportion p of people that need to be immune to achieve herd immunity¹ is p = 1−1/R₀.

Now, the basic reproduction number of Covid 19 is estimated to be below 4 (details depend on hygienic measures, variants and so on), which is not horribly high. The reason why Covid 19 is so successful is not its reproduction number but that it was completely new and thus nobody was immune to begin with (combined with a few factors like long incubation times, asymptomatic spreading, etc.). For the sake of the argument, let’s work with R₀ = 4. Then we get p = 0.75, i.e., 75 % of the population need to be successfully vaccinated (or otherwise immune) to achieve herd immunity².

As long this fraction of the population is willing and capable to get vaccinated, there is low epidemiological benefit from making vaccination mandatory. And even if you have less than 75 % willing, there are more efficient and less controversial ways to achieve 75 % than compulsion, as you do not need to convince almost everybody. Finally, if your willingness is far below 75 %, compulsory vaccination will likely be hard to enforce and politically dangerous, so you wouldn’t be amongst the likely states to enforce vaccination, anyway.

Contrast this with the measles, which has a much higher reproductive number such that about 95 % of the population need to be immune to achieve herd immunity². It is for this reason that we still get measles outbreaks in and around communities who tend to oppose vaccination. For the measles, vaccinating almost everybody is much more important, and vaccination has been indeed made mandatory or close to mandatory in many states.

¹ … in a perfectly homogeneous population. Real populations are more complicated, but this is a sufficiently good approximation for this argument.
² Mind that at these numbers, you must take into account vaccine efficiency, i.e., how many of the people receiving vaccination actually become immune. For example, if a vaccine has an efficiency of 98 %, you cannot achieve a higher ratio of immunity through vaccination, even if everybody is vaccinated.

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    Many countries are far away from 75% willingness to get vaccinated. And new variants apart to have a higher R0, which consequently requires a higher vaccination rate to attain herd immunity. There are good, practical reasons to think compulsory vaccination is problematic but epidemiology is not it. Commented Jun 11, 2021 at 17:32
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    Not only are real populations more complicated, the vaccine-hesitant/refusers specifically cluster, leaving enough breeding grounds to overwhelm the rest of the herd. Raw 1/R_0 does nothing, and conversely enforced mandatory vaccination will break these clusters. Epidemiology is all about network characteristics ("contact tracing"). Pretty close to -1.
    – obscurans
    Commented Jun 11, 2021 at 19:20
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    @SurpriseDog: Natural immunity would already be included in R₀.
    – Wrzlprmft
    Commented Jun 11, 2021 at 19:26
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    @obscurans: If that were true, we would be regularly overrun by measles epidemics and would never have gotten rid of the smallpox. Sure, a measles outbreak in an undervaccinated community will not remain completely isolated to that community, but it will also not overrun the entire population. Also, it’s not all about network characteristics. Sure, network models with correct parameters are more exact, but basic models are a sufficiently good approximation of reality for many purposes and in particular communicating the point I am making here.
    – Wrzlprmft
    Commented Jun 11, 2021 at 19:45
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    side note: measles outbreaks in Germany have about half of the cases adults, specifically people in the age cohort that was vaccinated once in childhood before the 2nd measles vaccination was introduced and who (and/or whose GP) forgot to get a 2nd one later on. (I learned this when the RKI said in the discussions before measles vaccination became mandatory for kindergarden, school, public health system that the proposed law doesn't really address the problematic subpopulation) Commented Jun 11, 2021 at 21:31

In the UK, there is at this moment no good reason to make vaccinations compulsory. Every single dose that the British national health service (NHS) can lay their hands on is immediately (within days) injected into someone.

Some people expected a slowdown due to anti-vaxxers. This hasn't happened yet for several reasons: The Indian variant (now named the "Delta" variant) has very strongly affected minorities that were reluctant to get vaccinated - now they learn that they are the only ones with significant numbers of deaths, and guess what: everyone is queuing up. Lots of lies have been spread, for example one website telling people from one African country in their own language that the vaccine was designed to kill them within one year. You can't keep up lies like this forever, people are wising up. And of course many anti-vaxxers are just big-mouthed contrarians and not very good at believing their own lies. So once they have the choice of acting according to their own lies or staying healthy, they suddenly decide to stay healthy. In London, young people are queuing up in the thousands now to get vaccinated.

In addition, while vaccination isn't compulsory, there is major pressure on people. My own next holiday requires me to be vaccinated. I would be in real trouble with my boss if I wasn't vaccinated. And so on. And being unvaccinated puts you more and more into a minority with social pressure.

So the UK isn't going to run out of people wanting to get vaccinated for a while. Then we'll see how Covid is still spreading. And then it could become compulsory. At a time when most people are vaccinated and don't care or actually support if it becomes compulsory.

PS. The UK government is blamed for not stopping incoming flights from India. The huge number of new infections is almost completely due to non-vaccinated people, which is driving vaccinations up right now.

PPS: Some recent actions: One US hospital told about 160 employees that they will be laid off if they don’t get vaccinated. And in Pakistan, there are plans that anyone not vaccinated could get their SIM cards blocked. And news: In the UK, 52% of all self-declared anti-vaxxers are now vaccinated.

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    The UK in particular is going to be very hesitant to mandate vaccines after 2009. During the swine flu outbreak, they made vaccines mandatory for health care workers. That was also an "emergency use" vaccine whose long-term effects had not been studied. It ended up having horrible, permanent long-term effects for people with a certain genetic mutation, got pulled off the market, and those affected successfully sued the government. With that precedent on the books, it's unlikely they'd expose themselves to that much legal risk except as a last resort.
    – bta
    Commented Jun 11, 2021 at 22:32
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    @bta sources: theguardian.com/uk-news/2016/aug/11/… en.wikipedia.org/wiki/Pandemrix?wprov=sfti1 - looks like similar (rare) rates to AZ clotting. But I think we can all agree that if people had been required to have that vaccine (especially healthcare workers, many young, at the start of the rollout, before we knew about the clotting) there would have been significantly more backlash when it was linked.
    – Tim
    Commented Jun 12, 2021 at 21:05
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    "And of course many anti-vaxxers are just big-mouthed contrarians and not very good at believing their own lies." ...like they are not very good at believing the majority's lies? I am so glad that these people exist, even if I may not agree with them on specific topics, because otherwise, the gene pool of opinions would be so narrow that we would be an easy prey for totalitarianists. Hence, I suggest you think twice about that derogatory spin in your answer.
    – user20276
    Commented Aug 31, 2021 at 6:06
  1. Constitutional concerns. In many countries, it's more or less questionable if the constitution allows to make a law which forces all citizens to undergo medical procedures. In many cases, the constitutional protections of bodily autonomy are rather vague, and many politicians would rather not want to test their limits in court. Especially not in a situation like this where such a constitutional court ruling would receive a lot of public attention. COVID-19 containment measures ran against constitutional barriers before, and it didn't make the politicians who pushed them look very good in the public perception.

  2. Ethical concerns. One generally accepted core principle of medical ethics is patient autonomy. The idea that a patient who is conscious and in a clear state of mind has the right to decide what is best for them and refuse medical treatments. As with any ethical question, there is of course room for debate. But many medical professionals follow codes of ethics which would prohibit them from performing medical procedures against the explicit wishes of the patient.

    During the COVID-19 pandemic, many politicians showed solidarity with the medical community by assuring them their full support and listening to their advice. It would not look very good for these politicians if they would now switch side and start to debate ethical questions with the same medical professionals.

  3. Resistance among the population. While the majorities in most countries are pro vaccination, there are small but vocal minorities in many countries who are skeptical of vaccination. Those movements often have a considerable overlap with those who are also skeptical of government authority in general. Whether or not these groups have a point is not relevant here. But a government-mandated vaccination program would give these movements the hook they need to recruit more people and to become more radicalized (a few of them are already radicalized to the point of committing acts of terrorism). This could turn these movements into a serious threat. But making vaccinations voluntary (only very, very encouraged) takes away the political justification for their cause.

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    It should be also noted that being sceptical of vaccination is entirely different from being sceptical of only some particular vaccines for reasons like their lack of maturity and potential side-effects. Commented Jun 10, 2021 at 22:33
  • While agreeing, I should point out that medical ethics and most laws, do not allow free choice if you are in a medical state to present an active significant risk to others wellbeing. So there's that to consider too, although its rarely an actual "issue" in reality.
    – Stilez
    Commented Jun 13, 2021 at 14:08
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    @Stilez: well, that would be isolation/quarantine for contagious diseases (incl COVID-19). But the isolated would still be allowed to refuse medical treatment, possibly via advance healthcare directive. Commented Jun 13, 2021 at 15:24

This answer applied to the situation in early June 2021.

In most countries, it just wouldn't make any sense yet to make the vaccine mandatory for the general public. This is because there are usually enough people willing to be vaccinated to use the available doses.

The main exception seems to be the US (at least some states thereof), and Hongkong. There were some reports of some African countries failing to use available vaccine doses, but there the logistics seem to be at least as much of a problem than vaccine resistance.

As far as I know, vaccine resistance in the US is very unevenly distributed geographically; and in quite a few places a significant fraction >30% of the population voices their intent to not be vaccinated at all. In these places there is of course a good reason to make the vaccination mandatory, but at the same time enforcement is going to be infeasible. The central government can make the rules, but it relies on the local authorities to enforce them. If too many of them are anti-vaccination, it just won't work.

  • It would also make sense in China where priority is given to cities with known outbreaks. They haven’t vaccinated the entire country yet but certain cities have enough shots for all. Commented Jun 10, 2021 at 9:01
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    Israel's vaccination rate seems to be flatlining at 60%, after very high rates early on. It seems the US is not the only exception. Canada has overtaken Israel in number of first doses already, only Seychelles, Malta, and tiny countries have gives more first doses than Canada. ourworldindata.org/…
    – gerrit
    Commented Jun 11, 2021 at 8:41
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    @gerrit: Careful, I think we're mixing percentages here. In general, the percentage of population vaccinated seems to be reported as total population, whereas 30% of the population voicing their intent not to take the vaccine would be 30% of the adult population. Since the adult population is often less than 80% of the total population, I would expect that Israel is flatlining at 75% of adult population, so would have 25% of non-vaccinated adults. Commented Jun 11, 2021 at 14:24
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    @gerrit: Do you have any indication that the flatline is due to people refusing the vaccine, or could it be either a shortage, or a segment of the population not being considered for vaccination? Commented Jun 11, 2021 at 14:24
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    It's not just the US, France has notorious hesitancy towards vaccines in general.
    – eps
    Commented Jun 11, 2021 at 20:18

In Denmark the biggest issue was the doctors. Their Union said that their members would refuse to forcefully inject needles into people that did not want it.

Edit: This was upvoted so I will just add how I recall how I recall it went.

Politicians were debating this an afternoon where we were still fairly afraid. It seemed like there could be a consent for mandatory vaccines, then the doctors trade union tweeted that they would newer do it, and also tweeted the politicians also didn't want videos uploaded by people being forcefully vaccinated, and then politicians agreed and it was never debated again.

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    However, "mandatory vaccination" doesn't necessarily mean forced vaccination - it could also mean that you go to jail if you don't get the vaccine. Commented Jun 10, 2021 at 17:53
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    As far as I know, it's not really any union, but the fact that a lot of doctors world wide still swear a modern version of the Hippocratic oath upon graduation and treating people against their will contradicts that oath in most cases.
    – Nobody
    Commented Jun 10, 2021 at 19:39
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    "Mandatory vaccination" can also mean "your school, workplace, or other entity refuses to let you in if you don't get the vaccine," which is certainly coercive in a sense, but doesn't involve literally holding people down to force them to be injected or imprisoning them for refusing. Commented Jun 11, 2021 at 2:47
  • @Nobody it was Lægeforeningen that I have decided to translate to Union. Commented Jun 11, 2021 at 8:59
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    Can you add some sources (even if they are in Danish)? And add dates (to some degree of accuracy. At the very least, the year) and places/publications (own website/newspaper/television)? Commented Jun 13, 2021 at 12:57

In Germany the decision appears to be political as well. There are quite drastic measures in the "legal toolbox" for pandemic response, and most of them had not been used for many decades. Citizens forgot that the laws were on the books. During the recent pandemic the laws regarding a "pandemic situation of national scope" (which COVID is) were changed, but mandatory vaccinations are not planned right now.

  • There is a small but vocal minority who mix conspiracy theories, questioning the legitimacy of the state, and partly justified criticism of the handling of the pandemic. As in the US, some likened their resistance to the persecution of the Jews by the Nazis, with stars labeled "unvaccinated" and the like.
  • In response, the government promised that the vaccination would be voluntary.

It would be politically damaging for the current government to go back on their often-repeated public statement, and no other government appears likely after the next elections that would do so.

  • When checking my Impfpass (vaccination document), I saw that some of the other vaccinations are labeled as mandatory. Can't recall which now, probably Polio and such, and I don't have a context when they're mandatory (i.e., for infants or whatever). I'm looking forward to the public discussions next year, when people will try to add COVID to the list of mandatories...
    – AnoE
    Commented Jun 11, 2021 at 9:50
  • @AnoE, it would be impolite to ask your age, but do you have the yellow or white one? Regarding making it mandatory, I don't see a government with either the Greens or the Union in it doing that, and I don't see a government without one or both.
    – o.m.
    Commented Jun 11, 2021 at 9:56
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    @AnoE: wikipedia tells me: Western Germany mandated vaccination against diphteria and scarlet fever 1946 - 54 and smallpox until 75 - 83 (obligations were reduced in a stepwise manner). Eastern Germany had mandatory vaccination against Tbc and smallpox from 1953 on, polio, diphtheria, and tetanus from 61 on, pertussis from 64 and measles from 70 on and smallpox mandatory vaccination ended in 80 - 82 (also stepwise). Since 2019/20 measles vaccination is mandatory for certain subpopulations. Commented Jun 11, 2021 at 12:20
  • ... wrt public discussion of mandating covid vaccination: if online newspaper comments are an indication, the pubic discussion is starting already - I see calls for manding covid vaccination and the mentioned vocal minority, let's say, express their fear of such a mandate. Commented Jun 11, 2021 at 12:24
  • @o.m. the yellow one ;) But cbeleites unhappy with SX already gave nice info as well.
    – AnoE
    Commented Jun 11, 2021 at 13:19


  • control aversion/reactance means that mandating may lower achieved vaccination rates
  • it's maybe not necessary from a public health system perspective
  • there are subpopulations for which at the moment it is not clear whether vaccination is advantageous for them personally,
  • and vaccinating them is also likely inefficient from a public health perspective (i.e., better vaccinate someone with high risk)
  • high risk groups risk mostly their own life, so the "danger to others" argument is also questionable for them.

Two additional points to what has been mentioned already

Control aversion aka reactance: mandating can backfire

The alternative to mandating COVID-19 vaccination is (highly) recommending it. It is not clear whether mandating vaccination will in the end lead to higher overall vaccination.

  • control aversion (see also reactance) describes the phenomenon that enforcement lowers compliance because people resent being forced.
    One may say that with moving from voluntary to mandatory vaccination the motivation moves (to some extent) from intrinsic to extrinsic - and extrinsic motivation often isn't as good as intrinsic motivation when it comes to compliance.

  • This is also related to the suspicion that mandating is only necessary if the vaccination isn't all that good. Thus, mandating can inspire distrust - particularly if the discussion is already perceived as not very transparent, honest and open. (with all the ingredients for a vicious cycle)

  • And to the suspicion that other freedoms are threatened as well, i.e., we may get an increasing general distrust in politics/government.

  • Mandating means legally requiring people to get vaccinated. They still need to do that, though. The question for the practical result thus includes how/to what extent vaccination is to be enforced.
    There are contraindications even for mandated vaccinations, not everyone can be vaccinated. One obvious difficulty is thus people who do not want to be vaccinated under the mandate to get more or less* spurious medical certificates that they cannot be vaccinated. Sure, some physicians here in Germany who provided spurious certifications that the bearer cannot wear a mask are on trial now.

See also:

Constitutional requirements...

... obviously vary a lot between countries. Here in Germany, a law that restricts constitutional rights (freedoms) must be proportionate.

Part of this is that the (legitimate) goal cannot be reached by less harsh measures, and that the difference in how far one gets towards this goal compared to weaker measures such as voluntary vaccination is sufficiently large.

In Germany right now (June 21) polls say that about 80 % of the adult population want to get vaccinated on a voluntary basis.
About half of the parents say they want their kids to be vaccinated, even though at the moment there isn't even a general recommendation for 12 - 15 year-olds (see below).
Some 4.5% of the population are officially registered as having been infected (for them a single shot of vaccine is recommended with a waiting time of at least 6 months after infection). Dark numbers are not very well known, but for some working age subpopulations 100 - 130% have been found, and 300 - 600% for children.
This leaves maybe 10 - 15% of the population who are still fully susceptible and not willing to get vaccinated. This fraction may be clustered together, so I'd expect noticeable outbreaks, but unless vaccine efficacy turns out to be low in practice (which would in itself make mandating questionable) it's unlikely to threaten the public health system.

Further, there is no vaccine (yet) approved for children under 12 of age, and for the 12 - 15 age group the Standing Committee on Vaccination (STIKO) concluded that at the moment the data on adverse events and infection outcomes allows them to recommend this vaccination only for risk patients in this age group.

  • A back of the envelope calculation: Four deaths that were found to be due to COVID-19 in the children + juvenile according to this preprint unfortunately they don't report the total number of cases, but the RKI dashboard currently shows roughly 360,000 cases for ages 0 - 14 (and btw. about 3,550 deaths of all causes in 2019). That would mean a case fatality rate of 1 in 90,000 which overestimates the risk for children and juveniles because I miss the case numbers for 15 - 17 year-olds and also the dark number estimates of 300 - 600%, which would mean a yet substantially lower risk of death.

  • Another IMHO important point in the preprint is that they say at the moment, no reliable estimates of long-term consequences of COVID-19 in children and juveniles are available because the potential symptoms coincide with a whole range of symptoms caused by lockdown and quarantine/isolation measures.

  • In contrast, they say that for older adult risk groups the risk assessment is in favor of vaccination even if all deaths registered as suspicious for being vaccination related were in fact caused by the vaccination (somewhere between 1 : 14,000 and 1 : 58,000 for Europe)

In general, I'd say (my opinion) that mandating vaccination would require the risk assessment to be even much clearer in favor of the vaccination than "only" recommending.

Another public good that one may consider is the danger an infected person is to others. In the age group 60 and older, Germany has a case fatality rate of about 10%, whereas it was roughly 0.15% below that age, overall maximum after 2nd wave i.e. before vaccination of the high risk groups rally took off: 3%. With an R0 of about 3, without any measures, one may say one infected causes on average 0.1 death. Actual R had a maximum at about 1.4 (excluding the start of the 1st wave when no one knew they could even be infected) and that was before the lockdown light measures started. With these numbers we can reasonably say that vaccinating a hypothetical young healthy individual may save 0.04 deaths. Vaccinating an additional above-60-year-old can save up to 0.1 death (assuming that the virus will become endemic and anyone will eventually be exposed to it). So for that healthy young it is neither clear whether vaccination is advantageous for themselves, nor is it efficient from a public health perspective: vaccinating a young healthy person saves a tiny "amount of death" for themselves, and a smaller fraction of a death in other people. Even if there is no one left in the high risk group who wants to be vaccinated (or can be coerced into vaccination by whatever enforcement level is considered OK), it may be considered unethical under these circumstances to enforce vaccination in healthy young people as long as there are high risk people left who could be forced as well.

(The situation may change over time: at some point the high risk group may be completely vaccinated, data for a more precise assessment of the vaccination for healthy young people will become available, vaccinations may get more efficient and also safer, variants more dangerous also for healthy young people, etc.)

As for mandating vaccination of high risk groups: the largest fraction of risk there is with themselves. As long as they are mentally fit, one may argue that at the very least in societies that accept e.g. the right to assisted suicide it is up to them to decide whether they run this risk or not.
An exception may be, e.g., inhabitants of nursing homes who have contact mostly to other high risk people. However, a nursing home making vaccination (masks, testing, etc.) mandatory if you want to move there is a much weaker measure than a legally mandating these measures.


As noted in the question, this is completely constitutional in the US. Requiring universal vaccination would not be a human rights crisis. Before vaccines even existed, there were well established laws in countries like the US and England allowing people to be involuntarily quarantined, even for long periods, which I think most people would consider a much worse infringement of personal liberty.

The big barrier is simply utilitarian. Before a vaccine was made mandatory in a particular country, the people making the laws in that country would want to have some articulable reason for doing so. There is no such reason. Doses of the vaccines are being manufactured as fast as possible. If one person on the planet doesn't get vaccinated, some other person will get that dose instead.

Herd immunity does not depend on getting some percentage of the population vaccinated. In the California county where I live, currently 57% of adults are vaccinated. That actually is herd immunity under the present circumstances, because by definition herd immunity is what obtains when the rate of transmission is decaying exponentially rather than growing exponentially. If everyone suddenly started behaving as they had before the epidemic (not wearing masks, hooking up at bars, ...), we would lose herd immunity, but then regain it as more people became immune through infection. Since the population of people that are at high risk from the disease have mostly already chosen to get vaccinated, that would happen without very many deaths -- and because this disease only really kills adults (with infinitesimally few exceptions) all such deaths would occur among adults who had chosen not to get vaccinated.

There is the argument that we need to get people vaccinated in order to stop the creation of new and possibly more dangerous/infectious variants of the disease. This actually doesn't make much sense, because of the fixed production capacity. Since the disease actually seems to be in abeyance in my area of the US, it might actually be better if people here didn't get vaccinated. Then those doses could go to Uzbekistan or Nigeria, and hopefully prevent the development of dangerous variants there.

  • That's a good answer presuming that governments are actually shipping off extra doses to other countries. But in reality the US is stockpiling them currently and only allowing a limited quantity to leave the borders. Commented Jun 11, 2021 at 0:02
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    Good answer. But I disagree with: involuntarily quarantined, even for long periods, which I think most people would consider a much worse infringement of personal liberty. Doing something physically to someone's body is, arguably, more permanent and therefore damaging than telling people where they can/can't go. Commented Jun 11, 2021 at 3:04
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    @JonathanReez NZ TV tells me today that the US is funding 500 million vaccinbe doses for counteries less able to buy them. Commented Jun 11, 2021 at 11:33
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    @RussellMcMahon Just political theater. In reality, the US severely disrupted vaccine manufacture in India by economic sanctions (and that didn't only impact India - for example it slowed down the UK vaccination programme in March and April because of reduced international supply.)
    – alephzero
    Commented Jun 11, 2021 at 15:38
  • @JonathanReez: The Biden administration is publicly discussing exporting vaccines very soon. They just haven't started doing it yet. As far as I know, there aren't any doses being systematically thrown out or allowed to expire, nor are manufacturers dialing back production.
    – user5526
    Commented Jun 11, 2021 at 19:58

I think one point missed by most of the previous answers, is that vaccination has effectively had a history of being politically weaponised in the past, against many large groups.

People don't forget that, so there is a large underlying willingness to believe and be deeply suspicious.

While laws can coerce many things, there are limits to what can be demanded by law without invoking mass civic disobedience, and ending up with a worse situation than you would have had without it. A population has a general sense of what is perceived by it, as reasonable or unreasonable, and what enforcement is okay or not okay.

Causes of public suspicion

When you consider mass vaccination, you need to look at it in the context of things both real and fantastical, because this is emotion you're discussing:

The worldwide war on truth vs. truthiness, conspiracy theories, and sowing of distrust

  • QAnon (look how many people were willing and eager to believe theories about satanic pedophiles, 9/11, and conspiracy theories generally)
  • Bill Gates microchipping the world
  • Some elite controlling everything for the last few thousand years
  • Fake news claims
  • The Big Lie

Politicians who themselves deny that COVID-19 matters

  • USA (previously)
  • Brazil
  • Others?

Reasonable fears by those ignorant of scientific and medical matters

  • First mRNA style vaccines
  • Concerns about genetic modification, tampering at the DNA level (most people wouldn't know the difference between DNA and RNA, and anyway, how do scientists know that it can't or won't modify in some way they hadn't thought of?)
  • Previous medicines that have had serious effects down the line
  • Mass use of an entirely new type of medicine (will it be forced on us? After only a few months testing?)

Widespread belief in other healing methods

  • If people believe in magic, spiritual healing, or a "just world" run by deities, will they be more prone to see a pandemic as something that is by that deity's choice, and morally wrong to be interfered with by humanity? ("God sent AIDS to punish the gays for transgressing His law", COVID-19 has had similar claims too. If you see COVID-19 as Gods righteousness, what does that make vaccination?)

Abuse/weaponisation of vaccines previously

  • People in some countries and cultures, may be unaware of this. But vaccine programs and vaccinations have been abused in the past. Tested in developing countries with poor results hidden, or used to trace, identify and hunt down persons of interest (Bin Laden in Pakistan, for example). People in many cultures and of many ethnic backgrounds do remember these and are deeply suspicious of vaccines as a result.
  • More broadly, this is within a context of not-uncommon officially sanctioned medical abuse - think of women sterilised in some countries and programs, without being told that's what was going to happen, or other horrific examples that breached trust in the medical world.
  • Consider even older established vaccines such as polio, were already being treated with suspicion and the disease eradication program outcomes over recent years.

Which means that....

With such a bunch of strong motives by so many, combined with all the other reasons (medical ethics/freedom of choice political beliefs, etc.) it becomes politically impossible to force vaccination on the world in most countries.

  • Enough people would refuse to be complicit to make the delivery chain work (production, distribution, vaccination delivery staff, and doctors)
  • Politicians, being vote and sentiment sensitive, would feel that to be an unreachable proposition, as a bottom line
  • If approved and delivered, the backlash from the population would be immense. Rioting, civil disobedience and plain noncompliance/refusal.


  • By the time vaccines have become available and tested, uptake is very high anyway and social perception acts to support further uptake (you can see your friends and neighbours doing it, so you're more likely to agree to do it)
  • It may prove unnecessary to coerce, enough uptake may happen by peer pressure and exhortation, that coercion was never required too.

So it's a non-starter, pure and simple, however attractive in theory.

Update - examples of historical track record (as requested in comments)

One of the comments asks for more examples of misuse of vaccines, and the resulting long term historical distrust of modern public medicine, related to vaccines and more broadly, modern health medicine campaigns.

I think Lowes & Montero “The Legacy of Colonial Medicine in Central Africa” (2018) PDF direct link is a good starting paper, so I'll quote from its summary:

Over the course of several decades, millions of individuals were subjected to medical examinations and forced to receive injections of medications with dubious efficacy and with serious side effects, including blindness, gangrene, and death. The sleeping sickness campaigns constituted some of the largest colonial health investments, and for many, these campaigns were their first exposure to modern medicine (Headrick, 1994; Lachenal, 2014).

There is a large body of anecdotal evidence from Africa of mistrust in medicine leading to under-utilization of health care [note 2]. Relatedly, research in developing countries has highlighted that even when there is access to high-quality preventative and therapeutic tools, demand remains puzzling low (Dupas, 2011; Dupas and Miguel, 2017; Banerjee et al., 2010). Motivated by work from anthropology and history which links colonial medical campaigns against sleeping sickness and mistrust in medicine (Feldman-Savelsberg et al., 2000; Lachenal, 2014), we hypothesize that the colonial medical campaigns may have had a series of unintended effects on both beliefs about modern medicine and the success of modern health interventions. The campaigns may have affected use of medicine because: villagers were forced to receive injections, many of the medications had serious negative side effects, and the medications were ineffective. Additionally, the campaigns may have also caused the spread of contagious diseases because of the re-use of unsanitary needles during the campaigns (Pépin, 2011; Lachenal, 2014).

Note 2: For example, during the 2014 Ebola outbreak in West Africa, some communities rejected health workers and did not follow recommended practices to avoid transmission of the virus (Blair et al., forthcoming). In northern Nigeria, communities boycotted the polio vaccination leading to a large outbreak of a nearly eradicated disease (Jegede, 2007).

Also with useful references, "Determinants of trust in the flu vaccine for African Americans and Whites", by Freimuth et al (2017), which states in its summary that:

...the American Academy of Arts and Science (AAAS), calls for research on the role of trust in vaccine decisions, particularly within “at-risk communities”where social norms may contribute to lower vaccine trust and greater vaccine hesitancy (AAAS, 2014). Reflecting upon both calls, we recognized the need for research on trust as it relates to vaccine disparities, as growing evidence indicates African Americans experience greater distrust and vaccine hesitancy when compared to their White peers (Quinn et al., 2017) .... Major theoretical work surrounding vaccine trust comes from the World Health Organization's (WHO) Strategic Group of Experts on Vaccination (SAGE). SAGE hypothesizes that trust is a major factor in vaccine hesitancy, contributing to vaccine delay and refusal (MacDonald, 2015). Trust influences vaccine hesitancy at many levels, including “trust in the effectiveness and safety of vaccines, the system that delivers them, including the reliability and competence of the health services and health professionals and the motivations of policy-makers who decide on the needed vaccines” (MacDonald, 2015, 4162) ...[polling data shows that] trust in pharmaceutical companies is at an all-time low (Harris Poll, 2015; Gallup Poll, 2016). A recent study confirmed 65% of American adults trust the CDC and 63% trust the FDA (Kowitt et al., 2017). Trust in the role these institutions play in the vaccine process is less studied. Qualitative investigation revealed widespread mistrust in the motives that drive pharmaceutical companies, as well as some skepticism regarding the competence of government agencies in developing appropriate influenza vaccines (Quinn et al., 2016).

Sociological evidence demonstrates that in general, African Americans are significantly less trusting than Whites, likely due to historical and contemporary experiences of discrimination and racialized social norms (Smith, 2010). Medical distrust is also widespread in the Black community, stemming from a long history of medical racism and abuses and reinforced through ongoing experiences of discrimination in health care (Freimuth et al., 2001; Gamble, 1997). Numerous studies have confirmed the impact medical racism and events like the Tuskegee Syphilis Study have had on trust in medical research (McCallum et al., 2006), on trust in physicians (Benkert et al., 2006), and on trust in the healthcare system more broadly (Boulware et al., 2003) ...

Sadly, much of the distrust is self-created - by unethical behaviour within highly developed countries, towards countries in developing regions and at tomes towards minorities and the less privileged. Therefore much of the history in this area, is racially and ethnically slanted, as the above studies demonstrate.


I suspect the government won't have to make it mandatory because workplaces will do the job for them by implementing policies that essentially say: 'You can't work here unless you are vaccinated'. According to The New York Times:

The bottom line is that companies are legally permitted to make employees get vaccinated, according to recent guidance from the federal agency that enforces workplace discrimination laws, the U.S. Equal Employment Opportunity Commission.

They will most likely able to do this because they will argue that they have a duty of care to all employees and the policy is in line with that.

So, while you can refuse the vaccine, you may find your activity extremely limited when you can't go to work or can't fly overseas. Therefore, there would be no need to create an overt government mandate

My view is that this is what will happen in the next year.

  • 2
    Employment laws differ widely from country to country. Some can terminate "at will," others only "for cause." And refusing a non-mandated vaccination may or may not be legimitate cause.
    – o.m.
    Commented Jun 11, 2021 at 16:05
  • @o.m. Your points, while correct, are also obvious. The original question clearly singled out the US therefore my response was in that context.
    – NetServOps
    Commented Jun 12, 2021 at 0:10
  • 2
    The OP compared the US with other places, including China, and wanted a global answer. I think. But my observation was "just" a comment.
    – o.m.
    Commented Jun 12, 2021 at 4:00
  • @o.m. I understand your point however the mention of China was simply to compare and contrast against the US, it seemed clear to me OP was looking for an answer about the US response. I also assumed from the OP's post that they are not in China (based on their comments about China) therefore my view is its a waste of time to discuss what China would do as its not relevant to the OP's location.
    – NetServOps
    Commented Jun 12, 2021 at 8:29
  • That begs the question why a negative (PCR) test wouldn't be sufficient, especially when the majority would be fully vaccinated. Why do you think this will hold up in a court of law? You could address this in your answer. Commented Jun 13, 2021 at 13:40

I conjecture that there might be a significant fraction of political decision makers in the west, that view Covid-19 as a kind of "fire drill" against future biological warfare. If one accepts the risk of biological attacks, however minor, as a given, it is pretty clear that the target of these attacks is not people's physical lives (like a bomb directly threatens lives), but rather their social behavior, their political views, their economic decisions as responses to the biological hazards.

Consequently, it is not that far-fetched to assume a certain awareness among policy-makers, that any measures that severely aggravate the social, economical or political damages of a biological attack, play into the hands of the attackers. One such damage could be, that people might fail to recognize distinctions between supposedly democratic systems and totalitarian systems, which might lead them to ask, why they should still support democracy. In the view of a totalitarian attacker, this could certainly be considered an ideal success, and hence, provoke further attacks.

Therefore, if one can suppose, that there is a natural will to defend one's system against intrusion, manipulation and hostile takeover, it is perfectly understandable in my opinion, that even if Covid-19 does not literally fall into the category of a biological warfare manoeuver, many politicians see it as a strategic symbol of one, and struggle to develop responses that defeat the intentions of hypothetical enemies, and allow them to get ahead of their "political competition".


Involuntary treatment typically only happens when a person has been deemed mentally unfit to decide on his own medical treatments. There also often is a issue of a threat from the unstable person either to himself or someone else. Sometimes in emergencies medical practitioners are given the right to save a person's life, but this can still be superseded by a DNR

Generally speaking a person's constitutional right to privacy also insure he has the right to refuse medical treatments. There is a slew of bio-ethical concerns that if this is to happen. When we start forcing vaccines on people it strikes me that this is the same type of justification that led to the mass sterilization of ethnic minorities in the early 20th century.

Unfortunately the medical profession does not operate in a moral vacuum, the end does not justify the means. We are going to have to find a way to achieve herd immunity without forgoing people right to choose over there bodies .

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