S Srinivasan in his article “The vaccine mandates judgment: Some reflections”, in this journal, analyses a judgment of the Hon’ble Supreme Court of India in summer this year [1]. Therein, he underscores significant points of interest, the logic behind them, a few points of contention, their scientific basis and areas where logic defies rationality and prudence. Nevertheless, certain relevant points about vaccination are overlooked in the article. Under the subheading, “Vaccine mandates and the right to privacy”, the author states that the order “finally zeroes in on this proposition…and that is that the risk of transmission of the Severe Acute Respiratory Syndrome (SARS-CoV-2) virus from unvaccinated individuals is almost on par with that from vaccinated persons”. Therefore, when the immunisation does not serve the social purpose of stopping propagation of the infection, why should the authorities mandate people to accept vaccination? This is the argument put forth by the author.

The point needs to be made here that that is not the only rationale of the government’s vigorous efforts to increase the vaccination rate of the population. When the virus gets the opportunity to spread widely, it multiplies and mutates producing variants which may be more pervasive or severe [2]. Such variants have higher chances of emergence when the virus gets an opportunity to spread like wild fire [3]. And this is one more reason to stop its devastating march, which not only exhausts the healthcare system, with most available resources being diverted towards Covid-19 care; but also affects the economy, further depriving those already marginalised, and frays the social fabric [4]. Now, we in India know what happened when migrant workers had to walk, sometimes for hundreds of kilometres, and when religious groups were pilloried saying they had deliberately spread the virus.

The only way to control the disaster is by stopping the pandemic and restoring normalcy to society. That is not possible while novel variants keep emerging. Hence, every possible effort should be made to stop providing the virus the opportunity to run amok among susceptible communities. That is possible only when all of us get vaccinated, wear masks — especially when indoors — observe social distancing, gather outdoors as far as possible and improve ventilation of the buildings in our surroundings. We need to remember that vaccines are among the few ways to reduce overloading of the healthcare system along with Covid appropriate behaviour. Experience of robust data from a politically divided United States of America provides us the insight that when people comply with these simple measures, a pandemic is brought under control and when not, unnecessary and avoidable suffering ensues [5].

At the end of the day when only one bed is available in my hospital ICU, I would think twice before allotting that to a patient who made a conscious decision to remain unvaccinated despite having full knowledge of the possible outcome. Such a person — through sheer recklessness — has risked not only his own life but those of his family members, fellow workers, friends, and possibly of healthcare workers tending to him. When someone asserts his right to privacy, he should consider whether healthcare workers too have the right to decide whether to treat such people when they arrive at a hospital gasping for oxygen, with dipping vital signs and perhaps, together with their family members. While working in a Covid hospital, we saw several family members being admitted and wondered if one of them had infected the others. We were overwhelmed when more than one family member — usually the elderly — did not survive the course of admission despite our best efforts.

Were all their civil rights protected when one among them decided to remain careless? I wonder. All of us are together sailing into uncharted territory and the collective interest should be our first priority, overriding personal choices when uncertainty looms large. Looking after the most vulnerable, the frail, those with comorbidities, must be our choice even when we have the right not to do so. We may exercise our rights in a way that others may be harmed unintentionally. But our goal should be to make a protective shield around them when we can. The law may permit us to work around weaknesses in scientific assertions and data generation in our less-than-optimal human enterprise; but our morality should guide us to leave no stone unturned to protect as many lives as we can. History may judge us by how much we cared for others when the law did not mandate us to do so. The US Supreme Court’s overturning of the Roe v. Wade judgment in the Dobbs v. Jackson Women’s Health Organization case this year taught us the hard lesson that judges may be swayed against the scientific community and public interest [6]. Let us make every possible effort to ensure that freedom from disease and benefit for all is our slogan, superseding and overtaking individual freedom.

Harish Gupta ([email protected]), Department of Medicine, King George’s Medical University, Lucknow 226 003, Uttar Pradesh, INDIA