With the Congress in Santa Clara only days away we are delighted to share another exclusive Congress Conversation ahead of the event. In this interview we hear from Professor Mark Navin, who will join us for a roundtable and a panel discussion. This conversation was conducted over email, and we are very grateful that Professor Navin made time to answer our questions! In the interview we refer to a book, America’s New Vaccine Wars, written by Professor Navin and Associate Professor Attwell. For details of the book and where you can purchase it, please read to the bottom of the interview.  

Introducing Professor Navin 

Professor Navin kindly explains that he is a philosopher and bioethicist at Oakland University, working on “ethical issues in both clinical decision making and public health policy, especially immunisation”. He also works as a clinical ethicist for the Corewell Health system.  

It is also helpful to introduce his colleague, Associate Professor Katie Attwell, with whom he wrote the book and who will also join us at the Congress. She is a vaccination policy scholar who leads VaxPolLab at the University of Western Australia and has an honorary appointment with the Wesfarmers Centre of Vaccines and Infectious Diseases at Telethon Kids Institute, Perth.  

Vaccine mandates: politics and policy 

The first session that Professor Navin will lead is the roundtable on the “politics and policy of vaccine mandates in California and around the world”. We asked if vaccine mandates have become more politically significant in recent years. Professor Navin comments that “school-based vaccine mandates in the United States” were not always as “politically contentious” as they are now. 

“Historically, these mandates enjoyed bipartisan support among state and national political leaders.” 

Indeed, he refers the introduction of nonmedical exemptions (NMEs) as a “strategy to make vaccine mandates less contentious”. The “main advocates” of new school mandates in the 1960s and 1970s “did not view these policies as coercive”. 

“They believed that mandates should encourage parents to seek vaccinations for their children, rather than force them. The idea was that by allowing objectors to opt out, resistance to new mandates and vaccination in general could be minimised.” 

When these NMEs were introduced, policymakers “anticipated that only a few people” would request them, “expecting overall compliance to remain high”. However, Professor Navin suggests that “recent efforts to eliminate NMEs have made vaccine mandates more politically contentious”.  

“Eliminating NMEs is not a minor policy adjustment but is a significant change. It replaces efforts to persuade people to vaccinate with an ultimatum: vaccinate your children or they cannot attend school.” 

Professor Navin believes that this “shift in policy” has “radically reshaped” immunisation governance, causing “politicised conflict” about vaccines. 

The United States

Professor Navin’s book, America’s New Vaccine Wars, has a US focus. We asked him to comment on any distinguishing features in the American vaccine landscape compared to the rest of the world, or to address any concerns that the book raises. He reflects that the book highlights how California’s “more coercive approach” to vaccine policy, including the elimination of NMEs, “served as a point of reference for policy changes” in other “high-income countries”. These include Italy, Australia, France, and Germany, although Professor Navin recognises “local” reasons for “revising or implementing” vaccine mandates in these countries.  

“A pressing question we want to explore in our roundtable is why vaccine mandate reforms have been so much more politically contentious in the US than they have been in other countries. We think part of an answer to that question is that different political values motivate people in different countries.” 

So, what values does Professor Navin identify in the US? 

“We suspect that America’s robust culture of ‘parental rights’, its libertarian anti-government tendencies, and the low value it places on children’s rights help to explain popular resistance to more coercive vaccine laws.” 
Vaccine Wars 

Turning to Professor Navin’s book, America’s New Vaccine Wars, we note the emotive imagery of “war”, and questioned him on this choice and its implications. He states that the term “vaccine wars” in the book refers to “the emergence of intense and polarised conflicts” over immunisation policy in the US. 

“The war metaphor identifies these conflicts as failures of democratic politics: they often involve simplistic thinking about public health goals and individual rights, leading to threats and acts of violence against public health officials, school board members, and government representatives.” 

These wars have “disrupted communities, damaged relationships, and even prevented children from attending school”.  

“The book’s intent is not to defend these ‘vaccine wars’ but to explain them. In particular, the goal is to question whether efforts to eliminate nonmedical exemptions may have unintentionally contributed to these wars.”  

For many of us, COVID-19 may have brought attention to the intensity of these ‘wars’, but Professor Navin warns against blaming the pandemic for “the failures of America’s immunisation social order”. 

“Mid-2010s battles over NMEs illustrate that this order was already breaking down before the pandemic.” 
Adapting to our times 

If you have read Professor Navin and Associate Professor Attwell’s essay for TIME, you may recall the phrase “adapting to the times we live in”. We asked what implications this has for the vaccine community.  

“The book suggests that we may need to adapt to a world where the immunisation social order is unable to control vaccine-preventable infections as effectively as in the past. This adaption involves preparing for a future with lower immunisation levels and more frequent outbreaks of vaccine-preventable diseases.” 

The book “draws an analogy to climate change” to suggest that “just as communities are slowly adopting an adaption orientation” to climate change, a similar strategy may be required for immunisation.  

“In this new reality, individuals and private institutions will have a crucial role. They will need to decide how to respond to the increase in outbreaks, especially in communities where governments are unable or unwilling to implement mandates or other disease control measures.” 

Professor Navin suggests that private institutions, “including businesses and cultural organisations”, might need to implement their own disease control measures or vaccine mandates to “protect their economic interests and ensure the health and safety of our workforce”.  

“Importantly, continuing to increase the coercive capacities of mandates by eliminating NMEs may not be a successful policy model for the entire country. This is due to potential implementation failures and resistance from vaccine-refusing parents. Therefore, in a scenario where support for school vaccine mandates diminishes, individuals and institutions will need to find new ways to manage and mitigate the risks associated with lower vaccination rates.” 
Why WVC? 

Our final question, as always, invites our speakers to share their reasons for joining us. For Professor Navin, opportunities to learn from “other presenters and attendees” during his sessions and others, is exciting. 

“The World Vaccine Congress plays a centrally important organising role for communities that care about immunisation. I’m delighted to get to play a part!” 

We are so grateful to Professor Navin for his fascinating perspective on immunisation policy. As promised, the details for purchasing his book are below: 

Link to purchase on Amazon 

Link to purchase through Oxford University Press  

For those of you who choose to go through OUP, Professor Navin has generously shared a discount code for 30% off: AMPROMD9.  

If you’d like to join us at Professor Navin’s sessions in Santa Clara, it’s not too late to get your tickets here! Once you have your tickets make sure you sign up to the roundtable on our app to secure your space. If you can’t make it, do subscribe for more insights like this.