Updated Statement on COVID-19 Vaccine Mandates

The National Catholic Bioethics Center (NCBC) does not endorse mandated COVID-19 immunization with any of the three vaccines that have received approval or emergency use authorization as of August 23, 2021, from the US Food & Drug Administration (FDA).

The most authoritative guidance from the Catholic Church issued on this topic comes from the Congregation for the Doctrine of the Faith (CDF) and emphasizes that individuals must discern whether to be vaccinated or not in conscience and without coercion:

“Practical reason makes evident that vaccination is not, as a rule, a moral obligation and that, therefore, it must be voluntary. In any case, from the ethical point of view, the morality of vaccination depends not only on the duty to protect one’s own health, but also on the duty to pursue the common good. In the absence of other means to stop or even prevent the epidemic, the common good may recommend vaccination, especially to protect the weakest and most exposed. Those who, however, for reasons of conscience, refuse vaccines produced with cell lines from aborted fetuses, must do their utmost to avoid, by other prophylactic means and appropriate behavior, becoming vehicles for the transmission of the infectious agent.”(See full text here)

Several key points should be kept in mind by any institution that might consider incentivizing or requiring the use of COVID-19 vaccines currently available in the USA.

1.       The Church has consistently pointed out the ethical problems with vaccines produced and/or tested using abortion-derived cell lines. The Church has judged it permissible for people to either accept (under protest) or reject the use of such vaccines. In other words, there is no universal moral obligation to accept or refuse them, and it should be a voluntary decision of the individual. Catholic institutions, in particular, should respect the decisions of people to decline use of vaccines dependent on abortion-derived cell lines. This is especially relevant when there are other means of mitigating risk.

2.       The best ethical decision-making occurs when individuals have sufficient information for discernment and are able to reflect without undue external pressures placed on them. Mandates, by their very nature, exert pressure that can be severe if employment or the ability to further one’s education are threatened.

3.       The novelty of the SARS-CoV-2 and of the technologies for eliciting an immune response to prevent or mitigate COVID-19 leave several medical questions unanswered. Only time and careful study of the virus and benefits and adverse effects of the vaccines will provide the answers many persons need to give free and informed consent. Clinicians, public health authorities, government agencies, and health care institutions should fulfill with integrity their responsibilities to ensure that people “receive all reasonable information about the essential nature of the proposed treatment and its benefits; its risks, side-effects, consequences, and cost; and any reasonable and morally legitimate alternatives, including no treatment at all” (ERDs n. 27) so that they can appropriately form their consciences (CCC, nn. 1790-1791).

4.       If any institution mandates COVID-19 vaccination, the NCBC strongly urges robust, transparent, and readily accessible exemptions for medical, religious, and conscience reasons. Safeguarding the well-formed judgments of conscience (see CCC, nn. 17761802) of all individuals affiliated with the institution helps establish trust and avoid undue pressure during the important and personal process of deciding about appropriate medical care and serving the common good.

5.       Recognizing the importance of public health, institutions that grant an exemption may require that recipients restrict their interpersonal interactions, but these restrictions should be the least burdensome possible.

6.       COVID-19 vaccine mandates for persons incapable of giving their own fully informed consent, including children, warrant additional considerations.

a.     Parental authority. Parents or legal representatives have the right and responsibility to make medical decisions on behalf of persons in their charge who are unable to give proper informed consent as part of providing for their physical and spiritual needs (see CCC, n. 2228). Their decisions to accept or decline COVID-19 vaccines for those in their care should result from free and informed consent and should be respected. COVID-19 vaccines should never be administered—and minors should never be induced to accept or demand vaccination—without the knowledge and consent of parents or legal representatives. Procedures that are directed to “safeguarding or healing” and that “do not involve disproportionate risks” can be legitimately chosen (see CCC, nn. 2274-2275).

b.     Applicability of ethical standards for medical research. Despite the completion of certain stages of the clinical research trials, much remains unknown about these novel COVID-19 biologics. They are the first genetic vaccines (i.e., that introduce genetic material which instructs the person’s cells to create viral antigens, rather than directly introducing the viral antigens) to be used in human populations on a large scale. Phase 3 trials in adults, initiated in the summer of 2020, have not yet been concluded for any of the vaccines authorized for emergency use or approved by the FDA. Phase 4 observational research regarding the safety and efficacy of the vaccines began in December 2020 and remains ongoing. Consequently, there is no robust data on the long-term consequences of the genetic vaccines. From an ethical standpoint, the use of the COVID-19 vaccines remains subject to the ethical standards of medical research, which are higher than the standards applicable to thoroughly studied and well-understood medical interventions with firmly established and time-tested risk-benefit profiles.

c.      Direct benefit to research subjects. The preeminent ethical requirement for any medical experimentation on persons incapable of giving their own consent is a compelling expectation of direct benefit to the person receiving the intervention. Indirectly protecting others, such as teachers, grandparents, caregivers, or immunocompromised persons, is not an ethically appropriate rationale for administering to a child or other person unable to consent a novel biologic with largely unknown long-term risks. Yet this other-focused risk reduction is one of the key reasons invoked in support of mandates for COVID-19 vaccines. While it has a place in the personal decision-making of competent adults who may generously wish to expose themselves to risks for the benefit of others and could be invoked under certain circumstances by an employer or government seeking to protect the common good, a proper ethical focus on the direct benefits and burdens for the vaccine recipient alone removes the basis for a mandate. On the practical order, it now appears that the COVID-19 vaccines do not offer the robust protection against viral transmission that was initially hoped.

d.     Therapeutic proportionality. Therapeutic proportionality, or the weighing of benefits versus burdens and risks in light of the integral well-being of the person, is assessed differently for persons who are unable to give their own consent. “Some groups and individuals are particularly vulnerable and may have an increased likelihood of being wronged or of incurring additional harm. All vulnerable groups should receive specifically considered protection” (Declaration of Helsinki, n. 19). The direct benefits to the patient should be greater while the risks and burdens should be lower than what might be acceptable for a fully competent adult: “The greater the person’s incompetency and vulnerability, the greater the reasons must be to perform any medical experimentation” (ERDs, n. 31).

                                               i.     Regarding children, extensive data from around the world have confirmed an age-based risk stratification of COVID-19 with children at the lowest risk of COVID-19 mortality and severe disease. For example, according to state-level data reported by the American Academy of Pediatrics as of November 18, 2021, a total of 0.00%-0.03% of children with a positive COVID-19 test have died, with six states reporting zero child deaths. Additionally, the unknown long-term risks of the COVID-19 vaccines authorized or approved by the FDA take on greater significance for the young: a serious adverse event could radically impact the whole lifetime of a child.