DOI: https://doi.org/10.1111/bioe.13344

Abstract: An increasing vaccine hesitancy among parents, which has resulted in insufficient rates of immunization, provides reason to reconsider childhood vaccination practices. Studies suggest that parents' decision-making process concerning whether to vaccinate their child is highly influenced by cognitive biases. These biases can be utilized to increase vaccination uptake via changes in the choice context. This article considers childhood vaccination programmes, which involve children being vaccinated in school or daycare unless their parents actively ‘opt out’. We suggest that such programmes reconcile parents' decisional authority and vaccination duties. First, opt-out childhood vaccination based in schools or daycare centres are not disrespectful of parental authority. Second, the programme aligns the default setting with a moral obligation to vaccinate one's child that most parents have (open access).

The article is part of a collaboration with VIVE and supports an ongoing project on child vaccination programs financed by the Novo Nordisk Foundation. Part of the article focuses on social inequality in health care and suggests that changing the default to opt-out vaccination might have an especially positive effect on vaccination uptake in more deprived areas. However, Andersen D. B. and Pedersen V. M. L. argue more evidence is needed to establish whether there is in fact a social gradient in the default effect.