Page 47 - Preventing pertussis in early infancy - Visser

respondents indicated to consider public health information as biased, because it was provided by the organisations that also seek to promote vaccination. As a result of these issues, respondents in all investigated groups considered the information that public health authorities provide about vaccination an insufficient base for an informed and deliberate choice about their participation in vaccination.
Consequently, these respondents sought additional information from a variety of sources. However, this information did not seem to support their decision making. Respondents indicated it was difficult to get a full picture of the advantages and drawbacks of the vaccination and to come to a conclusion because of the amount of information, and their inability to estimate which information to trust. Some respondents reported that they eventually ended up basing their choice ‘on a feeling’, or they reported ‘just flipping a coin’. It is for this reason that respondents expressed decisional uncertainty, and some respondents indicated being dissatisfied with their own choice. In the focus group discussions, respondents indicated that they especially appreciated the discussion among their peers in the focus groups before reaching a conclusion. The subsequent strategy we observed to eventually come to a decision, was that respondents ascribed values to the proposed vaccination and tried to relate these values to their own personal values, such as responsibility, justice, freedom or safety.
In sum, respondents in our study indicated to feel the need of making an informed and deliberate decision, but felt unable to do so based on the available information. Mandatory vaccination would pass over this strong motivation to make an informed and deliberate decision, which would make it difficult to accept. Therefore, mandatory policy might meet opposition by individuals, which is eventually detrimental to the success of any vaccination programme, given that vaccination depends on the continued acceptance of people. This would make voluntary vaccination the preferred option in this setting.
Case study arguments compared with literature
The findings of our case study, and the arguments to which they give rise, do not stand alone. Respondents in our case study considered decisions about vaccination to be their personal responsibility. This is in line with the findings of Stuart Blume, who states that the people who refuse vaccinations are individual parents who are generally highly educated. They are used to making decisions based on information and arguments and seek ways to make responsible decisions about the vaccination of their children (Blume 2006). In a similar vein, Maya Goldenberg explains that the individualised way in which regular parents (with high and lower education) think about the benefits and drawbacks of vaccination coheres with recent calls for personalised health care, which encourage parents to actively engage in their children’s healthcare decisions and become experts on their own child’s health. It is considered ‘better for children’s health’ and ‘better for overburdened healthcare systems’ if individuals take charge of their own healthcare, and the healthcare of their children (Goldenberg 2016). It is for these reasons that Blume and Goldenberg defend voluntary vaccination: they consider calls for mandatory vaccination inconsistent with the
Mandatory versus voluntay
Mandatory versus voluntary
46
45