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This first chapter introduces some ethically relevant concepts that illustrate why we need an “ethics of vaccination”, such as “herd immunity”, “public good”, and “vaccine refusal”. It argues that the choice whether to vaccinate oneself or one’s children is by its own nature an “ethical” choice: it requires individuals to act not only or even not primarily to promote their self-interest but also or even primarily to contribute to an important public good like herd immunity. Besides, since herd immunity is an important public good, ethical questions arise also at the level of state action with regard to the obligations to implement vaccination policies, if necessary coercive ones, that allow to realize herd immunity.

This chapter discusses the relation between collective, individual, and institutional responsibilities with regard to the realization of herd immunity from certain infectious diseases. The argument is put forth that there is a form of collective moral obligation to realize herd immunity, that there is a principle of fairness in the distribution of the burdens of collective obligations, and that such principle entails that each of us has the individual moral responsibility to make their fair contribution to herd immunity through vaccination. These individual moral obligations, in turn, entail a further individual obligation to support policies aimed at realizing herd immunity. The chapter concludes with a suggestion that the individual moral obligations to support such policies generate an institutional responsibility to implement them.

The principle of least restrictive alternative (PLRA) states that policymakers have significant reason to implement the policy that is effective in achieving a certain result and that is least restrictive of individual liberty or autonomy. This chapter provides a ranking of vaccination policies, or an intervention ladder, on the basis of the PLRA, assessing the level of coercion of each type of policy. The ranking of vaccination policies I suggest, in order of increasing restrictiveness or coerciveness, is as follows: persuasion, nudging, financial incentives, disincentives (including withholding of financial benefits, taxation, and mandatory vaccination), and outright compulsion. Each type of policy suggestion is presented with a discussion of the level of restrictiveness or coerciveness involved and the potential effectiveness.

This chapter presents an argument for compulsory vaccination and against allowing non-medical vaccine exemptions. The argument is based on the idea that the proper aim of vaccination policies should be not only herd immunity but also a fair distribution of the burdens entailed by its realization. I argue that a fairness requirement need not and should not be constrained by a principle of liberty and a principle of least restrictive alternative. Indeed, I argue how compulsory vaccination is more successful than other types of vaccination policies at satisfying the principles of fairness, least restrictive alternative, and maximizing expected utility, once these principles have been properly understood.