28 Sep 2019
The Nuffield Council on Bioethics has written to Matt Hancock, Secretary of State for Health and Social Care, following a Government announcement of new measures to increase uptake of vaccinations in the UK.
Last week the Prime Minister announced that urgent action would be taken to drive up vaccination rates, in the wake of a rising incidence of measles cases in the UK.
Our letter offers strong support for the sort of practical measures which aim to remove barriers to accessing childhood vaccinations e.g. improving appointment booking and reminders.
In particular, we note the increasing and disturbing influence of misinformation about vaccination as a key factor in the rise of vaccine hesitancy, and therefore welcome plans to compel social media companies to consider how they can play their part in promoting accurate information about vaccination.
We urge caution against any move towards compulsory vaccination programmes at this time, as is hard to see how this would be ethically justified unless other, less intrusive, measures had been taken (and had been shown not to have worked).
The Nuffield Council on Bioethics looked at the ethical issues relating to vaccination policies in our Public health: ethical issues report. Whilst the report was published in 2007, it remains highly relevant today.
In our report, we proposed a stewardship model to inform public health policies. The central premise is that the state has responsibility to look after the health of all its citizens – both collectively and individually – and public health policies should aim for the least intrusive means possible to achieve the required health benefit.
Our ‘intervention ladder’ is a useful way of thinking about the different ways that public health policies, including on vaccinations, can affect people’s choices. Interventions that are higher up the ladder are more intrusive and therefore require a stronger justification:
At the time of the report, we did not find enough justification to recommend that the UK moves away from a voluntary approach to childhood vaccination and in our view, this has not changed. However, given developments such as the rising incidence of measles infections, other approaches to strongly encourage and support vaccination are clearly warranted.