Childhood immunization, vaccine hesitancy, and provaccination policy in high-income countries

Increasing vaccine hesitancy among parents in high-income countries and the resulting drop in early childhood immunization constitute an important public health problem, and raise the issue of what policies might be taken to promote higher rates of vaccination. This article first outlines the background of the problem of increasing vaccine hesitancy. It then explores the pros and cons of 3 types of policy: (a) interventions focused on increasing awareness of the benefits of vaccination while eliminating mistaken perceptions of risks, (b) “nudges,” which make certain choices more likely to be voluntarily chosen by manipulating the decision environment, and (c) policies that impose costs to make nonvaccination undesirable even for parents who are hesitant. It argues that a wide range of policies, including coercive policies, is desirable from a public health perspective, as the least intrusive policies alone are unlikely to achieve and sustain the important public good of herd immunity