Mandatory childhood vaccination: Should Norway follow?

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

Attitudes towards mandatory vaccination and sanctions for vaccination refusal

“…All in all, researchers disagree at least partly about whether such outcomes, and if so, then more specifically which outcomes, are ethically defensible [22,23,24]. It is not self-evident that mandatory vaccination is the way forward from an ethical perspective, even if one recognises that, in general, the aim is to protect a social good like public health and the individual right to health, and that states have certain responsibilities in this respect [11,25,26].…”

“…In another Nordic context, Gamlund et al (2020) [24] point to a recent Norwegian survey experiment by Arnesen et al (2018) [44] on positions on herd immunity, the results of which ''suggested that a concern for others highly influences people's decision to vaccinate or not to vaccinate" [24], even somewhat more so than potential individual benefits of vaccination [44]. (We can also talk here of ''the self-and other-directed effects of vaccination" [45]).…”

“…Such individual freedom needs to be balanced with the rights of others and community welfare, including the prevention of serious harm [7]. There are limits to parental autonomy when it comes to making decisions about their children [24].…”

“…For example, in their discussion about sanctions following upon vaccine refusal, Gamlund et al (2020) underline the importance of distinguishing between sanctions against parents and sanctions against children. Refusing unvaccinated children the chance to attend day care or school means in effect making them ''suffer doubly" [24]. It is a problematic sanction that should be avoided.…”

After the European Global Vaccination Summit—The need for practical policies to boost vaccination delivery to children in Europe

“…Senior paediatricians in the UK have argued against mandatory vaccination as damaging trust in health systems and professionals, 8,9 while ethical discussions in Norway regretted the lack of debate on compulsion but reached a different conclusion. 10 This suggests instead the need for a more focused and innovative vaccination policy approach, combining rediscovery of past good practice and better application of new innovation, and their integration into a set of practical policies focussed on delivery. This paper reviews 10 aspects in order to indicate a suite of practical actions to complement and facilitate for children's vaccination the high-level Actions proposed by the Vaccination Summit.…”