Deliberation on Childhood Vaccination in Canada: Public Input on Ethical Trade-Offs in Vaccination Policy

O’Doherty, Kieran C.; Crann, Sara; Bucci, Lucie M.; Burgess, Michael; Chauhan, Apurv; Goldenberg, Maya J.; McMurtry, C. Meghan; White, Jessica; Willison, Donald J.

doi:10.1080/23294515.2021.1941416

Cited by 6 publications

(10 citation statements)

References 34 publications

(31 reference statements)

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“…Our results suggest that, even when informed of potential risks, harms, costs, and benefits, members of the public will, on balance, support childhood vaccine mandates with clear caveats. The variation in jury responses is consistent with what is known: mandates involve challenging ethical and social trade‐offs, and there is often persistent disagreement among experts and publics on which type of mandate should be applied 11,23 …”

Section: Discussionsupporting

confidence: 73%

“…Given that community jury processes on childhood vaccination mandates in Australia and Canada 23 have produced similar kinds of consistencies and disagreements, we tentatively conclude that the social norm and importance of vaccination is now culturally conditioned in both nations, and perhaps others too. In this context of widespread approval of vaccination, it is hard to obtain agreement on specific measures to promote its uptake when these impose various costs and inequities on those who refuse.…”

Section: Discussionmentioning

confidence: 79%

“…The variation in jury responses is consistent with what is known: mandates involve challenging ethical and social trade-offs, and there is often persistent disagreement among experts and publics on which type of mandate should be applied. 11,23 Recent analyses indicates Australian policymakers focus on how mandates can drive up vaccine coverage rates rather than the reasons why they are using them and the various benefits that high vaccine coverage can deliver. 11 However, in designing and implementing ethical policies to maintain common goods like collective health protection, it is important to consider what communities value.…”

Section: Discussionmentioning

confidence: 99%

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Public values to guide childhood vaccination mandates: A report on four Australian community juries

Degeling,

Leask,

Attwell

et al. 2023

Health Expectations

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ObjectiveGovernments use vaccination mandates, of different degrees of coerciveness, to encourage or require childhood vaccination. We elicited the views of well‐informed community members on the public acceptability of using childhood vaccination mandates in Australia.MethodsFour community juries were conducted in Canberra, Launceston, Cairns and Melbourne, Australia between 2021 and 2022. We recruited 51 participants from diverse backgrounds, genders and ages through random digit dialling and social media. Two juries were held in metropolitan areas, and two in regional/rural settings. Outcome measures included jury verdicts and reasons in response to structured questions.ResultsAll juries were concerned about collective protection and individual rights but prioritised the former over the latter. A majority in all juries supported mandates but juries disagreed with respect to the appropriate mandate types. All juries endorsed using the least restrictive or coercive means to encourage vaccination (providing incentives or education, e.g.) before imposing penalties such as financial losses and school exclusions. The overriding view was that it is fairer to place a direct burden on parents rather than children and that mandates should be designed to avoid inequitable impacts on less advantaged groups in society. Many jurors found conscientious objection acceptable as a controlled option for resolute refusers, provided that overall vaccination coverage remains high.ConclusionThis paper gives policymakers access to the reasons that Australians have for supporting or opposing different mandates under conditions of high knowledge, understanding and deliberation regarding policy options. Sustaining high rates of vaccination requires high levels of co‐operation between governments, public health actors and the public. Our findings highlight the importance of considering public values in the design and implementation of vaccination mandates.Patient and Public InvolvementWe sought input from individuals who did and did not vaccinate during the study design. The views and perspectives of nonvaccinating parents were presented in the evidence to juries. We deliberately excluded nonvaccinating individuals from participating, as the divisive and often hostile nature of the topic, and their minority status, made it difficult to ensure they would feel safe as members of the jury without overrepresenting their perspective in the sample. Two related projects engaged directly with these parents.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

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Public values to guide childhood vaccination mandates: A report on four Australian community juries

Degeling,

Leask,

Attwell

et al. 2023

Health Expectations

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“…Small group discussions allowed participants to deliberate more intimately with up to 7 other participants and prepare for deliberation in the large group. Across the entire deliberative process, participants addressed four overarching questions and developed 20 recommendations (for details, see O’Doherty et al., 2021). The final day concluded with a panel discussion with decision‐makers and a ratification of the recommendations.…”

Section: Methodsmentioning

confidence: 99%

“…The Ontario Vaccine Deliberation (OVD) was conducted over 4 days and led to the formulation of 20 recommendations that were conveyed to policy makers. A detailed report of the rationale for the deliberation, methods, and outcomes has been published elsewhere (O’Doherty et al., 2021). The OVD provided Ontario residents with the opportunity to engage in discussions regarding policy on childhood vaccination in Ontario, a topic of considerable importance in Canada (Dubé et al., 2016; Goldenberg, 2021).…”

Section: Introductionmentioning

confidence: 99%

Constructing the Anti‐Vaxxer: Discursive analysis of public deliberations on childhood vaccination

White

O’Doherty

2023

J Theory Soc Behav

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Public deliberation is a form of dialogue that allows members of the public to provide input on a policy issue. Public deliberation processes invite participants to engage with each other respectfully, learn about the topic and each other's perspectives, and then work together toward solutions to an issue that are broadly acceptable. In this article, we develop a discursive psychological analysis of public deliberation on the topic of childhood vaccination. In particular, we focus on how descriptions of a parent who did not have her children vaccinated were developed iteratively by a small group of deliberants; how these descriptions came to be accepted as factual; and how these descriptions came to be used to support normative claims about childhood vaccination. Our main argument is that we can develop a deeper understanding of deliberation processes if we understand participants' statements to be rhetorically organised. This is achieved by examining how descriptions of events or people that are relevant to the final conclusions of the group are developed in the course of deliberation; how they come to be accepted as factual and accurate by the group; and how they then become instrumental in supporting a final consensus position.

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Public Engagement on Childhood Vaccination: Democratizing Policy Decision-Making Through Public Deliberation

Chuong¹,

Rotella²,

Cooper³

et al. 2023

Democratizing Risk Governance

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Immunization is considered one of the most successful and cost-effective public health interventions by the World Health Organization, preventing an estimated 2 to 3 million deaths per year globally (WHO, 2018). From a public health perspective, there is growing concern that vaccination rates are insufficient to effectively control the spread of infectious diseases. From a public trust perspective, there is increasing doubt in some groups of the claims made about vaccination by authorities. Active and meaningful public engagement in health service delivery and health research is considered essential to quality improvement of health services, greater responsiveness to public needs, and more legitimate, transparent, and accountable decision-making. Public engagement through deliberative processes has garnered increasing interest from public health researchers and policy makers on a number of health-related topics, including priority setting, planning and governance of health services, and health technology assessment (Degeling et al., 2015). Calls for deliberative approaches relating to vaccine-related policy decisions have also been made. Nevertheless, to our knowledge, there has not been any official, government-sponsored public engagement event for members of the public in Ontario to deliberate on the topic of childhood vaccination. In this chapter, we begin by providing a brief overview of the current regulatory context in Ontario with regard to childhood vaccination. We then outline the Ontario Vaccine Deliberation, an academic-led project in which a lay public was convened to discuss challenges and controversies regarding childhood vaccination in Ontario, and the recommendations that were generated and endorsed by the participants through small and large group discussions during the deliberation. We draw on the Ontario Vaccine Deliberation, as well as scholarly literature, to illustrate the importance of engaging publics in decision-making about childhood vaccination. We focus our discussion on the main issues that were raised during the deliberation, namely mandatory vaccination and non-medical exemptions, communication about vaccination, and compensation for serious adverse events following immunization. The chapter includes an appendix that examines the application of democratization processes through public deliberation to the COVID-19 pandemic.

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Deliberation on Childhood Vaccination in Canada: Public Input on Ethical Trade-Offs in Vaccination Policy

Cited by 6 publications

References 34 publications

Public values to guide childhood vaccination mandates: A report on four Australian community juries

Public values to guide childhood vaccination mandates: A report on four Australian community juries

Constructing the Anti‐Vaxxer: Discursive analysis of public deliberations on childhood vaccination

Public Engagement on Childhood Vaccination: Democratizing Policy Decision-Making Through Public Deliberation

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