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Vaccination Mandates vs Opt-Out Programs and Rates of Influenza Immunization—Reply

Vaccination Mandates vs Opt-Out Programs and Rates of Influenza Immunization—Reply In Reply: Dr Rakita and colleagues relate our study findings to influenza vaccination of health care workers. It is important to clarify that our study participants were not health care workers but rather university faculty and staff, who tend to have influenza vaccination rates that are lower than that of health care workers1 and close to the national average. The default effect has theoretical implications that go beyond influenza vaccination, as it could potentially be used to encourage a variety of healthy behaviors. Rakita et al are correct that mandating vaccination does indeed raise vaccination rates above what can be achieved with an opt-out intervention. Mandates, however, require enforcement and consequences for noncompliance. It seems likely that most US citizens want to preserve a voluntary basis for most healthy behaviors. In some cases healthy behaviors cannot be mandated because doing so would be unethical (mandating organ donation) or difficult to enforce (mandatory adherence to an outpatient medication regimen). In addition, sometimes a vaccination mandate meets with considerable resistance. For example, although the Japanese mandate for influenza vaccination of school children in the 1980s decreased influenza mortality among elderly persons, the mandate was discontinued in 1994.2 In February 2007, Texas Governor Rick Perry issued an executive order to mandate vaccination against human papilloma virus (HPV) for sixth grade girls, but the state legislature rescinded that order 3 months later.3 When it is important to preserve freedom of choice, an opt-out intervention can be useful for nudging decision makers toward the healthy option.4 Indeed, the HPV vaccination mandate in Virginia and Washington, DC, is in reality an opt-out program, because parents can choose not to participate.5 Back to top Article Information Financial Disclosures: None reported. References 1. Capolongo MJ, Dibonaventura MD, Chapman GB. Physician vaccinate thyself: why influenza vaccination rates are higher among clinicians than among nonclinicians. Ann Behav Med. 2006;31(3):288-29616700643PubMedGoogle ScholarCrossref 2. Reichert TA, Sugaya N, Fedson DS, Glezen WP, Simonsen L, Tashiro M. The Japanese experience with vaccinating schoolchildren against influenza. N Engl J Med. 2001;344(12):889-89611259722PubMedGoogle ScholarCrossref 3. Hoppe C. Legislature defeats HPV mandate, Perry. May 9, 2007. Dallas Morning News Web site. http://www.dallasnews.com/sharedcontent/dws/news/texassouthwest/stories/DN-hpv_09tex.ART0.State.Edition2.42f0a16.html. Accessed August 12, 2010 4. Thaler RH, Sunstein CR. Nudge: Improving Decisions About Health, Wealth, and Happiness. New Haven, CT: Yale University Press; 2008 5. HPV vaccine a suggestion, not mandate, in US. MSNBC Web site. http://www.msnbc.msn.com/id/32628957/. Accessed August 12, 2010 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Vaccination Mandates vs Opt-Out Programs and Rates of Influenza Immunization—Reply

Chapman, Gretchen B.
JAMA , Volume 304 (16) – Oct 27, 2010
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Vaccination Mandates vs Opt-Out Programs and Rates of Influenza Immunization—Reply

Abstract

In Reply: Dr Rakita and colleagues relate our study findings to influenza vaccination of health care workers. It is important to clarify that our study participants were not health care workers but rather university faculty and staff, who tend to have influenza vaccination rates that are lower than that of health care workers1 and close to the national average. The default effect has theoretical implications that go beyond influenza vaccination, as it could potentially be used to encourage a...
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References (5)

Publisher
American Medical Association
Copyright
Copyright © 2010 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2010.1479
Publisher site
See Article on Publisher Site

Abstract

In Reply: Dr Rakita and colleagues relate our study findings to influenza vaccination of health care workers. It is important to clarify that our study participants were not health care workers but rather university faculty and staff, who tend to have influenza vaccination rates that are lower than that of health care workers1 and close to the national average. The default effect has theoretical implications that go beyond influenza vaccination, as it could potentially be used to encourage a variety of healthy behaviors. Rakita et al are correct that mandating vaccination does indeed raise vaccination rates above what can be achieved with an opt-out intervention. Mandates, however, require enforcement and consequences for noncompliance. It seems likely that most US citizens want to preserve a voluntary basis for most healthy behaviors. In some cases healthy behaviors cannot be mandated because doing so would be unethical (mandating organ donation) or difficult to enforce (mandatory adherence to an outpatient medication regimen). In addition, sometimes a vaccination mandate meets with considerable resistance. For example, although the Japanese mandate for influenza vaccination of school children in the 1980s decreased influenza mortality among elderly persons, the mandate was discontinued in 1994.2 In February 2007, Texas Governor Rick Perry issued an executive order to mandate vaccination against human papilloma virus (HPV) for sixth grade girls, but the state legislature rescinded that order 3 months later.3 When it is important to preserve freedom of choice, an opt-out intervention can be useful for nudging decision makers toward the healthy option.4 Indeed, the HPV vaccination mandate in Virginia and Washington, DC, is in reality an opt-out program, because parents can choose not to participate.5 Back to top Article Information Financial Disclosures: None reported. References 1. Capolongo MJ, Dibonaventura MD, Chapman GB. Physician vaccinate thyself: why influenza vaccination rates are higher among clinicians than among nonclinicians. Ann Behav Med. 2006;31(3):288-29616700643PubMedGoogle ScholarCrossref 2. Reichert TA, Sugaya N, Fedson DS, Glezen WP, Simonsen L, Tashiro M. The Japanese experience with vaccinating schoolchildren against influenza. N Engl J Med. 2001;344(12):889-89611259722PubMedGoogle ScholarCrossref 3. Hoppe C. Legislature defeats HPV mandate, Perry. May 9, 2007. Dallas Morning News Web site. http://www.dallasnews.com/sharedcontent/dws/news/texassouthwest/stories/DN-hpv_09tex.ART0.State.Edition2.42f0a16.html. Accessed August 12, 2010 4. Thaler RH, Sunstein CR. Nudge: Improving Decisions About Health, Wealth, and Happiness. New Haven, CT: Yale University Press; 2008 5. HPV vaccine a suggestion, not mandate, in US. MSNBC Web site. http://www.msnbc.msn.com/id/32628957/. Accessed August 12, 2010

Journal

JAMA – American Medical Association

Published: Oct 27, 2010

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