Open access at MITpress: Inducing Immunity -- But what's new?

Summary

How should liberal-democratic governments regulate collective immunization programs in the face of vaccine hesitancy and refusal? Protection of society against threats from inside and outside is one of the core tasks of government. This also includes promoting herd protection against vaccine preventable diseases, as a strategy to protect society at large and the basic interests of vulnerable persons, notably children. This book discusses some of the main grounds for people to refuse vaccination for their children or themselves. We argue that, in a liberal democratic society, such concerns can’t be simply pushed aside as irrelevant – also not if such views are based upon misinformation.

The core of this book is a defense of the claim that, in specific circumstances, the state is justified in constraining people’s freedom to forego immunization. The justification builds upon John Stuart Mill’s harm principle, but is also informed by an analysis of legal argumentation in liberal democratic contexts – especially the principle of proportionality. We propose a novel and comprehensive approach of conditional mandatory immunization that strikes a reasonable balance between respecting fundamental liberty rights on the one hand, and the protection of society and notably the basic interests of children on the other. The policy implications are elaborated in detail. After having developed the core argument and applied it to childhood immunization, we extend our argument to the vaccination of competent adults, taking the Covid-19 pandemic as an illustrative case. Finally, we discuss how governments should deal with the spread of misinformation and vaccine hesitance.

What’s new?

Our book presents many novel arguments, proposals and insights that will shed new light in ethical, legal and political debates about immunization – but which also raise new controversies about such policies.  For example,

• we offer a typology for more and less coercive immunization policies, that can help government officials to develop approaches that might interfere with freedom but only in a proportionate way.
• we explain how in discussions about parental autonomy, a distinction needs to be made between best and basic interests of children. Governments are not responsible for securing best interests, but they do have ultimate responsibility for ascertaining a child’s basic interests – and this may, under specific circumstances, justify restricting parental autonomy.
• we explain how the right to bodily integrity cannot clearly be invoked as an argument against compulsory childhood immunization.
• we argue that a decision to refrain from vaccination can be considered as a case of wrongful harm, either because there are direct risks for others (including one’s child) or because it undermines the collective endeavor to maintain herd protection. This offers a principled ground for mandatory or compulsory immunization.
• we make clear that vaccine refusal can amount to freeriding, but such freeriding is not unfair, hence this feature of refusal cannot be a ground for the use of government force.
• we show that current legal practice in most states in the USA, to allow for non-medical exemptions if parents have deep (religious or non-religious) concerns about vaccination, cannot be justified in a democratic context.
• we discuss different coercive approaches towards immunization of adult citizens in the context of a massive outbreak (taking Covid-19 as one example) and argue that in exceptional cases it can be justified to make vaccine refusal illegal.
• We also make clear that in such cases compulsory immunization (make refusal illegal) may be better justifiable than mandatory immunization (e.g. requiring proof of vaccination to participate in societal events).
• we argue that there is a strong case for democratic states to respect freedom of expression and that this involves tolerating the spread of vaccine misinformation; when misinformation is posing a real risk to vaccine uptake and herd immunity, it may preferable from an ethical perspective to mandate vaccination rather than restricting freedom of expression.
• we present an account of trust and trustworthiness of health authorities in which mandatory and compulsory immunization have a solid place and which is also trustworthy towards vaccine hesitant groups.
• we come with a practical proposal for a proportionate and trustworthy immunization policy, that includes a political decision for a vaccine coverage minimum threshold, and that specifies what coercive approaches will be implemented if participation rates drop below this threshold.