1.5.2.4 What to do if someone refuses the vaccination of themselves or their children?

In the context of the necessary ‘informed consent’, it is to be welcomed that people form their own thoughts about the medical interventions and applications a person undergoes, including with regard to vaccination. However, if the consequence of this is that vaccination rates fall, one has to wonder whether these choices are right. Where people can and may still weigh up for themselves whether they consider the risks proportionate, additional considerations apply in terms of the health of society as such. Vaccination is a particularly light intervention that eliminates serious diseases. This trade-off should always be in favour of vaccination. Moreover, people who do not get vaccinated on the basis of loss of sense of urgency will begin to see the need for it again when it becomes clear that some infectious diseases are gaining ground again.

A difficult question is what should be done in respect of someone who refuses vaccination of himself or his children. According to the principle of freedom and responsibility (see Chapter I.2.2.4), a person cannot in principle be forced to undergo treatment. This also applies to vaccination. At most, the competent government may decide to make people undergo treatment under duress for the sake of public welfare. For instance, under certain circumstances, it may order that a prisoner on hunger strike be forcibly administered food and fluids to prevent him from becoming a martyr in the eyes of his supporters. Forced vaccination of people who have conscientious objections to it convinced in conscience that they should not have them vaccinated, however, goes too far. The same applies with regard to the temporary disqualification of parents from parental rights to vaccinate their children. Forced vaccination would be a traumatic experience for the people in question and for the parents and their children. It should be borne in mind that a vaccination rate of 95% and above provides society with adequate protection against epidemics of serious infectious diseases. From this perspective, it is acceptable if a small percentage of people are not vaccinated on the basis of conscientious objections.

The government can take a number of measures to try to increase vaccination coverage. Broadly speaking, there are two types of measures, suggested by the media and politicians and applied to varying degrees in western countries (France, Germany, Britain, Australia). The first measure involves a financial incentive, mainly in the form of a child benefit reduction for parents who do not have their children vaccinated; the second measure involves banning unvaccinated children from childcare. This is also already practised in the Netherlands, although it is not yet allowed under Dutch law. Incidentally, childcare managers are already finding so much sympathy for their position even now, especially because of the risks that children younger than the vaccination age face when unvaccinated children are admitted to the nursery, that it is expected that there will be no point for parents to take legal action against this decision. However, if these measures become legally enshrined, this will also meet resistance. Support for the desire to forgo vaccination should not be underestimated. That this support is strong is evidenced by the falling vaccination rate

Is it right to punish people who reject vaccination financially or practically for it? Society has many proper examples of punitive measures for undesirable behaviour, ranging from a visit by the school attendance officer to parents of truant children (behaviour that does not comply with the regulations on compulsory education), to excise taxes on alcohol and tobacco, to encourage people to live a healthier way of life (while the use of alcohol and tobacco is not prohibited by law). The question here is whether behaviour is harmful and needs correction. That maintaining high vaccination rates is important for society needs no argument. In this sense, the government may certainly take guiding measures in view of the common good, for which it bears primary responsibility. The severity of the measures to be taken against undesirable behaviour should be in proportion to the seriousness of the damage that that undesirable behaviour causes to the public welfare. Clearly, a high vaccination rate is important, but also that if a small percentage of the population rejects vaccination, it does not pose a high risk of spreading infectious diseases and thus does not have a serious impact on public welfare. Moderation in the application of punitive measures therefore seems appropriate. The government should therefore first try to achieve the desired vaccination rate among the population through information and media campaigns before considering punitive measures. This involves providing accurate and reliable information about the risks of not vaccinating for those involved and society and about the risks associated with vaccination. It will have to be made clear that fully proportionate to the risks of the infectious disease it prevents. It will also be necessary to point out the responsibility one bears not only for one’s own health but also for that of society.

There is thus a delicate balance: vaccination is morally right and also a moral duty and should be promoted. However, there are also good reasons not to judge harshly people who want to refrain from vaccination, especially when they are convinced that it goes against their conscience. Vaccination implies an act, which, more than any other, presupposes the free consent of human beings: it involves an intervention in the body. Admittedly a limited one, but the intrusion and intervention into the human body in any form is a delicate subject. In the Dutch Constitution, this sensitivity is expressed in Article 11:

“Everyone has the right, subject to any limitations to be imposed by or under the law, to the inviolability of his body”. Compared to other (international) treaties or the Universal Declaration of Human Rights, this right to the integrity of the body is very explicitly articulated in the Dutch Constitution.