Winter is drawing in, Covid-19 cases are rebounding and European Union countries with middling vaccination rates are tightening the screws.

What began as an arm-twist in July, when France’s Emmanuel Macron rolled out a mobile health pass to control access to leisure venues, has become a headlock. In Austria, where intensive-care wards are filling up and 64% of the population is fully vaccinated (below the EU average), the government is implementing new restrictions, including what’s effectively a lockdown for those refusing to get their remaining jabs. Latvia has banned unvaccinated lawmakers from parliament.

Given how the EU is swimming in safe and effective vaccines, which have been shown to reduce severe illness and death, it seems like a no-brainer to keep pushing jabs. Fear of saturated hospitals has no doubt colored people’s view of the holdouts and encouraged governments to get tougher — France’s health pass was viewed positively by 62% of the country as of last month.

But there are ethical questions to consider. How far should governments be prepared to go? Should the last mile of vaccination dangle ever-greater threats, such as Singapore’s plan to stop the unvaccinated from getting free healthcare? Is the logical conclusion mandatory jabs?

The chart above suggests that Austria’s policy may be accelerating uptake without making vaccinations mandatory. The trade-off here is that the unvaccinated are being asked to give up certain freedoms — of choice, as well as of movement and privacy — in return for better individual and collective health outcomes. This seems fair considering what we know of Covid’s impact — the threat of a blanket stay-at-home order looms large if case numbers aren’t brought under control, and this is harder to do with middling vaccination rates. 

One criticism of crackdowns on the unvaccinated is that they ignore the risks of transmission among the vaccinated. But even if research indicates the delta variant is highly transmissible within vaccinated households, it’s disingenuous to claim the risks are the same. If individuals have less of a chance of developing severe illness or death, and are less likely to burden hospitals, the benefits accrue to everyone. So there’s a case to be made that persistent vaccine holdouts are themselves behaving unethically.

However, things get complicated when you move from targeting the unvaccinated by restricting entertainment to restricting more basic necessities, according to Nancy Kass, a professor of Bioethics and Public Health at Johns Hopkins University. The Singaporean approach of barring the unvaccinated from free healthcare looks like an extremely blunt tool. Reducing risk in a space like a restaurant makes sense, but reducing access to universal public services would create a serious social divide.

The stricter the measures, the more they should be balanced against governments’ own duty of care. It’s easy to propose curbs against the kind of anti-vaxxers who spread lies and disinformation. But multiple European polls estimate hardened opponents to vaccination make up only single-digit percentages of the population. The bigger challenge is hesitancy, which we don’t always understand the causes of and which varies by gender, education and age.

For example, Austrian data show younger people are less likely to be fully vaccinated than the elderly — probably due to different perceptions of the direct risk posed by Covid. In such cases, we should seek to build up vaccination as a communal virtue, not as punishment. If better messaging about the benefits to others of getting vaccinated could increase uptake, governments should keep trying. Cambridge University Professor Stephen John gives the example of the HPV vaccine, which has been promoted to boys not just as direct protection against disease but also as an ethical way to protect their sexual partners.

Austria is justified in feeling it’s run out of time to play good cop. But the stick should be accompanied by some carrots: better-funded hospitals, clearer communication and social-distancing aids like masks. The irony is that, as immunity wanes, governments will have to not just convert the unvaccinated but retain the trust of the under-vaccinated to promote third doses and booster shots. If mandatory vaccination is to remain a last resort, it’s time to promote moral — not just legal — duty.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

Lionel Laurent is a Bloomberg Opinion columnist covering the European Union and France. He worked previously at Reuters and Forbes.

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