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Charles E. Binkley, MD (@CharlesBinkley) is the director of bioethics at the Markkula Center for Applied Ethics at Santa Clara University, and David S. Kemp, JD (@DavidKemp) is a professor of legal writing at U.C. Berkeley School of Law. Views are their own.
The COVID-19 pandemic has taken a substantial toll on the airline industry. Airline companies have had to resort to extensive lay-offs, furloughs, and government bailouts in their efforts to avoid bankruptcy. Once the U.S. Food and Drug Administration (FDA) has granted a full Biologics License Approval to one or more vaccines and everyone has had a reasonable opportunity to obtain the vaccine, airlines should implement policies requiring passenger vaccination. A vaccination requirement to fly is the most medically and ethically sound way for airlines to protect employees and passengers, earn public trust, and facilitate the industry’s financial recovery.
Airlines have both a legal and an ethical obligation to ensure the safety of their crew and passengers. This obligation is rightfully prioritized above all else, given our society’s dependence on these “common carriers.” It explains why flights are cancelled or delayed for bad weather. It explains why aircraft are taken out of service upon detection of a mechanical problem. Today, the source of one of the greatest risks of harm to travelers is SARS-CoV-2. Currently accepted public health measures to decrease the risk of contracting COVID-19 are simply not possible on airplanes.
Airlines also have a duty to protect their employees. Flight attendants often have to interact with patients in a manner that doesn’t allow for appropriate distancing. Flight attendants have admirably stepped up to act as pre-flight and in-flight enforcers of mask wearing to ensure the safety of passengers and crew, but this is a substantial burden that is likely not sustainable in the long term. As well, flight attendants are commonly called on to assist acutely ill passengers. Mandating a COVID-19 vaccination would protect the flight attendant, the ill patient, and any other passengers that volunteered to assist with an in-flight emergency.
Airlines have tried to assuage the public’s fears about contracting COVID-19 by touting the efficiency of their air filtration systems, increased hygiene, and partnerships with well-respected health care organizations. However, the dire warnings from the CDC about the risk of contracting COVID-19 while flying is likely to continue to dissuade passengers. Mandating that passengers prove COVID-19 vaccination is the most medically sound and efficient way for airlines to recover economically. In fact, Qantas Airlines has already announced its intention to require that international passengers be vaccinated.
Some would-be passengers are certain to object to a vaccine requirement, citing their right to decide whether to get the vaccine. Patients reasonably expect that health care providers will respect their individual autonomy, but airlines have no such obligation. In fact, passengers already relinquish some autonomy to board and remain on a flight: they can’t smoke on board, and they can’t go to the bathroom during certain parts of the flight—just to name a few. Passengers forfeit these individual freedoms for their own safety, as well as that of the airline employees and other passengers. If a person exercises their right not to get the vaccine, airlines can and should exclude them from service. No ethical harm is done by denying a potential passenger service out of a duty to protect the safety of other passengers and the flight crew.
Some passengers may have medical or religious exemptions. Indeed, there are legitimate medical exemptions, such as a history of severe allergic reaction to vaccines or other rare medication reactions. Pregnant passengers may be able to claim an exemption based on the limited data available in this population.
Potential passengers may seek a conscience-based exemption since all the currently approved vaccines have some association with stem cells from aborted fetuses. However, in the carefully reasoned judgment of the Roman Catholic Church, one of the most strident institutions to oppose abortion, the vaccines are still morally permissible. In fact, many Christian religious leaders argue that receiving the vaccine to prevent infecting other people is a moral obligation based on charity and love for one’s neighbor.
Before mandates are enacted, the airlines would have to figure out the logistics of verifying vaccination status, but doing so seems eminently feasible. They would also need to take steps to ensure that the policy does not disproportionately burden passengers from areas that may not yet have the same full access to the vaccine as other areas. If enacted justly and transparently, mandating COVID-19 vaccines for airline passengers and employees is economically, medically, and ethically the right thing to do.