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Victims, vectors and villains: are those who opt out of vaccination morally responsible for the deaths of others?
  1. Euzebiusz Jamrozik1,
  2. Toby Handfield2,
  3. Michael J Selgelid1
  1. 1Centre for Human Bioethics, SOPHIS, Monash University, Clayton, Victoria, Australia
  2. 2Department of Philosophy, SOPHIS, Monash University, Clayton, Victoria, Australia
  1. Correspondence to Dr Euzebiusz Jamrozik, Centre for Human Bioethics, Monash University, Clayton, VIC, 3800, Australia; zeb.jamrozik{at}monash.edu

Abstract

Mass vaccination has been a successful public health strategy for many contagious diseases. The immunity of the vaccinated also protects others who cannot be safely or effectively vaccinated—including infants and the immunosuppressed. When vaccination rates fall, diseases like measles can rapidly resurge in a population. Those who cannot be vaccinated for medical reasons are at the highest risk of severe disease and death. They thus may bear the burden of others' freedom to opt out of vaccination. It is often asked whether it is legitimate for states to adopt and enforce mandatory universal vaccination. Yet this neglects a related question: are those who opt out, where it is permitted, morally responsible when others are harmed or die as a result of their decision? In this article, we argue that individuals who opt out of vaccination are morally responsible for resultant harms to others. Using measles as our main example, we demonstrate the ways in which opting out of vaccination can result in a significant risk of harm and death to others, especially infants and the immunosuppressed. We argue that imposing these risks without good justification is blameworthy and examine ways of reaching a coherent understanding of individual moral responsibility for harms in the context of the collective action required for disease transmission. Finally, we consider several objections to this view, provide counterarguments and suggest morally permissible alternatives to mandatory universal vaccination including controlled infection, self-imposed social isolation and financial penalties for refusal to vaccinate.

  • Public Health Ethics
  • Ethics

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors All authors contributed to the research and the writing of this article, and approved the final manuscript.

  • Funding Green Templeton College, Ethox Centre and Green Templeton College, Oxford University (Andrew Markus Visiting Scholarship), Monash University (Australian Postgraduate Award).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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