Title: Moral Obligation, Epistemology and Public Health: The Case of Vaccine Hesitancy
Funder: Arts and Humanities Research Council

Abstract: This project considers vaccine hesitancy as the expression of understudied problems at the intersection of ethics and epistemology. First, there is the problem of free-riding. The vaccine hesitant tend to want maximal amounts of evidence of vaccine safety. While demanding as much evidence as possible may be an epistemological virtue, in the case of vaccine hesitancy it may turn out to be a moral vice. By not deferring to the standards of evidence set by the public health experts, vaccine sceptics may engage in free-riding. A 'free-rider' is someone who receives some benefit from a system of social co-operation but refuses to contribute to the maintenance of the system which generates that benefit. Widespread refusal to contribute to maintenance of the system would mean that no one could enjoy the relevant benefit. Being vaccinated involves some costs, such as the exposure to risk of adverse reaction. Nonetheless, an individual not vaccinated in a community where everyone else is, still benefits from protection by herd immunity, so there will be no cost for a single individual of not being vaccinated. If an individual refuses to be vaccinated for no good reason, they enjoy the benefit of being vaccinated without paying the involved cost: hence, they are free-riding. A second problem concerns expertise. Living in a world of increasing specialisation, deference to experts is integral to even the most mundane activities. But which experts should one trust? How are medical knowledge and power related? How are we to distinguish between science for the people and science for corporate interests? When is it more rational to think for oneself than to defer to the relevant expert? What is the rational thing to do when one realises that one's own views disagree with those of the experts? These questions become particularly relevant when knowing whom or what to believe may make the difference between one's own survival and death, or the survival and death of one's children or other dependent relations. Third, there is the problem of trust in science and politics. Trust is indispensable to our everyday lives, yet it can be dangerous. If we don't trust others, we cannot function in society, but being overly trusting can leave us open to exploitation and abuse. And not only is trust pragmatic, but it also has a moral dimension: trustworthiness is a virtue, and well-placed trust often benefits us all. An under-theorised aspect of vaccine hesitancy is its relation to the ongoing crisis of trust in the political and social arena. Politicians are often held in contempt or distrusted by the public at the best of times: how can they be trusted to handle emergencies competently? There is increasing evidence of a correlation between political affiliation and hesitancy, with those on the right distrusting vaccines more, e.g. in France. How should the knowledge communication between experts and laypersons be designed so that it does not fail due to barriers of understanding and merchants of doubt? A successful communication strategy must take account of normal lay ignorance of virology and epidemiology as well as beliefs about the status of experts, the rights of parents, when they decide on vaccines for children and the elderly, and the conditions under which lay people are required to defer to expert opinion while exercising the right and perhaps the obligation to think for themselves and make their own choices.


Research activity codes: 3.4 VACCINES;7.1 INDIVIDUAL CARE NEEDS
Health categories: INFECTION