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Mandatory Vaccination: Individual Freedom Of Choice v/s Public Health And Order

In a recent ruling, the Meghalaya High Court found that mandatory or coercive vaccination has no legal foundation and should be deemed ultra vires ab initio. The development occurred when the high court was reviewing a PIL concerning orders issued by the state government requiring shopkeepers, vendors, local taxi drivers, and others to get inoculated before they may resume their business.

Whether or not vaccination may be made obligatory, and whether or not such a requirement would jeopardise a citizen's ability to earn a living, is a question that needs to be examined. Vaccination is an imperative necessity in order to combat the global pandemic that is overtaking our globe, and it must be expressed firmly.

More than 3.85 million people have died as a result of the pandemic in India, and the number is expected to rise. Families of many have been affected by these tragedies, including the wealthy and the poor, professionals and non-professionals, labourers, traders, and farmers. The covid-19 is not a "once-in-a-lifetime tragedy"; it will continue to strike in waves, necessitating a "broader approach" to combat this adversity.

However, the issue raised in the PIL requires a thorough examination of some fundamental rules that govern the sector.

Article 21 reads as:
No person shall be deprived of his life or personal liberty except according to a procedure established by law.

This right has long been considered the Constitution's heart, the most organic and progressive clause in our living document.

The right to health is enshrined in Article 21 as a basic right. The right to health care, which includes vaccination, is a fundamental right in the same way. However, forcing vaccination or making it mandatory through forceful ways defeats the exact objective of the welfare associated to it.

It violates fundamental rights, particularly when it comes to the right to a means of living, which allows a person to live. The right to life, according to Olga Tellis & Ors vs. Bombay Municipal Corporation & Ors (1985), includes the right to a means of subsistence. Article 19(1) is directly affected by any state action that is in complete violation of this fundamental principle . Despite the fact that Article 19(6) calls for reasonable restrictions in the interest of the general public, the current case is exemplary and distinguishable. It has a much greater impact on an individual's right, choice, and liberty than it does on the general public .The interests of the latter are jeopardised as a result of an individual human being's autonomous decision not to be vaccinated.

It's more about finding the correct balance between an individual's right and the public's right in general.

In line with Mill's notion of the liberty to exercise one's right until it infringes on the right of another, the "welfare State" is aiming to protect the rights of others, which, while justified, is plainly excessive due to the technique used.

Another essential question is whether a State Government or its authority can issue any notification or order that is likely to have a direct impact on its people' fundamental rights, particularly on a subject that involves both public health and individual fundamental rights. The problem here fundamentally revolves around the State Government's legislative power, which, despite being granted under Entry 6, List II of the Seventh Schedule, must be in accordance with an individual's fundamental right to life and livelihood.
The fundamental right to life of an individual cannot be encumbered or fettered by a state notification or order. Taking away his or her right to a living, unless he or she follows the legal procedure.

In response to a PIL, the Madras High Court voiced reservations about the 'right to refuse' Covid-19 vaccination because its administration is in the public interest.

"When such a larger public health interest is at stake, and it is possible that a person who has not taken the vaccine may not show any symptoms but still be a silent carrier," the Bench continued, "it is doubtful whether the right to refuse to take the vaccine can be exercised in such circumstances."

The observation was made after the State revealed that there is apprehension about the vaccine among the general public.

All students over the age of 18 must be vaccinated in order to appear for the winter 2021 examination, according to an order issued by Gujarat Technological University, Ahmedabad.

Because the Union Ministry of Health and Family Welfare has previously decided that vaccination is purely voluntary, the Gujarat Technological University's circular should be considered illegal.

There's a good chance that more institutions will follow suit and employ similar coercive methods. As a result, it's important to comprehend why mandated vaccination is such a risky precedent to set.

Disparity in access
Any requirement to give vaccines is predicated on the assumption that vaccine availability is guaranteed on an equitable basis for all. The reality, on the other hand, is rather different. In most states, there are no slots available for those between the ages of 18 and 45. Several state governments have offered free immunisation for all people aged 18 to 45, while others have yet to do so. In India, private hospital prices are also very high. Access to healthcare will be more challenging for marginalised and vulnerable communities.

As a result, a mandatory vaccination programme will exacerbate societal disparities and inequities, disproportionately affecting the poor and marginalised. Many people may not get vaccinated through no fault of their own due to the improbability of vaccine availability, such as students who may suffer significant academic consequences if they are not allowed to take their exams.

Individual autonomy and informed consent
When a person is competent to consent and it is informed consent, it becomes legitimate. In medical law, the patient's informed consent is required for any choice. Individual liberty and autonomy are protected in Article 21 of the Indian Constitution as part of the right to life and personal liberty. Making vaccination compulsory will thereby deprive them of their basic right to life. Furthermore, by using coercion to force persons to be vaccinated, the state is infringing on their right to decisional and bodily autonomy, as well as their right to privacy (Justice K.S.Puttaswamy). There is a need to convey basic information regarding vaccine dangers to patients or parents so that they may make informed decisions; otherwise, there will be a lot of uncertainty.

The ability to make decisions about one's own body and life is basically protected by the concept of "private life. As a result, health-related decisions are also included. Medical treatment usually compromises one's bodily (and potentially psychological or even moral) integrity, and therefore can only be carried out with the permission of the individual concerned. However, there is an external component to 'private life,' which includes relationships with other people and the outer world.

The Madras High Court suggested that the state undertake public awareness programmes and provide scientific facts to persuade people of the usefulness of vaccines.It had stated that people should be able to make a "informed decision" about vaccination.

Risks associated with vaccines
Diseases are inevitable in life, but the present pandemic has had a greater impact on our daily lives than in the past. Vaccination carries a risk of death because it does not provide complete protection and can cause side effects as well as vaccine-related deaths. This means that when it comes to vaccinations, which interfere with an individual's bodily integrity, the right to life is only impacted when potentially life-threatening conditions emerge.

In the case of allergies or other contraindications on the part of the person concerned, such a threat posed by the immunisation is feasible. Infection may endanger life, for example, in persons who belong to a high-risk category and are unable to get inoculated. This includes persons who don't have a completely functioning immune system, such as those who have chronic illnesses or severe allergies, are undergoing chemotherapy, or are just too young or old to be safely vaccinated.

Conscientious demur to vaccination
Although the compatibility of mandatory vaccinations with religious attitudes and convictions may not look clear at first glance but are more closely linked than it may initially appear. This is due to the fact that some vaccines contain components that are incompatible with particular religious systems.

Some vaccines, for example, contain porcine gelatin, which Jewish and Muslim beliefs say should not be consumed. The fact that certain types of viral vaccines require cell lines derived from aborted foetuses conflicts with certain Christians' religious convictions. Several vaccines may contain animal components or be tested on animals, which might present issues for vegetarians and vegans.

Compulsory vaccinations, therefore, may infringe on the forum externum of religious liberty. This isn't far-fetched, because in many instances, a person's decision to get vaccinated or not has ramifications for society as a whole, and so ethical considerations may play a role. If a person chooses not to be vaccinated because of his or her conscience, the mandatory order infringes on that person's right to act in line with his or her conscience. Mandatory vaccination could jeopardise these safeguarded values. If there were fines for not vaccinating, for example, this would effectively be a punishment for following one's own principles.

For all of these reasons, it should be considered whether refusing to vaccinate can be classified as a practise or rite, and thus be protected under Article 25 (freedom of conscience and free profession, practise, and propagation of religion) of the Constitution.

Conclusion
There are several ambiguities and doubts about whether asserting one's basic right through coercion will tend to abrogate another's equally important fundamental right. The question also arises as to whether a basic right can be imposed forcibly even if the beneficiary is not disposed to exercising it, because if this is done, there is a risk of infringing on the fundamental right to privacy and personal liberty. Furthermore, whether or not to subject one's body to an intrusion, even if minimal, such as with a needle, raises problems of personal and bodily autonomy and bodily integrity like abortion and non-sterilization rights. or even sex reassignment surgery.

Several reasonable goals could be considered suitable in order to justify mandatory vaccination. In addition to the "protection of others' rights and freedoms," the "protection of one's own health" is, justifiably, extremely important. Vaccines against diseases that are transmissible from one person to another protect both the individual and society, health protection is effected on both a personal and societal level.

Members of the United Nations and specialised international organisations agree that the highest feasible vaccination coverage should be pursued. However, because there is no unanimity on how to attain this goal, and the Court believes that making vaccination a legal obligation raises sensitive ethical and moral problems and the states should be given a broad range of discretion.

Certain important elements should be considered when assessing whether or not compulsory vaccination is required like,the individual risk of the person in question (i.e. probable contraindications) must be considered.Another key issue to examine is the societal benefit derived from vaccine intervention and good implementation. When a disease is spread from person to person, the health risk extends beyond the individual and affects the entire community.

As a result, the order of mandatory vaccination should be proportional to the dangers of side effects, vaccination-related damage, public health, and morality.

The Court held that it is the State's responsibility to inform citizens about the entire vaccination process, including its benefits and drawbacks, and to facilitate informed decision-making, particularly in situations where the beneficiaries are sceptical, susceptible, and belong to a vulnerable and marginalized section of society, as well as ingenuous members of indigenous communities.

The welfare nature of the state does not lie in coercive negative reinforcement by seizing their right to livelihood and prohibiting them from working without justification in the garb of public interest, but rather in concerted efforts to effectuate a social order as mandated under Article 38 by approaching people directly and engaging them in one-to-one dialogue ,court mentioned.

A careful and purposeful interpretation of the law, as well as the principles of equity, good conscience, and justice, indicates that compelled or coercive vaccination has no legal basis, making such acts ultra vires ab initio.

Mandatory vaccination efforts have been condemned by international organisations such as the World Health Organization. While striking a balance between individual autonomy and public health is critical, such ethical discussions are impossible to have when there are significant barriers to healthcare and knowledge. In the face of so many worries and uncertainties looming , compulsory measures to give vaccines will merely add to the panic and fail to increase vaccine uptake.It is the government's responsibility to raise knowledge and correct misinformation about immunisation procedures in order to facilitate organic administration.

Meghalaya high court was of the view that the strategy enacting any form of behavioural change must be adaptive, which means that individuals must be mobilised and persuaded to witness the impact of the new intervention in order for it to be accepted by the community. In their recommendations, the Principal Secretary to the Government of Meghalaya's Health and Family Welfare Department advises that the district orders should be viewed as a persuasive advisory rather than a coercion on the topic of vaccination. At the same time, vaccination accessibility is a state responsibility, and no citizen should be penalised if they fail to meet it.

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