A lesson from COVID-19: Persuasion can be a more powerful tool than mandates in improving vaccine uptake

By Jennifer O’Neill.

Only months ago, it would have been hard to believe that the citizens of Western democracies would forsake their basic liberties. Yet, in recent weeks, the public have accepted that life as we know it is on hold for an undefined period of time and that during that time they cannot see friends or family, nor even say goodbye to dying loved ones. If, months ago, we had been asked to consider what it would take for such a situation to become reality, the only conceivable option might have been through some form of government mandate.

However the UK Coronavirus Act 2020 only mandates the isolation of those infected, or suspected to be infected, with the SARS-CoV-2 virus. It has, instead, been a strong campaign of government information disclosure and persuasion which has compelled the general public to accept that such measures are necessary to mitigate the harm caused by this new pathogen. To protect our health services and one another, people have taken extraordinary measures to restrict contact with the outside world. This serves as a testament to the power of public health persuasion founded upon engagement and information sharing.

Last year when a state of emergency was declared in New York State, on account of a measles epidemic, few would have foreseen that one year later the world would be gripped by a global pandemic. At that time, the issue of a measles resurgence sparked debate over whether compulsory vaccination should be introduced in the United Kingdom. This is, perhaps, an ever-more pertinent question as the world battles to contain a new disease. In light of recent events, some may argue that compulsory vaccine mandates are even more crucial. However, studies have yet to show a direct link between vaccination mandates and increased uptake. Improvement has however been linked to enhanced public information campaigns. During recent weeks, the public have embraced government guidance on issues from hand washing to social distancing.

Similarly, society needs to be better informed about the importance of routine childhood vaccinations. Reports suggest that in wake of the COVID-19 outbreak, measles vaccine uptake rates are falling further. However, this should not be interpreted as a growing resistance to vaccination. There has been a sharp decline in patients seeking treatment across all medical specialities, even emergency admissions – such is the awareness of potential COVID-19 transmission. On the contrary, current public awareness of disease transmission is likely to favour vaccination and may even have silenced some anti-vaxxers.

Now is the time to engage and inform parents of the importance of vaccinations, in order to tackle the international risk of vaccine-preventable disease in children. When proposing a medical treatment, doctors must gain informed consent which involves explaining the “material” risks and benefits of any treatment. A material risk is one which a reasonable person would consider significant. Since parents are making decisions on behalf of their children, arguably doctors should go further to persuade parents to consider why certain treatments may be in their child’s best interests. COVID-19 has demonstrated, to great effect, that when it comes to disease, we do not live in isolation. It has shown how unimmunised individuals can act as hosts for disease pathogens, risking the spread of disease throughout society and putting the most vulnerable at risk.

Parental decisions on vaccination, therefore, should not focus solely upon individual risk, but wider risk too. To facilitate parents in making decisions, doctors should engage in a discussion about both the risks to the individual child and society.  This would include a conversation about the side effects of any given vaccine. It would also address the increased risk of disease which comes with choosing not to vaccinate – not only in the individual child, but to society as a whole.

Recent statistics show that parental confidence in vaccines was as high as 95% in 2019. Therefore, sustainable vaccine uptake, and improved herd immunity can likely be achieved through informed consent and persuasion.

Last year the Royal College of Paediatrics and Child Health warned that vaccine mandates would, instead, backfire to create determined vaccine refusers. In light of the current curtailments to freedoms, and heightened conspiracy theories surrounding COVID-19, a vaccine mandate would likely backfire, creating determined refusers. By instead fully informing parents and even using persuasion to appeal to a sense of social-obligation to vaccinate and contribute to herd immunity, the medical community can uphold parental autonomy whilst building trust in the profession.The COVID-19 outbreak has demonstrated that the public can come together, whether it be to celebrate our health service, offer signs of hope or to achieve a collective goal, such as protecting the health of the most vulnerable.


Paper title: The Case for Persuasion in Parental Informed Consent to Promote Rational Vaccine Choice

Author(s):  Jennifer O’Neill


Lecturer, University of Glasgow, College of Medical, Veterinary & Life Sciences

Course Co-ordinator for Clinical Bioethics and Legal Medicine, European University Cyprus, School of Medicine

Competing interests:  No competing interests

Social media accounts of post author(s): Twitter:  @j_o_neill_

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