2019冠狀病毒病疫情下的疫苗猶疑與強制疫苗接種: 初步的道德評估

疫苗猶豫，亦即延遲甚至拒絕接受疫苗接種，不只是人們對科學有多少了解的問題，亦混雜着不同信念和對權威的不信任。另一方面，有支持強制接種疫苗人士認為，因為疫苗是相對安全的方法令得社會達至群體免疫；權衡輕重之下，強制接種是道德上可以容許的做法。社會能否要求民眾強制接種新冠疫苗，抑或是疫苗猶豫有其合理性，應予尊重，是一個值得我們探討的道德課題。

本文會用以下的方式探究此項課題。歷來有不少學者提出各類支持強制接種麻疹疫苗的理由。另一方面，我們亦必須考慮各類支持疫苗猶疑的理由。正反的道德論證，皆涉及不能約化，但是在不同情境需要比較和排序的價值。我們會論證應以阿馬蒂亞•森(Amartya Sen)提出的後果評價作為道德推論和基礎去評估這些多元價值。在後果評價的基礎上，才可以比較接種新冠疫苗與麻疹疫苗在道德上的異同，並由此建立一套框架去評估強制疫苗接種的道德議題。

Vaccine hesitancy, a delay in acceptance or even refusal of vaccination, is a problem not only linked to public knowledge of science but also caused by complex beliefs and a lack of confidence in authority. People who support coercive vaccination argue that vaccination is a comparatively safe path for people in a community to reach herd immunity. Weighing the benefits and costs, coercive vaccination is morally permissible. However, whether we should enact it for Covid-19 vaccines or respect people who have vaccine hesitancy is a moral issue worthy of detailed investigation. Similar debates have also been around coercive use of the measles vaccine, which will serve as a point of comparison in this evaluation.

There are different kinds of arguments for and against policies of coercive vaccination, but whether positive or negative, they involve values that are incommensurable but should be compared and ranked accordingly in different situations. We argue that consequential evaluation, as suggested by Amartya Sen, forms the moral reasoning and foundation to evaluate these plural values. Using consequential evaluation, we can compare the moral similarities and differences between Covid-19 vaccines and measles vaccines and develop a framework to evaluate the moral issue of coercive vaccination.