Parents in the US and other societies are increasingly refusing to vaccinate their children, even though popular anti-vaccine myths – e.g. ‘vaccines cause autism’ – have been debunked. This book explains the epistemic and moral failures that lead some parents to refuse to vaccinate their children. First, some parents have good reasons not to defer to the expertise of physicians, and to rely instead upon their own judgments about how to care for their children. Unfortunately, epistemic self-reliance systematically distorts beliefs in areas of inquiry in which expertise is required (like vaccine immunology). Second, vaccine refusers and mainstream medical authorities are often committed to different values surrounding health and safety. For example, while vaccine advocates stress that vaccines have low rates of serious complications, vaccine refusers often resist vaccination because it is ‘unnatural’ and because they view vaccine-preventable diseases as a ‘natural’ part of childhood. Finally, parents who refuse vaccines rightly resist the utilitarian moral arguments – ‘for the greater good’ – that vaccine advocates sometimes make. Unfortunately, vaccine refusers also sometimes embrace a pernicious hyper-individualism that sanctions free-riding on herd immunity and that cultivates indifference to the interpersonal and social harms that unvaccinated persons may cause.

This open access book discusses individual, collective, and institutional responsibilities with regard to vaccination from the perspective of philosophy and public health ethics. It addresses the issue of what it means for a collective to be morally responsible for the realisation of herd immunity and what the implications of collective responsibility are for individual and institutional responsibilities. The first chapter introduces some key concepts in the vaccination debate, such as ‘herd immunity’, ‘public goods’, and ‘vaccine refusal’; and explains why failure to vaccinate raises certain ethical issues. The second chapter analyses, from a philosophical perspective, the relationship between individual, collective, and institutional responsibilities with regard to the realisation of herd immunity. The third chapter is about the principle of least restrictive alternative in public health ethics and its implications for vaccination policies. Finally, the fourth chapter presents an ethical argument for unqualified compulsory vaccination, i.e. for compulsory vaccination that does not allow for any conscientious objection. The book will appeal to philosophers interested in public health ethics and the general public interested in the philosophical underpinning of different arguments about our moral obligations with regard to vaccination.

The public has voiced concern over the adverse effects of vaccines from the moment Dr. Edward Jenner introduced the first smallpox vaccine in 1796. The controversy over childhood immunization intensified in 1998, when Dr. Andrew Wakefield linked the MMR vaccine to autism. Although Wakefield’s findings were later discredited and retracted, and medical and scientific evidence suggests routine immunizations have significantly reduced life-threatening conditions like measles, whooping cough, and polio, vaccine refusal and vaccine-preventable outbreaks are on the rise. This book explores vaccine hesitancy and refusal among parents in the industrialized North. Although biomedical, public health, and popular science literature has focused on a scientifically ignorant public, the real problem, Maya J. Goldenberg argues, lies not in misunderstanding, but in mistrust. Public confidence in scientific institutions and government bodies has been shaken by fraud, research scandals, and misconduct. Her book reveals how vaccine studies sponsored by the pharmaceutical industry, compelling rhetorics from the anti-vaccine movement, and the spread of populist knowledge on social media have all contributed to a public mistrust of the scientific consensus. Importantly, it also emphasizes how historical and current discrimination in health care against marginalized communities continues to shape public perception of institutional trustworthiness. Goldenberg ultimately reframes vaccine hesitancy as a crisis of public trust rather than a war on science, arguing that having good scientific support of vaccine efficacy and safety is not enough. In a fraught communications landscape, Vaccine Hesitancy advocates for trust-building measures that focus on relationships, transparency, and justice.

Immunization against disease is among the most successful global health efforts of the modern era, and substantial gains in vaccination coverage rates have been achieved worldwide. However, that progress has stagnated in recent years, leaving an estimated 20 million children worldwide either undervaccinated or completely unvaccinated. The determinants of vaccination uptake are complex, mutable, and context specific. A primary driver is vaccine hesitancy - defined as a "delay in acceptance or refusal of vaccines despite availability of vaccination services". The majority of vaccine-hesitant people fall somewhere on a spectrum from vaccine acceptance to vaccine denial. Vaccine uptake is also hampered by socioeconomic or structural barriers to access. On August 17-20, 2020, the Forum on Microbial Threats at the National Academies of Sciences, Engineering, and Medicine held a 4-day virtual workshop titled The Critical Public Health Value of Vaccines: Tackling Issues of Access and Hesitancy. The workshop focused on two main areas (vaccine access and vaccine confidence) and gave particular consideration to health systems, research opportunities, communication strategies, and policies that could be considered to address access, perception, attitudes, and behaviors toward vaccination. This publication summarizes the presentations and discussion of the workshop.

A thoughtful evaluation of the vaccine debate, its history, and its consequences. Since 1990, the number of mandated vaccines has increased dramatically. Today, a fully vaccinated child will have received nearly three dozen vaccinations between birth and age six. Along with the increase in number has come a growing wave of concern among parents about the unintended side effects of vaccines. In Vaccine, Mark A. Largent explains the history of the debate and identifies issues that parents, pediatricians, politicians, and public health officials must address. Nearly 40% of American parents report that they delay or refuse a recommended vaccine for their children. Despite assurances from every mainstream scientific and medical institution, parents continue to be haunted by the question of whether vaccines cause autism. In response, health officials herald vaccines as both safe and vital to the public's health and put programs and regulations in place to encourage parents to follow the recommended vaccine schedule. For Largent, the vaccine-autism debate obscures a constellation of concerns held by many parents, including anxiety about the number of vaccines required (including some for diseases that children are unlikely ever to encounter), unhappiness about the rigorous schedule of vaccines during well-baby visits, and fear of potential side effects, some of them serious and even life-threatening. This book disentangles competing claims, opens the controversy for critical reflection, and provides recommendations for moving forward.

Antivaxxers are crazy. That is the perception we all gain from the media, the internet, celebrities, and beyond, writes Bernice Hausman in Anti/Vax, but we need to open our eyes and ears so that we can all have a better conversation about vaccine skepticism and its implications. Hausman argues that the heated debate about vaccinations and whether to get them or not is most often fueled by accusations and vilifications rather than careful attention to the real concerns of many Americans. She wants to set the record straight about vaccine skepticism and show how the issues and ideas that motivate it—like suspicion of pharmaceutical companies or the belief that some illness is necessary to good health—are commonplace in our society. Through Anti/Vax, Hausman wants to engage public health officials, the media, and each of us in a public dialogue about the relation of individual bodily autonomy to the state's responsibility to safeguard citizens' health. We need to know more about the position of each side in this important stand-off so that public decisions are made through understanding rather than stereotyped perceptions of scientifically illiterate antivaxxers or faceless bureaucrats. Hausman reveals that vaccine skepticism is, in part, a critique of medicalization and a warning about the dangers of modern medicine rather than a glib and gullible reaction to scaremongering and misunderstanding.

In this volume a range of issues in public health ethics are explored using the resources of theory, political philosophy, philosophy of science, applied ethics, law and economics. [Ed.]