By Brian M. Cummings, MD and John J. Paris, SJ, PhD

John Stuart Mill proclaimed, “Over himself, over his own body and mind, the individual is sovereign.”  Mill’s statement appears to come in conflict with public health expert mitigation recommendations. How can we mitigate a pandemic when individual sovereigns chose not to follow these recommendations.  The United States is experiencing a fourth surge of Covid-19 infections and hospitalizations related to the delta variant.  This is despite the profound effectiveness of available vaccines in preventing serious illness, hospitalization and death related to Covid-19.   Masks are available to mitigate disease spread, yet remain controversial.  Media attention on expected ‘breakthrough’ infections provokes doubt about vaccination, endorsing hesitancy.  The reality is nearly all Covid-19 infections, hospitalizations and deaths are among the unvaccinated.  

John Stuart Mill’s influential 1859 essay On Liberty described ‘liberty’ as the freedom of the individual in opposition to unlimited state or social control. In Mill’s words, “The sole end for which mankind are warranted, individually or collectively, in interfering with the liberty of action of any of their number is self-protection. The only purpose for which a person can be rightfully exercised over any members of a civilized community, against his will is to prevent harm to others…In the part which merely concerns himself, his independence is, of right, absolute.” The shorthand version of Mill’s Harm Principle is that you’re free to do what you want, as long as it doesn’t harm anyone else.

The shorthand version of Mill’s Harm Principle is that you’re free to do what you want, as long as it doesn’t harm anyone else… with increasing infection rates, individual and collective risks to the public are more concrete.

What would Mill say of the two main tools currently advocated by public health authorities: vaccines and masks? Vaccines offer secure protection to the individual and provide the greatest communal protection once a very high percentage of the population is vaccinated. Masks mitigate the individual risk of exposure from outbreaks in the community, and reduce harm to others by limiting spread. Mill’s argument on the limit to individual sovereignty is pertinent.

In Mill’s own words, “harm to others” is the reason to intervene over one’s self determination. What do we know, “individually or collectively,” about the evidence to intervene? Adults that get vaccinated against Covid-19 get protection. Almost all of the deaths and hospitalizations, 99% and 97% respectively, are among the unvaccinated. Communities with low vaccination rates are suffering outbreaks, increasing collective risks to all individuals. In response, indoor mask wearing was endorsed this past week by the CDC in high transmission areas. Dr. Fauci advised people may want to “go the extra mile” as a precaution since no vaccine is perfect and in regions of high rates of viral transmission the risks are greater to the individual and public. When mask compliance is high, the evidence suggests disease spread is reduced, supporting its role in this mitigation.

Travis Rieder argues there is not a specific moral obligation to get vaccinated. This position notes the individual risk of contracting and spreading Covid-19 may be small, and the individual contribution to communal benefit unclear, so the action does not cause a direct harm to others. The same might be equally said of masks. But with increasing infection rates, individual and collective risks to the public are more concrete. And the imposition of vaccination is minor and accepted for many other diseases. Masks mandates implemented in highly specific ways serve to minimize constraints, dependending on local rates, sites of transmission and ultimately community vaccination rates.

Mill’s Harm Principle supports vaccine mandates to stop the spread of the virus, which is causing widespread harm. Governments and employers agree, now setting mandates across the country. New York City’s Mayor Bill de Blasio declared that the more than 300,000 municipal workers must get vaccinated by the start of school in September or agree to weekly testing for Covid-19. Almost paraphrasing Mill on harm to others, De Blasio stated, “We have the right to guarantee the health and safety of our employees and everyone they serve.” Officials in the state of California agree, mandating vaccines with regards to the 435,000 students as well as faculty and staff at Cal State’s 23 campuses. The first federal mandate by the Secretary of Veterans Affairs for all Veteran Administration (VA) workers has followed. Just yesterday, the U.S. military announced it will require vaccination for service members to maintain military readiness.

Over himself, over his own body and mind, the individual is sovereign, except when a public pandemic demands restriction to protect the public.

Self-determination has plagued public health mitigation efforts throughout the pandemic. Reliance on individuals will not solve the current Covid-19 delta variant surge.  As in all health concerns, science, not personal opinion ought to determine the policies adopted to control the spread of a lethal virus.  Masks and vaccinations are worthy tools to utilize. The VA and the multitude of universities and employers now imposing vaccine and mask mandates have it right.  We have long accepted immunization at our workplaces and our universities as tickets to entry.   Over himself, over his own body and mind, the individual is sovereign, except when a public pandemic demands restriction to protect the public.