Ethics and Effectiveness of US COVID-19 Vaccine Mandates and Vaccination Passports: A Review

Alexa G. Canning, Kyleigh E. Watson, Katelyn E. McCreedy, John O. Olawepo


Background: The highest-income countries procured 50 times as many COVID-19 vaccines as low-income countries, a global health inequity that resulted in only 4.6% of the poorest 5th of the world receiving a COVID-19 vaccine. High-income countries are considering vaccine mandates and passports to contain the spread of COVID-19. This study is a curated discourse aimed at examining how vaccine mandates and passports may impact global vaccine equity from an ethics perspective.

Study design: Narrative review adapted for a debate.

Methods: In November 2021, we conducted a review of studies examining global vaccine mandates for an upper-level global health course at Northeastern University, Boston, United States (U.S.). In total, 19 upper-level students, one research assistant, and one instructor participated in the data collection, analysis, and discussion.

Results: The review showed vaccine mandates are ethical and effective if autonomy-centered alternatives like soft mandates are first exhausted. Unwarranted stringent public health measures degrade public trust. In the U.S. alone, COVID-19-related deaths hovered above 300,000 before COVID-19 vaccination began in mid-December 2020. Since then, the number of COVID-19 deaths more than doubled, despite the wide availability of the vaccine. For many low- and middle-income countries (LMICs) vaccines are not available or easily accessible. Global collaboration to facilitate vaccine availability in LMICs should be a priority.

Conclusions: It is essential to get as many people as possible vaccinated to return to some normality. However, vaccine mandates and passports need to be used only sparingly, especially when other options.


COVID-19 vaccines; Global health; Travel-related illness; Vaccine mandates; Vaccination passports

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