By Marin Agris (C’28)
When the structures currently in place to protect public health shatter, the burden of safeguarding collective well-being shifts from the hands of the government to that of local communities. Nowhere is this more evident than in the case of vaccines, one of the greatest public health achievements to date. They are responsible for eradicating deadly diseases like smallpox, polio, and measles. Yet, in the wake of the COVID-19 pandemic and the change in national leadership, public trust in vaccines has diminished. The combination of pandemic fatigue, misinformation, and political rhetoric has led to declining immunization rates – even for routine vaccines like the flu shot and childhood immunizations. The effects of this decline are evident: the United States recently recorded its first measles-related deaths in over a decade. Given that measles had been declared eliminated in the early 2000s due to widespread vaccination, the return of fatal cases underscores just how fragile public health gains can be when vaccination rates decline.
Traditionally, conversations about vaccine ethics have focused on individual responsibility. The ethics have considered whether people have a moral duty to vaccinate for the good of society at large. It has been well-established that there is an individual moral obligation to be vaccinated under both the utilitarian argument (based on Parfit’s Principle of Group Beneficence) and a contractualist argument. Historically, similar ethical arguments have underpinned broader public health policies to justify mandates such as seatbelt laws, smoking bans, and food safety regulations – which all exist because individual choices regarding these issues have the potential to endanger others. Similarly, the critical role of herd-immunity in protecting public health forms the foundation in which coercive vaccination policies – such as school vaccination mandates – have been institutionalized in both the federal and state governments.
However, in the wake of widespread federal mistrust and a presidential administration that openly questions vaccine science, a new ethical question has emerged. When national leadership – typically tasked with safeguarding public health in a democratic society – fails to protect the people, do communities themselves have a moral obligation to fill the ethical gap?
When vaccination rates fall below the threshold needed for herd immunity, the consequences ripple far beyond individual choice, putting entire communities at risk. In this context, community inaction – in light of federal failings – can itself become a form of harm through unintentional neglect. The collapse of centralized vaccination efforts by the federal leaves a profound ethical gap. The moral obligation, however, does not vanish. Rather, when higher-level structures fail, local actors are ethically bound to assume responsibility for safeguarding communal health by forging new avenues for immunization.
Under the same bioethical principles of beneficence, justice, and solidarity that created the foundation of federal vaccine mandates, communities must now actively take up the task of safeguarding herd immunity. This ethical obligation of making vaccines accessible within the community should not be conflated with merely ensuring that vaccines are available. This key distinction lies in the way in which communities provide their constituents with vaccination opportunities. Instead of simply offering vaccines at hard-to-reach and inaccessible locations, communities must meet their members where they are both physically and culturally. Recent evaluations of community-based vaccination initiatives, such as the CDC’s Partnering for Vaccine Equity (P4VE) program, demonstrate the success of an initiative is based on building trust and removing structural barriers.
This evidence suggests that communities fulfilling their ethical obligations must prioritize strategies that directly address the root causes of vaccine hesitancy: mistrust, misinformation, structural inequities, and lack of culturally specific outreach. Case studies have illustrated that embedding vaccination efforts into existing trusted community structures – such as schools, churches, and local businesses – thereby respecting community autonomy promotes widespread immunization even in the absence of governmental mandates. Organizations like El Buen Samaritano offer proof that embedding vaccination services within trusted community events, and providing bilingual support, led to large-scale successful vaccine drives. Other initiatives like the Arab-American Family Support Center created simple analogies – such as comparing booster shots to refueling a car – to help immigrant communities understand the importance of vaccination in terms that were relevant to them. With this culturally relevant communication came increased booster rates within these select communities. It is through community-driven, ethically grounded initiatives similar to these that local organizations must now forge a new path forward in safeguarding public health.