Childhood Imunisation Australia

Introduction

Today, mixed debates exist regarding mandatory childhood immunisation (Williamson & Glaab,

2018; Giubilini, 2019). As such, vaccination creates ethical challenges as they often involve mass

immunisation, including with children where parents play an important role in decision-making. Whereas

mandatory vaccination in Australia is well intentioned, such policies and legislation can serve to

contravene bioethical principles which are often meant to promote safe and quality healthcare. When

treating children of vaccine-hesitant parents, each situation is unique and ought to have a personal and

individual approach. This paper draws on the bioethical principles attempting to examine whether

childhood vaccination should be mandatory in Australia.

McBride, 2022). As such, when vaccinating children at the individual level, conflicts can exist between

respecting the best interests of the child, the autonomy and self-determination of the parents, and just

contribution of herd immunity (Giubilini et al., 2018; Rus & Groseli, 2021). Respect for autonomy and

patient self-determination is one of the most crucial principles of bioethics and has been well embraced in

the developed world. Autonomy in the Western world has meant that individuals can engage in

autonomous decision making about their healthcare and about the health of their children which is

reflective of their values, wishes, and needs. Mandatory immunisation infringes the upholding of this

principle.

In Australia, Australians have to either choose between accepting immunisation for their children

or forego significant family tax and childcare benefits and refusal has been associated with financial

need to be treated with respect irrespective of their ethnicity, gender, status, ability, age, and so forth and

they possess a special value intrinsic to their humanity and are worthy of respect. Critics of mandatory

vaccination argue that such policies deny parents the right to conscientious objection thus failing to

observe their human dignity (Balák, 2014; Bonanni, 2018; Harmon et al., 2021).

Proponents of vaccination have argued that compulsory vaccination drives are in the best interests

of the child. The principle of justice can be examined within the context of herd immunity, according to

Rus and Groseli (2021). This principle calls for just contribution to herd immunity and contravenes the

upholding of parental autonomy and self-determination. Herd immunity is often regarded as a common

good and perhaps a right promoted by the law of the land. As such, in terms of promoting the principle of

justice, Rus and Groseli (2021) ague that ‘negative’ policies for vaccination such as vaccination mandates

coercion or coercive policies. Diseases such as measles which had been dreaded in the past are no longer

feared by parents, even though this is not meant to downplay or dismiss the devastating impacts that such

diseases can have if they were to emerge. Such diseases as measles have been successfully controlled

diseases. Vaccines are not perfect despite remarkable safety record. Moreover, many safety concerns that

parents may have still remain unaddressed or unresolved and governments have been criticised for a lack

of effective and efficient tools at the macro, messo and micro levels aimed at addressing vaccine

hesitancy, for instance among parents. Today, the hypothesised association between autism and measles,

mumps, rubella (MMR) vaccine continues to contribute to concern and fuel vaccine hesitancy, with such

myths propelled by misguided science but proving to cement anti-vaccination beliefs among the public

(Hviid et al., 2019; Davidson, 2017). Additionally, low trust placed on governments that buy, promote

and impose mandatory vaccines as well as pharmaceutical companies that manufacture these vaccines

cannot be simply overlooked. As such, on top of the failure to address such concerns, exclusively

(2015) have cited the Vaccination Act of the 1840s and 1850s in the United Kingdom, for instance the

Vaccination Act of 1953 which instituted mandatory vaccination. Defaulting parents were made liable for

imprisonment or fine and mandatory vaccination was extended to the age of 14, with cumulative penalties

for non-adherence (Adedeji, 2021). What followed was the anti-vaccination resistance movements with

several occasions leading to violent demonstrations. The UK had to establish a new law and resorted to

conscientious exemption. Consistent with arguments made by Salmon et al. (2015), perhaps policy

makers and key decision-makers might consider learning from history on the impacts that mandatorily

and coercively imposing immunisation on parents and children and ignoring their voices and disregarding

their concerns. This might be helpful in ensuring that history is not repeated from counterproductive

Ethical justification for mandatory vaccination

Nonetheless, proponents of a utilitarian approach would argue in support for parental moral

responsibility to vaccinate their children in order to achieve herd immunity (Giubilini et al., 2018). Their

involved in collective duty (Giubilini et al., 2018). Utilitarianism focuses on the betterment of the society

as a whole and utilitarian ethicists are concerned with increasing the net utility (Gensler, 2017). As such,

in the case of mandatory immunisation, a utilitarian ethicist would argue that ‘the end justifies the means’

drawing on their consequentialist orientations that people only have one basic duty: to maximise long-

term good consequences (Gensler, 2017). As such, they would see the benefits of vaccination as being

sufficiently large for the society thus justifying an obligation for parents to vaccinate their children.

Special situations such as the advent of a devastating disease that is vaccine-preventable, might

justify the introduction of a mandatory immunisation program, if the disease were adequately severe and

the vaccine effective and safe (Isaacs, 2012; Jennings et al., 2016; Rus & Groselj, 2021). During such

circumstances, a public health perspective triumphs over an individual-centred approach where autonomy

revealed the extents to which vaccine hesitancy can go, including in Australia (Attwell et al., 2021;

Edwards et al., 2021). Nonetheless, there is a likelihood that voluntary vaccination would increase and

the mistrust and that the ethical justification for compulsion might be altered by the altered risk-benefit

ratio. This is particularly evident in the case of Covid-19 vaccination drives.

instance in the case of MMR vaccine (Greenberg et al., 2017; Hviid et al., 2019; Davidson, 2017). It is

also critical to acknowledge the ‘controlling impact’ of anti-vaccination movements, conspiracy theories,

and other people’s opinions which limit parental self-determination. A systemic approach to

immunisation education and better communication at all levels can help solve these dilemmas and reduce

the levels of coercion which may not be exclusively necessary. Importantly, the principle of veracity calls

for healthcare workers to be honest and engage in truth-telling in all their interactions with clients (Amer,

2019). To engage parents in shared decision-making and ensure they make informed decisions and

encourage them to engage in voluntary vaccination, healthcare workers can also adhere to this principle

when educating parents on matters concerning vaccines such as benefits, risks, their rights, and so forth.

Conclusion

ensuring parents exercise their moral obligation, a duty that utilitarian ethicists expects of them. Heeding

to the voice of parents and educating them can help with addressing this conundrum.

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