Abstract
This paper argues that significant aspects of the vaccination debate are ‘deep’ in a sense described by Robert Fogelin and others. Some commentators have suggested that such disagreements warrant rather threatening responses. I argue that appreciating that a disagreement is deep might have positive implications, changing our moral assessment of individuals and their decisions, shedding light on the limits of the obligation to give and respond to arguments in cases of moral disagreement, and providing an incentive to seek alternative ways of going on in the face of intractable moral disagreement. Non-coercive, non-reasoned strategies have been used or recommended to increase vaccination rates. Such strategies look problematic when judged by the standards of ideal moral and rational argumentation, but more acceptable if seen as responses to deep disagreements.
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Notes
We will see that the term “deep disagreement” has been used to describe different types of disagreement. This slight looseness of terminology will not matter for these introductory comments.
I will not discuss this possible consequence of an appreciation that a disagreement is deep in this paper. In short, the idea is that there is a moral difference between someone who acknowledges the benefits of vaccination and relies upon the fact most people vaccinate to avoid the risks of doing so themselves, and someone who avoids vaccination because they genuinely deny that such programmes deliver any benefits.
Albeit with provision for ‘conscientious objection’.
Someone has a cognitive shortcoming “… when [they] are unaware of some relevant considerations, or there is a malfunction in [their] belief-formation process, such as a mistake in formal logic, forgetting something, overlooking evidence, not paying attention, or assessing evidence in a biased way (Davis 2010). Deep disagreements in this sense are sometimes called faultless disagreements (Kölbel 2003).
For a summary of vaccine monitoring systems and processes in the United States, see US CDC, ‘Vaccine Safety’.
The alleged correlation between the MMR vaccine and autism has been a particularly intense point of dispute since Anthony Wakefield and others published a subsequently retracted paper claiming such a link in 1998: See Wakefield et al. (1998). Wakefield is regarded as a fraud by vaccine advocates and a hero by opponents.
The anti-vaccine literature is most readily available through web-sites, a source which proves challenging for footnoting purposes if only because of the length of the URLS and addresses. Sites offering support for each the anti-vaccine claims listed in this paragraph, and more, can be accessed through http://www.whale.to/vaccines. I provide more specific references for some strands of the anti-vaccine side of the debate when I discuss them below.
See for instance “The ethical issues that arise when we seek to protect the population by immunising have long been clearly defined. The risks of adverse effects to individuals have to be balanced against the benefits to the community. Faced with an outbreak of smallpox… the public health authorities… vaccinated about 5 million people; the human costs of this were 45 known cases of post-vaccinal encephalitis with four deaths—an acceptable risk, in view of the enormous benefit, the safety of the city of 8 million, but a heavy price for the victims of vaccination, and their next of kin” (Last 1998, pp. 353–354).
See also Relman (1998).
These considerations would disqualify a disagreement from being deep in the first, ‘faultless’ sense: they amount to cognitive shortcomings.
The required coverage for different diseases rates vary depending upon the reproductive rate of the infective agent.
I argued that these two categories of disease generate different moral obligations. There was, I argued, a stronger obligation to vaccinate where doing so might lead to the eradication of a disease than there was where ongoing vaccination would be required for self-protection because eradication was not possible or likely.
One might count a policy of excluding non-vaccinated children from school during vaccine outbreaks as coercive, but, arguably, it is justified by the harm principle and permitted paternalism given the age of excluded children, and compels declaration of vaccination status and absence from school, not vaccination itself.
“Numerically, small numbers of children in NZ receive immunizations via the outreach services, and these services are expensive; however, these children are likely to be in the higher-needs group and hence there is an important ethical reason to support services to access them. Second, as immunization coverage gets higher in a community, these children become a significant percentage of those still missing out”. (Turner 2012, p. 10).
“The value of the lentils was about 40 rupees (about $1), equivalent to three quarters of 1 day’s wage, and the value of the thalis (plates) was about 75 rupees. … The amount roughly corresponds to the opportunity cost of time for the mother.” (Banerjeen et al 2010, pp. 2–3).
The Australian system has a much more straightforward remedy for these concerns. Conscientious objectors can collect the allowance that comprises the incentives, provided they obtain a letter from a vaccine-provider who has explained the risks and benefits of vaccination.
Some commentators have thought this distinction so difficult to locate that the disagreement about its placement is itself a deep disagreement in the sense I have described. “[T]he debate … is unresolvable”, they write, “because the positions arise out of irreconcilable paradigms. The argument that incentives maximize choice and therefore maximize freedom arises from the economic paradigm according to which an incentive is simply one form of trade. The alternative argument that incentives can constitute undue influence evaluates incentives as one form of power” (Grant and Sugarman 2004, p. 727). My own view is that these matters are better viewed as threats to equality, rather than autonomy. A reluctant choice may still be autonomous, but we might think it improper that some people face many more, and many more serious, reluctant choices than others.
As I speculated was the case for most non-vaccinators in New Zealand in the 1990s.
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Dare, T. Disagreement Over Vaccination Programmes: Deep Or Merely Complex and Why Does It Matter?. HEC Forum 26, 43–57 (2014). https://doi.org/10.1007/s10730-013-9227-z
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DOI: https://doi.org/10.1007/s10730-013-9227-z