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Vaccination: Is There a Place for Penalties for Non-compliance?

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The introduction of punitive measures to control outbreaks of measles in Europe has sparked debate and public protest about the ethical justification of penalties and exclusionary processes for non-immunisation. This article advances an ethics framework related to compulsory vaccination policies, which we use to analyse three case studies: of mandatory policies that are enforced by fines; of policies that require vaccination for the provision of social goods; and of community-led policies in which communities themselves decide how to enforce vaccination compliance. We report on contemporary, ongoing and past measures that have been used to increase vaccine uptake, consider their rationale and the related public responses, elaborate on socio-cultural and contextual influences, and discuss the ethical justification for mandatory vaccination. We argue for a measured approach that protects fundamental human rights to evidence-based information and medical counsel to support health decision making and that simultaneously raises awareness about the role of immunisation in protecting the wider community. We think more emphasis needs to be placed on immunisation as a means of promoting social good, reducing harm and protecting vulnerable groups.

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This research was supported by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Immunisation at London School of Hygiene and Tropical Medicine in partnership with Public Health England (PHE). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health or PHE. This paper also draws on some research findings from a study funded by ‘The International Rescue Committee’, the grantee to the International Initiative for Impact Evaluation (3ie).

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Tracey Chantler wrote the first draft of this paper. Emilie Karafillakis and James Wilson commented on the first draft and contributed to writing the final draft.

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Correspondence to Tracey Chantler.

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Tracey Chantler, Emilie Karafillakis and James Wilson have no conflicts of interest to report.

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Chantler, T., Karafillakis, E. & Wilson, J. Vaccination: Is There a Place for Penalties for Non-compliance?. Appl Health Econ Health Policy 17, 265–271 (2019).

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