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  • Karis Clark

Vaccination Resistance in the United States

One of the challenges to preventing further spread of the coronavirus, especially the newly circulating Delta variant, is public backlash against COVID-19 vaccine mandates. As vaccine mandates increase across the nation in COVID-19 mitigation efforts, debates surrounding government power, HIPAA violations, and bodily autonomy have surfaced.

Universities, companies, and healthcare institutions have received pushback from their students and employees as COVID-19 vaccine mandates have increased in prevalence, with many citing mandated vaccinations as an infringement of their rights and bodily autonomy and as violations of HIPAA, the Health Information Portability and Accountability Act.

While the fear and distrust associated with new medical technology such as vaccines developed in under a year is expected and understood by scientists in the field, the majority of vaccine-resistance is rooted in misinformation. A lack of understanding of public health, health information privacy, and the government’s role in bodily autonomy contribute to the spread of social resistance to the different COVID-19 vaccines, even when demonstratively safe and effective in mitigating the severity of COVID-19.

To better understand the resistance to vaccination in the USA, the rationale for vaccine mandates must first be explored. One of the fundamental roles of the government is to oversee public health institutions and protect the safety of those it governs in the event of a public health crisis. Under the Fourteenth Amendment to the United States Constitution, states are given the power to protect the health and safety of its inhabitants.

Despite this, those resisting vaccinations continue to oppose vaccine mandates: in August of 2021, a group of Indiana University students brought their case against university vaccine mandates to the Supreme Court. The question of the constitutionality of recent vaccine mandates has been prompted before in the 1905 Supreme Court case of Jacobson v. Massachusetts. In this case, mandatory Smallpox vaccinations were found to be legal under the Fourteenth Amendment; the court decided that, “The police power of a state absolutely included reasonable regulations established by legislature to protect public health and safety.” This established a precedent that states have the right to enforce vaccinations if they are vital for public health and the common good.

Jacobson v. Massachusetts set another important precedent regarding citizens’ right to liberty. The Supreme Court also ruled that liberty can be constitutionally restrained when it jeopardizes the well-being of other citizens. This concept is at the heart of vaccine mandates. When citizens’ personal choices to refuse vaccinations begin to encroach on the safety of others in their community, such as fellow university students or patients in a hospital, it is the constitutionally-given obligation of the state to take action to preserve public health.

Along with questions of rights and the power of the government to mandate vaccines, arguments about HIPAA violations have arisen, some involving government officials including Rep. Marjorie Taylor Green (R-GA).Misconceptions about what constitutes a HIPAA violation are at the core of such arguments. HIPAA, the Health Information Portability and Accountability Act, is responsible for protecting against the release of protected health information (PHI) by healthcare providers. HIPAA is responsible for protecting information about a patient’s recent hospital visit, existing medical conditions, medical bills, prescriptions, medical record, and health information that is identifiable to a patient by birth date, name, or social security number. All of this information and more must be kept confidential to a patient’s healthcare providers and any healthcare power of attorneys that may exist. HIPAA obligates healthcare providers to keep PHI confidential and protected.

While HIPAA covers a broad range of information and assigns many responsibilities to healthcare providers, its applicability is limited to healthcare providers. That is, only those directly involved in the provision, protection, and billing of healthcare are under the authority of HIPAA. Employers and universities are not obligated to protect information about vaccination status nor are individuals’ rights under HIPAA violated by requests to confirm vaccine status.

Another prong in the anti-vaccination argument is the notion of threat to bodily autonomy. Bodily autonomy describes a person’s wish to choose what happens to their own body, whether that be in relation to reproduction, organ donation, or vaccinations. Bodily autonomy has existed as a complex topic of debate in intellectual and political forums for decades, with topics like abortion, physician-assisted suicide, and vaccinations often at the forefront of conversations. As such, the challenge with vaccine mandates is the required speed associated with public health crises like pandemics. The debate about bodily autonomy will not be settled in any immediate time frame, much less in one that accommodates for resolving a pandemic.

In terms of bodily autonomy, vaccine mandates for universities and companies are not violating individuals’ bodily autonomy so much as they are coercing action surrounding that autonomy. In the case of coercion, education and income are used as leverage to ensure adequate public health compliance. Again, institutional encroachment on personal liberty can be traced back to the case of Jacobson v Massachusetts.

While vaccination mandates may indeed exist as a form of coercion against bodily autonomy, it remains the legal obligation of states to protect the safety of every individual under their authority, even if that results in the encroachment of other existing liberties for some citizens. This obligation also supersedes the religious beliefs of citizens, when public health or the health of a child is on the line.

The challenge that the Center for Disease Control and President Biden currently face in the resistance to vaccines is overcoming the sociological and psychological causes for vaccination resistance. While a lack of understanding of HIPAA and government power can be combated with the provision of information, a lack of interest in collective well-being at the expense of personal liberties is much harder to address.

As governing bodies continue to increase vaccination mandates in the United States, they can expect continued resistance. The hardest barrier that vaccination efforts will meet is ideological in nature. Rooted in decades of American individualism, part of the vaccination resistance comes from a fundamental lack of collectivism in American society. Scientific research confirms that countries that lean towards collectivism ideologically have fared better during the pandemic than individualistic countries. The government is now challenged with the task of not only physically distributing vaccines, but convincing Americans to go against their internalized individualism.

In the short term, the Biden administration will need to consider how to appeal to unvaccinated communities of interest and employ bipartisanship to ensure local, governor, and state cooperation. In the long term, governing bodies in the U.S. may want to introduce more collectivist perspectives when it comes to public health and community safety if they want to avoid similar crises. A focus will also need to be placed on rebuilding community trust in scientific and healthcare institutions, especially for marginalized groups who have been mistreated by the industry historically.

Despite the practical and ideological challenges that lay ahead for the COVID-19 vaccination effort, President Biden remains persistent in ensuring compliance. The success of the endeavor will, however, depend upon the average American citizen and what role they choose to play in the grand scheme of public health, safety, and the ever-distant “normal” we have been trying to return to.


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