Moral Obligation, Epistemology and Public Health: The Case of Vaccine Hesitancy

这个项目认为疫苗犹豫是伦理学和认识论交叉点上未充分研究的问题的表达。首先，存在搭便车的问题。对疫苗犹豫不决的人往往希望获得最大数量的疫苗安全性证据。虽然要求尽可能多的证据可能是一种认识论上的美德，但在疫苗犹豫不决的情况下，它可能会成为一种道德恶习。由于不遵从公共卫生专家制定的证据标准，疫苗怀疑论者可能会搭便车。“搭便车者”是指从社会合作体系中获得某种利益，但拒绝为维护产生这种利益的体系做出贡献的人。普遍拒绝为维持该系统作出贡献将意味着没有人能够享受相关的福利。接种疫苗涉及一些成本，例如暴露于不良反应的风险。尽管如此，在一个其他人都在的社区中，一个没有接种疫苗的个体仍然受益于群体免疫的保护，因此，一个没有接种疫苗的个体不会有任何成本。如果一个人没有充分的理由拒绝接种疫苗，他们就可以享受接种疫苗的好处，而不必支付所涉费用：因此，他们是搭便车。生活在一个日益专业化的世界里，即使是最平凡的活动，对专家的尊重也是不可或缺的。那么，我们应该相信哪些专家呢？医学知识和权力有什么关系？我们如何区分科学为人民服务和科学为企业利益服务？什么时候自己思考比听从相关专家更理性？当一个人意识到自己的观点与专家的观点不一致时，什么是理性的做法？当知道相信谁或相信什么可能会影响一个人的生存与死亡，或一个人的子女或其他依赖关系的生存与死亡时，这些问题变得特别相关。第三，科学和政治的信任问题。信任对我们的日常生活是不可或缺的，但它可能是危险的。如果我们不信任他人，我们就不能在社会中发挥作用，但过度信任会让我们容易受到剥削和虐待。信任不仅是务实的，而且它还有一个道德维度：值得信赖是一种美德，适当的信任通常会使我们所有人受益。疫苗犹豫的一个理论不足的方面是它与政治和社会竞技场中持续的信任危机的关系。即使在最好的情况下，公众也常常对政客不屑一顾或不信任：如何才能相信他们能够胜任处理紧急情况？越来越多的证据表明，政治派别和犹豫不决之间存在关联，右翼人士更不信任疫苗，例如在法国。专家和外行之间的知识交流应该如何设计，才不会因为理解的障碍和怀疑的商人而失败？一个成功的传播策略必须考虑到普通人对病毒学和流行病学的无知，以及对专家地位的信念，父母在决定为儿童和老年人接种疫苗时的权利，以及要求普通人在行使自己思考和做出自己选择的权利（也许是义务）时听从专家意见的条件。

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.