The only thing this seems to leave out is the individual "will not be vaccinated"'s culpability in the spread of the disease to one of the "cannot be vaccinated

The only thing this seems to leave out is the individual "will not be vaccinated"'s culpability in the spread of the disease to one of the "cannot be vaccinated"s. Manslaughter charges as part of the utility function then? Two or more people living within each others influence is an engineered society. The only question is what does the engineering. "If you choose not to decide, you still have made a choice".