When the French president Emmanuel Macron announced a vaccine mandate in response to rising COVID-19 cases from the Delta variant, many predictably protested this move as an infringement of personal liberty, much like we have heard in several American states regarding mask mandates.
Unfortunately, continued resistance to commonsense public health measures has demonstrated that too many people in both Europe and the U.S. have a simplistic and erroneous view of liberty. Liberty does not mean you have the freedom to do whatever you want wherever you want. Nor does it make sense to conflate the concept of individual rights, which inform our liberties, with that of privileges, which are predicated on each of us upholding certain responsibilities.
It is hard to argue in good faith that American citizens have an inalienable “right” to dine at restaurants, attend shows in a theater, and travel for leisure. Indeed, if these were truly protected as rights, our government would be obligated to ensure basic access to them through entitlement programs or legal protection. But while food stamps are meant to ensure that all citizens can feed themselves, and federal law (namely the Emergency Medical Treatment and Active Labor Act) guarantees universal access to emergency medical care, equivalents do not exist for leisure or recreational activities. We have a tacit societal agreement that these are privileges to be obtained only if one has the requisite time and money for them, and if one agrees to abide by the rules of these establishments, such as wearing clothing and refraining from smoking.
Furthermore, there is ample precedent for limiting individual liberty. What you choose to do cannot impinge upon the liberty of others. Driving is a privilege that must be maintained by ongoing licensure, registration, vehicle inspection, and adherence to the rules of the road for the sake of personal and public safety so that all may drive. If you reject these responsibilities, you risk losing the privilege of driving. The concept of requiring COVID-19 vaccination to access privileges involving social gathering similarly protects public health and prevents reckless individuals from harming others, particularly those who cannot receive vaccines due to age or underlying illness or those who are unable to respond to them due to immunodeficiency.
The U.S. would do well to follow France’s example in regard to COVID-19 vaccine mandates. Though we may claim a right to life, liberty, and the pursuit of happiness, there is clear legal and cultural precedent that one individual’s pursuit of happiness may not jeopardize others’ right to life. Public privileges require civic responsibility.
A vaccination mandate would of course require a thoughtful framework in order to carefully delineate rights versus privileges, eliciting input from a diverse group of stakeholders to ensure proper participation and enforcement. In addition, there must be an equally clear framework for legitimate health exemptions to vaccination. But the time for begging and pleading to vaccinate must come to an end. The dangers we collectively face are too great to indulge bad choices any longer.
Sarah C. Hull, MD, MBE, is a cardiologist at Yale School of Medicine where she also serves as associate director of the Program for Biomedical Ethics. Arthur L. Caplan, PhD, is a bioethicist and the founding head of the Division of Medical Ethics at NYU School of Medicine.