title: Vaccine Refusal and Trust: The Trouble With Coercion and Education and Suggestions for a Cure.
abstract: There can be little doubt about the ethical imperative to ensure adequate vaccination uptake against certain infectious diseases. In the face of vaccine refusal, health authorities and providers instinctively appeal to coercive approaches or increased education as methods to ensure adequate vaccine uptake. Recently, some have argued that public fear around Ebola should be used as an opportunity for such approaches, should an Ebola vaccine become available. In this article, the author describes the difficulties associated with coercion and education when addressing vaccine opposition. Both coercion and education can cause opposite effects than intended in certain circumstances. The correct area of focus is to address the breakdown in trust within clinical relationships. The author presents suggestions for an approach towards vaccine refusal that may be more promising.
authors.affiliation: Department for Ethics, Humanities & Spiritual Care, Cleveland Clinic, Cleveland and Centre for Applied Ethics, University of Stellenbosch, Stellenbosch, South Africa. besterj@ccf.org.
authors.forename: Johan Christiaan
authors.initials: JC
authors.lastname: Bester
mesh_terms: D002755:Choice Behavior / Q000941:ethics; D003068:Coercion; D004196:Disease Outbreaks / Q000517:prevention & control*; D005610:Freedom; D006266:Health Education / Q000941:ethics / Q000379:methods / Q000639:trends; D006282:Health Personnel / Q000592:standards / Q000639:trends; D006801:Humans; D010290:Parents; D011369:Professional-Patient Relations / Q000941:ethics*; D011634:Public Health / Q000941:ethics / Q000331:legislation & jurisprudence / Q000379:methods / Q000592:standards; D012945:Social Values; D035521:Supreme Court Decisions; D035502:Trust; D014481:United States; D014611:Vaccination / Q000941:ethics / Q000331:legislation & jurisprudence / Q000523:psychology; D000072758:Vaccination Refusal / Q000331:legislation & jurisprudence / Q000523:psychology
keywords: Public health; Vaccination; Vaccine refusal