Abstract
Systematic public vaccination constitutes a tremendous health success, perhaps the greatest achievement of biomedicine so far. There is, however, room for improvement. Each year, 1.5 million deaths could be avoided with enhanced immunisation coverage. In recent years, many countries have introduced mandatory childhood vaccination programmes in an attempt to avoid deaths. In Norway, however, the vaccination programme has remained voluntary. Our childhood immunisation programme covers protection for twelve infectious diseases, and Norwegian children are systematically immunised from six weeks to sixteen years of age. In this article, we address the question of whether our country, Norway, should make the childhood vaccination programme mandatory. This question has received considerable public attention in the media, yet surprisingly little academic discussion has followed. The aim of the article is to systematically discuss whether it is morally justified to introduce a mandatory childhood vaccination programme in Norway. Our discussion proceeds as follows: We begin by presenting relevant background information on the history of vaccines and the current Norwegian childhood vaccination programme. Next, we discuss what we consider to be the most central arguments against mandatory childhood vaccination: the argument from the standpoints of parental rights, bodily integrity, naturalness, mistrust, and immunisation coverage. After that, we examine the central arguments in favour of mandatory childhood vaccination from the standpoints of harm, herd immunity, and as a precautionary strategy. We conclude that there are convincing moral arguments in favour of adopting a policy of mandatory childhood vaccination in Norway.
 Keywords: autonomy, harm principle, herd immunity, parental rights, precautionary approach
Highlights
If enough people opt out of our Norwegian childhood vaccination programme, this may result in the cessation of herd immunity, which in turn will increase the risk of an outbreak of preventable disease
We examined five arguments against mandatory vaccination: the argument for parental rights, the argument for bodily integrity, the argument for naturalness, the argument of mistrust, and the argument of immunisation coverage
We considered three arguments in favour of implementing a mandatory vaccination policy: the harm argument, the argument for herd immunity, and the precautionary strategy argument
Summary
The arguments that we examine against mandatory childhood vaccination are concerned with parental rights, children’s bodily integrity, the naturalness of disease, mistrust in the health system, and immunisation coverage. When introducing a policy of mandatory vaccination, the government would be advised to emphasise the benefits of both individual and herd immunity, rather than the fact that the policy implies that parents are being forced to vaccinate their children. If this approach is successfully implemented, we think it is reasonable to assume that the Norwegian population will welcome a policy of mandatory vaccination, or at least not oppose it to the extent that it creates a problem of mistrust. Such an increase in overall immunisation coverage would likely contribute to a more even distribution of immunisation coverage for the different subpopulations or municipalities in Norway.
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