Page 44 - Preventing pertussis in early infancy - Visser

Chapter 3
and mandatory vaccination, which respects autonomy but also takes into account the limitations of reasoned decision making (Thaler et al. 2009). It is defended by much the same arguments as weak paternalism. In comparison to mandatory vaccination, nudging represents a less coercive way to move the public towards vaccination acceptance (Thaler et al. 2009, Verweij et al. 2012). Nudging avoids compulsion, but it shapes the architecture of the context in which people make choices about vaccination in such a way as to make ‘acceptance’ the default option. For example, in situations where physicians proceed to provide vaccination as part of routine care and stopping only when parents explicitly tell them to do so (Navin 2017). Nudging involves triggering unconscious reasoning processes to make people incline towards a choice that is considered good for them, and good for society, while still preserving their freedom to dissent (Thaler et al. 2009, Verweij et al. 2012, Ontwikkeling 2014, Navin 2017).
From this literature overview we can conclude that both for defenders of mandatory vaccination and for defenders of voluntary vaccination the main considered values are autonomy and health. It is the weight that is ascribed to autonomy and consent on the one hand and the protection of the health of the general public on the other, that leads to a principal difference in opinion on the matter.
Reflections based on a case study
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. In a qualitative study performed in the Netherlands we encountered interesting viewpoints among respondents that shed light on their moral standpoints in the debate about voluntary versus mandatory vaccination. In this qualitative study we conducted 13 focus group meetings and six individual semi-structured interviews with parents, maternity assistants, midwives and paediatric nurses, exploring the perceived determinants (barriers/enablers) of intention to accept a future pertussis cocooning vaccination (Visser et al. 2016). Pertussis cocooning vaccinations aim to prevent pertussis transmission to infants < 6 months of age and will, if introduced, be offered to parents of newborns and healthcare workers who work with infants < 6 months of age. In the time that our study was conducted no major outbreak of pertussis had taken place. In the next paragraphs we will argue that voluntary vaccination is the better option in some contexts, and we will base our arguments on findings from our study.
Support for voluntary vaccination
In the focus group meetings and interviews we encountered broad support for voluntary vaccination, although some respondents reasoned they would rather see a firm mandate. The support for voluntary vaccination was expressed in terms of a feeling of aversion against compulsion by some respondents. Others made their reasons more explicit: they term the decision about vaccination a ‘personal responsibility’, or they referred to a right to decide about one’s own body (examples are shown in Table 1). While support for a
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