Public engagement on childhood vaccination: Democratizing policy decision-making through public deliberation

Immunization is considered one of the most successful and cost-effective public health interventions by the World Health Organization, preventing an estimated 2 to 3 million deaths per year globally (WHO 2018). From a public health perspective, there is growing concern that vaccination rates are insufficient to effectively control the spread of infectious diseases. From a public trust perspective, there is increasing doubt in some groups of the claims made about vaccination by authorities. Active and meaningful public engagement in health service delivery and health research is considered essential to quality improvement of health services, greater responsiveness to public needs, and more legitimate, transparent and accountable decision-making. Public engagement through deliberative processes has garnered increasing interest from public health researchers and policy makers on a number of health-related topics, including priority setting, planning and governance of health services, and health technology assessment (Degeling et al 2015). Calls for deliberative approaches relating to vaccine-related policy decisions have also been made. Nevertheless, to our knowledge, there has not been any official, government-sponsored public engagement event for members of the public in Ontario to deliberate on the topic of childhood vaccination. In this chapter, we begin by providing a brief overview of current regulatory context in Ontario with regard to childhood vaccination. We then outline the Ontario Vaccine Deliberation, an academic led project in which a lay public was convened to discuss challenges and controversies regarding childhood vaccination in Ontario, and the recommendations that were generated and endorsed by the participants through small and large group discussions during the deliberation. We draw on the Ontario Vaccine Deliberation, as well as scholarly literature, to illustrate the importance of engaging publics in decision-making about childhood vaccination. We focus our discussion on the main issues that were raised during the deliberation, namely mandatory vaccination and nonmedical exemptions, communication about vaccination, and compensation for serious adverse events following immunization.