“Freedom to refuse vaccination is not unlimited”

How can and should the government respond to the current low participation in the national immunization programme? Can certain forms of coercion be justified? The book Inducing Immunity? Justifying Immunisation Policies in Times of Vaccine Hesitancy provides answers. Marcel Verweij (Philosophical Ethics, Utrecht University) and Roland Pierik (Philosophy of Law, Maastricht University) make recommendations for responsible immunization policies that are trustworthy, both towards people who seek the protection of vaccinations and towards those who are hesitant about vaccinations or even reject them.

Ethical and legal analysis

Verweij and Pierik’s book (open access) is the first encompassing ethical and legal-philosophical analysis of collective vaccination. Marcel Verweij explains: “It addresses not only childhood immunisation, but also vaccination of adults, with a prominent role for interventions during the COVID-19 pandemic.”

“During the pandemic, the opposition to the pandemic control measures was often solid,” Verweij continues, “although eventually the vast majority did choose to get vaccinated.” However, participation in the National Vaccination Programme (RVP) is now already declining for years and currently at an all-time low. This is reflected in the recent number of children who are suffering from measles and pertussis (whooping cough).

To vaccinate or not to vaccinate?

“Each person’s choice to refrain from vaccination is protected by fundamental liberty rights, but that freedom is not without limits,” explains Roland Pierik. “The idea of the 19th-century philosopher John Stuart Mill is relevant here: liberty can be restricted if people make choices that are harmful to others.” The authors demonstrate how vaccine refusal undermines the collective endeavour to maintain group protection, to the detriment of public health. “Restriction of freedom may then be justified,” Pierik adds.

This is true both for childhood immunisation and also for immunisation of adults. Yet this does not mean that the government can simply require individuals to comply to a vaccination policy, says Verweij. “Because group protection does not require everyone to be vaccinated. A healthy society can tolerate some refusal. And, moreover, any form of pressure or coercion should be proportionate.”

When vaccine coverage is in decline, the government must take responsibility and draw a clear line. And lay down in law what measures will be taken at that lower limit.

Proposal for possibility of coercion

In their book, Verweij and Pierik discuss the many factors determining what kind of policy, in what kind of circumstances, is justified. “These include the severity of the disease, how easily the infection can spread, and the nature of measures being considered.”

In doing so, the researchers make a practical proposal for limited coercion within the Dutch National Vaccination Programme. Verweij: “When vaccine coverage is in decline, the government must take responsibility and draw a clear line: what is the lower limit that should certainly not be surpassed? And it must lay down in law what measures will be taken at that lower limit.”

Verweij and Pierik mention childcare in this context: “A reasonable response for the government is to enforce that, at that point, every child in daycare or after-school care is vaccinated according to regular schedule. Parents who refuse immunisation would then not be allowed anymore to bring their children to childcare centres. Obviously, the ideal is that a sufficient vaccine coverage is maintained so that coercion does not have to be applied at all.”