Background: Policy decisions about childhood vaccination require consideration of multiple, sometimes conflicting, public health and ethical imperatives. Examples of these decisions are whether vaccination should be mandatory and, if so, whether to allow for non-medical exemptions. In this article we argue that these policy decisions go beyond typical public health mandates and therefore require democratic input. Methods: We report on the design, implementation, and results of a deliberative public forum convened over four days in Ontario, Canada, on the topic of childhood vaccination. Results: 25 participants completed all four days of deliberation and collectively developed 20 policy recommendations on issues relating to mandatory vaccinations and exemptions, communication about vaccines and vaccination, and AEFI (adverse events following immunization) compensation and reporting. Notable recommendations include unanimous support for mandatory childhood vaccination in Ontario, the need for broad educational communication about vaccination, and the development of a no-fault compensation scheme for AEFIs. There was persistent disagreement among deliberants about the form of exemptions from vaccination (conscience, religious beliefs) that should be permissible, as well as appropriate consequences if parents do not vaccinate their children. Conclusions: We conclude that conducting deliberative democratic processes on topics that are polarizing and controversial is viable and should be further developed and implemented to support democratically legitimate and trustworthy policy about childhood vaccination.
Bibliographical noteThis is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/
licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not
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This project was funded by the Canadian Institutes of Health Research (FRN: 149074) and the Ontario Ministry of Research and Innovation (ER14-10-056). We are grateful to members of the Discourse, Science, Publics research group at the University of Guelph for their help in implementing the Ontario Vaccine Deliberation. We would like to thank Natasha Crowcroft and Timothy Caulfield for assistance in the conception of the project. Thank you to the expert speakers and members of the policy panel who came to engage with us at the deliberation. We are grateful to Heather Douglas and the Balsillie School of International Affairs for providing a venue for the Ontario Vaccine Deliberation. Thanks to the editor and three anonymous reviewers for valuable comments on an earlier version of this article. And finally, a warm and heartfelt thank you to the participants in the Ontario Vaccine Deliberation, who tackled the topic with sincerity, an open mind, and a will to develop solutions that take into account the diversity of opinions around them, even if they disagreed with them.
- childhood vaccination
- public deliberation
- non-medical exemptions
- vaccination policy
- value trade-offs
- Childhood vaccination