Abstract
BackgroundVaccine hesitancy is a growing threat to public health. The reasons are complex but linked inextricably to a lack of trust in vaccines, expertise and traditional sources of authority. Efforts to increase immunization uptake in children in many countries that have seen a fall in vaccination rates are two-fold: addressing hesitancy by improving healthcare professional-parent exchange and information provision in the clinic; and, secondly, public health strategies that can override parental concerns and values with coercive measures such as mandatory and presumptive vaccination.Main textIt is argued that such conflicting, parallel approaches seriously risk undermining trust that is crucial for sustaining herd immunity. Although public health strategies can be ethically justified in limiting freedoms, a parent-centered approach seldom acknowledges how it is impacted by contemporaneous coercive measures. In addition, the clinical encounter is not well suited to helping parents consider the public dimensions of vaccination, despite these being important for trust formation and informed decision-making. Efforts to address vaccine hesitancy require more consistent engagement of parental and citizen views. Along with evidence-based information, debates need to be informed by ethical support that equips parents and professionals to respond to the private and public dimensions of vaccination in a more even-handed, transparent manner.ConclusionEfforts to address vaccine hesitancy need to avoid simple reliance on either parental values or coercive public policies. To do this effectively requires increasing citizen engagement on vaccination to help inform a parent-centered approach and legitimize public policy measures. In addition, cultivating a more ethically consistent strategy means moving beyond the current silos of health ethics - clinical and public health ethics.
Highlights
It is argued that such conflicting, parallel approaches seriously risk undermining trust that is crucial for sustaining herd immunity
Cultivating a more ethically consistent strategy means moving beyond the current silos of health ethics - clinical and public health ethics
Rebalancing ethical commitments in vaccination strategies In addition to concerns that parent-centered care (PCC) is undermined by inconsistent delivery and conflicting policy approaches, there are fundamental questions regarding whether its focus on narrow, private parental interests is sufficient to attend to the wider public dimensions of vaccination
Summary
In what follows we begin by outlining concerns that competing vaccination strategies ethically conflict, before turning to examine related issues in more detail: the variable experience of PCC; the increasing use of mandatory vaccination; and, proposals for a ‘presumptive’ approach in vaccination consultations. Rebalancing ethical commitments in vaccination strategies In addition to concerns that PCC is undermined by inconsistent delivery and conflicting policy approaches, there are fundamental questions regarding whether its focus on narrow, private parental interests is sufficient to attend to the wider public dimensions of vaccination. This concern is evident in the context of debates on herd immunity and is discussed. In the context of vaccine hesitancy public deliberation would facilitate parents to work through doubts about vaccination and tensions between individual choices and public health using reasoned debate This approach differs from other civic engagement strategies because it goes beyond citizens merely sharing their opinions. Future vaccination crises risk being fanned by suspicions created by conflicting ethical promises across clinical practice and health policy
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