Vaccination Policies: Between Best and Basic Interests of the Child, between Precaution and Proportionality

Abstract

How should liberal-democratic governments deal with emerging vaccination hesitancy when that leads to the resurgence of diseases that for decades were under control? This article argues that vaccination policies should be justified in terms of a proper weighing of the rights of children to be protected against vaccine-preventable diseases and the rights of parents to raise their children in ways that they see fit. The argument starts from the concept of the ‘best interests of the child involved’. The concept is elaborated for this context into the dual regime structure in which parents have fiduciary authority over what they consider to be best for their child, and the state has fiduciary authority over a child’s basic interests. This argument leads to conditional mandatory vaccination programs that should be informed by a correct balancing of the two legal principles of proportionality and precaution. This results in contextual childhood vaccination policies of upscaling interference: a three-tiered approach of increased intrusion, from voluntary program when possible and mandatory or even compulsory programs when necessary to protect the child’s basic interests.

Vaccination Dilemma: Parents’ Vaccine Hesitancy Versus Informed Teenagers’ Accept – Case Report

“…Laws generally assume that parents make decisions based on the best interests of their children. Indeed, parents have the freedom to raise their children in accordance with family beliefs and personal values [13,14]. With regard to health care, laws generally require government agencies and courts to revoke parental authority only when parental decisions amount to child abuse or neglect, and the neglect provisions usually only involve substantial life-threatening situations [15].…”

How Mandatory Can We Make Vaccination?

“…It might be objected that the child is also restricted, but it is widely accepted that young children can sometimes be restricted for their own good, as well as that of others. However, debates over childhood vaccination are often entangled with those over the limits of parental decision-making ( Diekema, 2011 ; Opel et al , 2013 : 1041; Pierik, 2020 ). I wish to avoid these added complexities here so, for simplicity, assume we are dealing with adult vaccinations.…”

On the concept and ethics of vaccination for the sake of others

“…51 To justify mandates that would limit or override parental autonomy, there needs to be at least some indication that parents and guardians might not be adequately discharging their duties to safeguard the health and well-being of their children (Pierik 2018). Should neglect of children's basic interests be demonstrated, then there might be a legitimate reason for states to intervene and to coerce parents and guardians into making choices that are better aligned with their children's interests and well-being (Pierik 2020).…”