Nudges or mandates? The ethics of mandatory flu vaccination. Issue 22 (21st May 2015)

• Record Type: Journal Article
• Authors: Dubov, Alex; Phung, Connie
• Is Part Of: Vaccine. Volume 33:Issue 22(2015)
• Page Start: 2530
• Page End: 2535
• Publication Date: 2015-05-21
• Subjects: Influenza vaccination -- Healthcare professionals -- Vaccination mandates -- Behavioral economics -- Choice architecture; Vaccines -- Periodicals; 615.372
• DOI: 10.1016/j.vaccine.2015.03.048
• Languages: English
• ISSNs: 0264-410X

Abstract

Highlights: Influenza vaccination mandates are very effective but controversial. Those opposing mandates believe it is unethical to remove one's choice about own health. Behavioral economics offers choice-preserving strategies to increase vaccination. These strategies incentivize vaccinations and help better align intentions with actions. Abstract: According to the CDC report for the 2012–2013 influenza season, there was a modest increase in the vaccination coverage rate among healthcare workers from 67% in 2011–2012, to 72% in 2012–2013 to the current 75% coverage. This is still far from reaching the US National Healthy People 2020 goal of 90% hospitals vaccination rates. The reported increase in coverage is attributed to the growing number of healthcare facilities with vaccination requirements with average rates of 96.5%. However, a few other public health interventions stir so much controversy and debate as vaccination mandates. The opposition stems from the belief that a mandatory flu shot policy violates an individual right to refuse unwanted treatment. This article outlines the historic push to achieve higher vaccination rates among healthcare professionals and a number of ethical issues arising from attempts to implement vaccination mandates. It then turns to a review of cognitive biases relevant in the context of decisions about influenza vaccination (omission bias, ambiguity aversion, present bias etc.) The article suggests that a successful strategy for policy-makers and others hoping to increase vaccination rates is to design a "choice architecture" that influences behavior of healthcare professionals without foreclosing other options. Nudges incentivize vaccinations and help better align vaccination intentions with near-term actions.