Page 41 - Preventing pertussis in early infancy - Visser

Introduction
People currently refuse vaccines more often than they used to, including vaccines for childhood illnesses such as measles, mumps, rubella and pertussis (Omer et al. 2009). This has led to increased morbidity and mortality due to vaccine preventable diseases, like measles and mumps in different parts of the world, including the US and Europe (Sugerman et al. 2010, Hotez 2016, Phadke et al. 2016, Dyer 2017, ECDC 2017, Grammens et al. 2017). In response to the grown vaccine hesitance, attempts to increase vaccination uptake have focussed mostly on making the information provided about vaccination easier accessible and attuning it more to the information needs of the public (Gust et al. 2008, Omer et al. 2009, Brown et al. 2010, Larson et al. 2011). However, these adjustments have up to now been insufficient to change the tide.
In the field of ethics, the increased amount of vaccination refusals has revived the debate on whether vaccination programmes ought to be voluntary or mandatory. In the past, the debate about the ‘appropriate’ way to involve the public in vaccination was settled in different ways in different countries, leading to mandatory vaccination programmes in some countries – such as the USA and Australia – and voluntary programmes in others – such as the UK and the Netherlands (Colgrove 2006, Salmon et al. 2006, T.M. Schurink-van ‘t Klooster 2017). However, it is currently sometimes questioned in countries with a voluntary programme, whether the change in vaccination uptake should now lead to a change in policy regarding the possibilities to mandate a vaccination (Offit 2012, The Lancet Infectious 2017).
At the moment, the debate is usually conducted in normative terms. This means that the discussion is insufficiently based on concrete societal contexts, and the moral sensitivities that people experience about mandatory or voluntary vaccination do not inform the debate (Leget et al. 2009). In this article we aim to show that this is an omission that needs to be filled. We will first sketch the contours of the normative ethics debate and describe the main arguments used to defend voluntary and mandatory vaccination. Subsequently, we will provide arguments based on our own recent Dutch qualitative study among parents and three groups of paediatric healthcare workers (HCWs), and point out how they contribute to the debate (Visser et al. 2016). An ethical re-analysis of the study data showed specific viewpoints on the voluntariness of the vaccination programme and the role of information in a voluntary setting.
Mandatory versus voluntary vaccination: arguments from ethical literature
Mandatory vaccination
Measures to mandate vaccination nowadays include immunization requirements for school or kindergarten entrance, halted childcare payments to parents who do not vaccinate, or making vaccination part of the requirements for a job. As becomes clear from these examples, making vaccination mandatory usually implies that being vaccinated is the
Mandatory versus voluntay
Mandatory versus voluntary
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