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25 Med., Health Care & Phil. 1 (2022)

handle is hein.journals/medhcph25 and id is 1 raw text is: Medicine, Health Care and Philosophy (2022) 25:1-2 https://doi.org/l0.1007/s11019-022-10071-6 EDITORIAL Tackling vaccine refusal Bert Gordijn' Henk ten Have2 Published online: 2 February 2022 ©The Author(s), under exclusive licence to Springer Nature B.V. 2022 The COVID-19 pandemic has demonstrated that developing and producing the right technical tools to combat the disease such as vaccines, test kits and masks might not suffice to guarantee success. Even when the tools are produced in suf- ficient numbers, and the logistics and pricing are such that they are readily available and affordable for everyone, if peo- ple are not willing to use those tools, they are not going to be effective. This circumstance points to an important public health policy challenge, i.e., to develop effective means to increase public uptake of the tools deemed necessary to fight a disease. This challenge has increasingly become the focus of much political and public discussion. Stigmatization In the first paper of the current issue Karki (2022) argues that ethical condemnation of vaccine refusal is not the most effective means to enhance vaccine uptake. In fact, labeling vaccine refusers as free riders who intend to enjoy the ben- efits of herd immunity without being willing to bear any of the burdens themselves is a mistake. Motivations Karki (2022) explains that social science research has cast serious doubt on the idea of free riding on herd immunity as the factual motivation of vaccine refusers. For one, inten- tional free riding is subverted by the dissemination of anti- vaccination material, and yet, vaccine refusers frequently engage in it. In fact, free riding does not seem to play a sub- stantial role in motivating vaccine refusal. Instead, refusal is most often motivated by other factors such as negative Bert Gordijn bert.gordijn@dcu.ie Dublin City University, Dublin, Ireland 2 Duquesne University, Pittsburgh, PA, USA experiences with healthcare workers, observed injustices within the healthcare system, distrust of healthcare institu- tions, and distance from the political establishment (Karki 2022). For a better conceptual analysis of these motivations Karki (2022) deploys Hirschman's (1970) ideas of exit and voice, whereby citizens' frustration with an institution is either articulated, by voice, or in case this is deemed inef- fective, by exit, i.e., by giving up on the institution alto- gether. If citizens have lost trust in the effectivity of public outcries, they may turn to more invisible forms of opposing policies (Karki 2022). In these terms, Karki (2022) argues that vaccine refusal could be regarded as an endeavour to exit the public good of herd immunity. Solutions If vaccine refusal is solely understood from a specific nor- mative angle whereby it is denounced as free riding, sanc- tions may seem appropriate. However, based on her analysis of the factual motivations of vaccine refusal, Karki (2022) is concerned that stigmatization and attempts to enforce compliance might generate further polarization instead of convincing vaccine refusers to change their ways. Vaccine mandates run the risk of enhancing distrust and grievances (Karki 2022). Instead, if hesitancy and refusal are to be understood in terms of an exit dynamic, it is necessary to improve the communication and information channels to better hear and address the concerns of the vaccine refus- ers. Overall, we need to conduct better and more empirical research to develop improved approaches to counter vaccine refusal with success (Karki 2022). A call for social science research Without commenting on the correctness of the details of Karki's (2022) analysis, her focus on the factual motiva- tions for vaccine refusal and her call for empirical research with a view to develop effective means to address it are spot 9 Springer

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