As said by John Stuart Mill, “The only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others.” Under Mill’s principle, the state may justifiably stop individuals from becoming vectors of disease. Immunization serves this aim: it prevents harm before it occurs. During the COVID-19 pandemic, countries began mandating vaccines. COVID-19 vaccine mandates reflecting a utilitarian framework.[1] However, in pursuit of the greater good, compliance falls unequally onto certain communities that distrust the government and health systems. In Black, Hispanic, and other ethnic communities, most don't have the same access to insured health care as their non-Hispanic white counterparts, fueling distrust and low vaccine uptake. For instance, Black/Afro-Caribbean communities in the UK and the US are hesitant to get vaccinated.[2] This group doesn’t trust the health system due to receiving lower quality services. Already facing work and education challenges, low uptake worsens their situation. When mandating vaccines breeds injustice, and when not doing so breeds a public health risk, what can be done? Is there a way to balance the two philosophies of utilitarianism and libertarianism? To answer this question, we must examine the various and complex sides of this discussion. 

 

Vaccination, Public Goods, and the Ethical Stakes of Access 

 

     Vaccines have played a critical role in shaping the impact of an epidemic on a population. First invented in May of 1796 by Dr. Edward Jenner (A Brief History of Vaccination), vaccines became widespread and eradicated viruses like polio, smallpox, and measles in various countries. At a global level, vaccines have helped fight against more than 20 diseases, from cervical cancer to measles and COVID-19.[3] Before the invention of a vaccine in 1963, measles had an estimated 2.6 million deaths annually. Not to mention the thousands dead in pre-vaccine pandemics like the Plague and Antonine Plague.[4] 

     While vaccines have saved millions globally, their effectiveness also raises ethical questions when individuals choose to refuse them. In the present day, under the principle of autonomy — the right to self-govern — many refuse vaccination when it’s optional. However, opting out of vaccines isn't truly rejecting a public good because for vaccines to qualify as one, they must be universally accessible and affordable. Without this equity, mandating vaccines risks only benefiting those able to comply. 

     As communities continue to suffer due to the chaos left by COVID-19, a choice must be made. Do governments mandate vaccines or give people full autonomy and put public health at risk? Within a utilitarian framework, the former is optimal, while a libertarian framework would oppose. Both frameworks have compelling arguments, but major flaws. Despite these limitations, the inherent flaws in our current system make it crucial to critically examine both frameworks. 

 

Utilitarianism in Practice: Public Welfare, Mandates, and Ethical Blind Spots 

 

     Utilitarianism, a consequentialist ethical theory built upon the basis that the right course of action is always the one with the highest net benefits or the lowest net harm,[5] is used in many modern systems, including vaccine mandates. Such mandates produce unequal burdens on marginalized communities and engender public distrust, because improved public health promotes collective welfare, it’s considered ethically just within a utilitarian framework. This principle isn’t merely theoretical; it informed urgent real-world decisions during the COVID-19 pandemic. Hospitals and countries utilized when balancing scarce equipment and prioritizing the health of the public. 

     An example of a utilitarian policy occurred in Austria, the first European nation to mandate vaccines in February 2022. Consequently, as of February, over 71% of Austria's adult population was vaccinated, resulting in only 15,000 COVID-19-related deaths by March.[6,7] Were famous utilitarians like John Stuart Mill and Jeremy Bentham present today, they’d argue that since this action resulted in the greatest public health outcome, it isn't only justified, but optimal. 

     Yet any ethical defense of vaccine mandates must confront the unequal burdens they place on already marginalized communities. The extent of distrust in healthcare systems among marginalized communities is often overlooked. Generations of poor care and unethical experiments like the Tuskegee Syphilis Study have left a lasting scar. Beyond distrust, practical barriers including residing in rural areas, working at strict corporations, and unreliable internet access also hinder access. On a larger scale, global disparities further complicate the ethical justification for mandates, as during that era, many high-income nations were found to be hoarding millions of vaccines for their citizens even when their needs were already met.[8] Thus, while utilitarian reasoning justifies vaccine mandates in theory, it fails to account for the lived realities of those systematically disadvantaged. 

 

Libertarianism in Theory: Autonomy, Trust, and Social Pressure 

 

     Self-government is the cornerstone of libertarianism. Within a libertarian perspective, the highest moral value is placed on personal autonomy and individual freedom, particularly one's body. In such a framework, the government mandating vaccines is seen as forcibly jabbing two rounds of needles into someone's arm, thus unjustifiable and morally corrupt.[9] However, even when strictly following the libertarian framework, many individuals will be found to still be vaccinated. 

     Consider an individual who follows a strict libertarian philosophy. In his everyday life, the only possible thing affecting his actions is his own decisions. During the first COVID wave, he remained adamant. At the end of the second wave, he is unsure. After seeing the death tolls, he experiences a moral tension between self-governance and social responsibility. Even if one vaccination does not make a difference on herd immunity, in his community at work or at school, he can become a vector of disease.[1] Therefore, even without a mandate, there is a high likelihood he will get vaccinated. This raises the question: does libertarianism, in such cases, offer only the appearance of choice? In many ways the answer is yes, because while individuals may be free under the law, they are not free from public coercion and internalized pressure. Ultimately, most will end up vaccinated, while still upholding the principles of their philosophy.[10] 

     While the lack of mandates may backfire socially and psychologically, a libertarian framework can help build back trust with the government and health systems in marginalized communities. The power is put in their hands, making them free. This freedom encourages them to look into vaccination from a scientific point of view, and possibly decide to get vaccinated. Based on the psychology of reactance, when the power is not in their hands and they are coerced into vaccination, there will be more hesitancy and opposition.[11] Additionally, when states are not used to such power over medical decisions, more pushback will be given when they eventually do it in a way that is unethical. 

     Ultimately, libertarianism reminds us of the moral cost of coercion, especially for communities with deep-rooted distrust. Yet in times of global health emergencies, total autonomy may be a luxury we cannot afford. What we need, then, is a framework that honors autonomy while still protecting the collective. 

 

Care, Virtue, and Social Contract as Ethical Alternatives 

 

      The contrast between utilitarianism’s focus on collective welfare and libertarianism’s protection of autonomy reveals difficulty in applying binary solutions to intricate public health concerns. Perhaps our focus shouldn’t be on choosing one over the other, but turning to other ethical frameworks, or combining two or more, in a way that emphasizes both individual dignity and social responsibility. Several philosophies rooted in both personal and communal responsibility offer more nuanced guidance. Built upon sympathy, empathy, and compassion, care ethics, in the context we've been exploring, urges us to be vaccinated not by coercion but through the care we feel towards others.[12] In sensitive communities, this is manifested through trust-building, not through mandates. Regarding virtue ethics, which is choosing to do good because you strive to be good, vaccination becomes a means to moral cultivation in which one's actions are driven by courage, wisdom, and justice.[13] Lastly, social contract theory is a view built upon the idea that one's moral and political obligations are built upon an unspoken contract among them to form and integrate into the society they are a part of.[14] In this case, because it bridges personal autonomy and collective well-being with consent, accepting a vaccine is no longer a loss of freedom, but a contribution to mutual protection people in society owe to one another. The appealing aspect of this framework is that the ‘contract’ is not enforced through coercion, but through an individual’s informed agreement to uphold the common good. When reimagining public health through such frameworks, we are able to find a more balanced basis that both honors individual agency and rebuilds collective trust. 

 

A Balanced Framework for Public Trust and Health 

 

     Pertaining to critical issues such as public health, it is unrealistic to rely solely on one ethical lens without neglecting other vital concerns. Instead of harming communities or putting people at risk through either a utilitarian framework or libertarian framework, a more just and balanced framework would blend both through upholding autonomy while emphasizing mutual care and moral responsibility. Such a model would prioritize education and transparency instead of blatant coercion. If the public thoroughly knows the medical treatment they are receiving, they are more inclined to accept it. In marginalized communities, this would be emphasized beside community-based outreach by trusted individuals from that community alongside the ethical message of protecting others, because such communities have had to stick together throughout history, which formed an invisible bond. Lastly, before mandates are considered, vaccines should be accessible to everyone. This model encompasses all the principles of past frameworks such as personal dignity, collective well-being, empathy, character, and democratic consent. Ultimately, the goal should not be blind compliance, but ethical alignment in which individuals choose vaccination because they trust, understand, and care.