As COVID-19 vaccines are being rolled out around the world, there’s an unanswered question: Should it be an obligation for all of us to be vaccinated?

Does an unprecedented pandemic require the exceptional step of requiring everyone to be vaccinated?

That’s a question that has been thrust to the fore as vaccines against COVID-19 are rolled out, at varying speeds, across the world.

Those who support making a coronavirus vaccination mandatory say such a step would help ensure the world emerges from a pandemic that has killed millions of people, stifled economic growth and exacerbated socio-economic inequality.

Opponents say making a COVID-19 vaccination obligatory would discriminate against those unable to be inoculated and violate human rights.

Vaccination passports would show who has been inoculated.

Some governments and companies are moving towards “vaccination passports” that would enable those who have been inoculated against COVID-19 to travel and participate in public events such as concerts that would be off-limits for the unvaccinated.

Qantas will be testing two digital apps to check passengers’ medical history as the airline prepares to resume international travel. United Airlines CEO Scott Kirby has said he wants to make a COVID-19 vaccination mandatory for all employees, and he is encouraging other companies to do the same. Saga Cruises has begun requiring vaccination.

Ticketmaster has said it is exploring a way for fans to link their digital ticket to negative test results, vaccine status, health declaration or any other information that is determined to permit access.

Microsoft, Salesforce, Oracle and the Mayo Clinic have formed a coalition, the Vaccination Credential Initiative, to begin developing a technology that allows individuals to have a digital copy of their immunizations that could be stored in a digital wallet, such as Apple Wallet or Google Pay.

Many countries mandate vaccinations for common diseases.

There is precedent for mandatory vaccinations when it comes to other diseases.

Mandatory vaccination rules for measles, tetanus and polio exist in 105 of 193 countries in the world, according to a recent study. Most countries requiring vaccinations impose one or more penalties against individuals who do not comply, with educational and financial penalties the most common punishment.

Schools often require vaccinations. Seven European countries, two provinces of Canada, all 50 states in the United States (with exemptions in 45 states for religious, philosophical or non-medical reasons), Australia, Argentina, Jordan, Uganda and Indonesia mandate vaccines in public schools.

Some countries require vaccines for daycare enrolment, the military, pregnant women and healthcare workers.

Australia withholds welfare cheques from families who have not vaccinated their children, a controversial policy called “No Jab, No Pay.”

Many people just don’t want to be vaccinated.

Neena Gupta, an employment, labour and human rights lawyer in Ontario, Canada, said governments and companies must engage in a balancing act when considering making a COVID-19 vaccine mandatory.

“You’re balancing people’s rights to make their own medical decisions versus mandating public immunity,” Gupta said.

A growing number of people are reluctant to be vaccinated or oppose the very concept of vaccines, making rules requiring vaccinations difficult to impose on society.

Some people simply do not enjoy being jabbed with a needle. “There is just a visceral reaction to being injected with a fluid that we are asked to trust,” Gupta said. Many people do not understand how vaccines work.

The COVID-19 vaccines that have been approved have been rolled out far faster than usual, raising questions in some people’s minds. “These vaccines have been developed at a speed which never before has been accomplished by medical science,” Gupta said.

There are unanswered questions about whether the vaccines have long-term side effects, dosing requirements for different age groups and whether vaccinated individuals can continue to carry the virus.

To undermine trust in the COVID-19 vaccines, the anti-vaccine movement has peddled conspiracy theories and falsely linked them to autism.

“I am not surprised there is a hesitancy surrounding the COVID-19 vaccine,” Gupta said.

Most countries are reluctant to make a COVID-19 vaccine an obligation.

With such hesitancy in mind, most countries have said they will not be making the COVID-19 vaccine mandatory, but the governor of São Paulo, João Doria, said a vaccine will be obligatory in Brazil’s most populous state.

Vaccine proponents say it’s especially important to inoculate those most exposed to the virus. “If you work in a space where exposure to the virus is high, such as in healthcare, schools or jails, there is an employer’s health and safety obligation to their workers,” Gupta said.

But in Canada, some individuals who are eligible for the vaccine, especially personal support workers, are refusing to take it. In some cases, employers are not requiring the vaccine because there is already a shortage of trained workers, especially in long-term care facilities.

In workplaces where employees are less in demand, such as large warehouses or meat packing facilities, and where risks are high and social distancing difficult, could employers justify mandating vaccines?

Is a COVID-19 vaccine obligation a violation of civil liberties?

Privacy lawyer Allan Richarz says no.

“The requirement to carry some form of post-vaccine certificate in order to fully participate in a re-opened society is an unacceptable violation of civil liberties,” he wrote last month. “Such requirements are ripe for backsliding towards discrimination and stigma, as well as creating inequitable outcomes globally, with the harms arising far outweighing the purported benefits.”

Richarz said: “Requiring proof of clean health in exchange for services and accommodation is an affront to the last 30 years of human rights progress.”

Gupta said it is not necessary to mandate the COVID-19 vaccine to stop the virus from spreading. The world has a better chance of reaching herd immunity to COVID-19 with strong messaging from public health officials urging vaccination.

Still, she said there are sectors where COVID-19 vaccinations could be made mandatory. “There is not a constitutional or human right for someone to go to a fun concert, stay in a hotel or ride a Ferris wheel,” Gupta said.

Europe plans a “Digital Green Pass” to free up travel this summer.

The European Commission will present a proposal this month to create a “Digital Green Pass” that would allow Europeans to travel more freely over the summer holidays, Commission President Ursula von der Leyen announced this week.

Southern European countries including Spain and Greece are pushing for vaccine certificates that would boost their tourism sectors, but some countries say it first must be established whether vaccinated people can transmit the coronavirus to others. France and Belgium have expressed concern that easing travel only for inoculated people would be unfair.

“Vaccine passports provide a simple, convenient tool that can be quickly implemented to help get travel and many societal events moving again,” Kevin Trilli, chief product officer of technology company Onfido, told Reuters.

Others disagreed, saying vaccine passports pose ethical concerns. UK vaccine minister Nadhim Zahawi called vaccine passports “discriminatory.”

One issue is inequality, both between countries and within countries, because access to vaccines can be more difficult for citizens of poorer nations and economically disadvantaged citizens in richer countries.

A “vaccination passport” may not take into account those who are unable to be vaccinated for health or other reasons, or those without smartphones. There is also the risk of fraudulent passports or a data breach into private medical data stored in vaccine passport applications.

“Vaccine passports will create exclusions and discriminations globally, with billions prevented from travelling internationally, potentially for years to come,” Tom Fisher, senior researcher at Privacy International said. “Within countries, we will see similar concerns, as access to vaccinations and identity documents are often linked to issues like race, class and gender.”

Three questions to consider:

1. What are some arguments for and against mandating a COVID-19 vaccine? 
2. What is a “vaccination passport” and where could it be used?
3. Could mandating the COVID-19 vaccine lead to stricter public health regulation in the future?

Natasha Comeau is a former fellow in global journalism at the Dalla Lana School of Public Health at the University of Toronto. She holds a Master of Global Affairs from the Munk School at the University of Toronto. She currently works at Grand Challenges Canada, a nonprofit based in Toronto, where she supports global health innovations in low and middle-income countries.