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Chapter 3
Chapter 3
Abstract
An increase in vaccine hesitance has revived the debate on mandatory versus voluntary vaccination policies. Especially in countries where vaccination is voluntary, the question occasionally rises whether this policy should be changed. In this article, we first sketch the contours of the debate and describe the main normative arguments used to defend voluntary and mandatory vaccination. We will also draw attention to the attractions of nudging, which seems to bridge the two positions by trying to find a practical way to deal with the disadvantages of both sides: it develops the context in which vaccination is offered in such a way that acceptance is the default option, while at the same time preserving the liberty to dissent.
While we appreciate the clarity of arguments in this ethical discussion, we think the discussion pays insufficient attention to what people in concrete societal contexts think and feel about mandatory or voluntary vaccination. Based on an extensive case study, we argue that voluntary vaccination continues to be the better alternative in contexts where people (a) show broad support for voluntary vaccination, (b) do considerable effort to collect sufficient information to make an informed and deliberate decision, and (c) indicate mandatory vaccination might lead to adverse effects on trust and uptake. A damaged relationship with the population could be detrimental to the success of vaccination programmes, as its success depends on the people’s continued acceptance.
In order to b etter attune vaccination program mes to these contex tual moral convictions, we suggest an alternative strategy for dealing with the difficulty that people experience in making a deliberate choice about vaccination. We think that more effort should be put in helping them. Therefore, we suggest to develop a deliberation tool that helps people to articulate personal and societal values and use these to weigh the information they gather from diverse sources to make a choice that they can truly consider their own.
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