Immunisation: reviving the ‘social contract’

Gary Finnegan

Gary Finnegan

April 16th, 2012

Gary Finnegan

‘The decision to vaccinate yourself or your family can be viewed as a social contract whereby the majority of individuals take an action in the interest of protecting the entire community.’

TedxAccording to Angus Thomson, Director of Vaccination Advocacy at Sanofi Pasteur, who was the special guest at a TEDxBrussels event on April 5, the success of polio and smallpox vaccination gave birth to a new unwritten contract to cooperate in the name of public health.

“People understood that although there were risks associated with vaccination – albeit very very small – they were willing to accept this,” said Thomson.

He said that the minority of people who refuse vaccination “are willingly rejecting this contract because they no longer see the need for vaccines, because they no longer see the diseases”.

“If you willingly decide not to vaccinate your child you’re rolling a dice for your children. Furthermore you’re rolling the dice for others in your community, such as the very young and the immune-compromised.”

This, he added, is leading to the outbreak of diseases which had virtually disappeared from most countries. Thomson said diseases such as polio are like “dark passengers ready to rear their ugly heads” if immunisation rates fall, and he warned against complacency.

“When infectious diseases go viral it’s not measured in YouTube hits, it’s measured in deaths.”

[View Thomson’s Prezi presentation]

The resurgence of polio in northern Nigeria occurred when public trust in vaccination evaporated amid baseless conspiracy theories linking vaccination to a western plot against Muslim women.

The idea was endorsed by religious figures and polio spread to 20 countries within a couple of years, Thomson told the audience of technology experts, activists and business leaders.

“This wasn’t due to a lack of vaccines – it was due to a failure of the public to accept vaccines,” he said. Access to healthcare and vaccines is part of the equation but public acceptance is a major problem.

“Vaccines work but they don’t work if they stay in their boxes.” 

Thomson was speaking at a TEDx event in Brussels which coincided with the TEDxChange conference in Berlin hosted by The Gates Foundation.

TED began in 1984 as a conference devoted to ‘Ideas Worth Spreading’. These days it has grown into a global phenomenon, attracting renowned speakers and spawning a plethora of spin-off events across the world.


  1. Kirsty Armstrong

    Kirsty Armstrong

    April 17th, 2012

    I would really like to show this to my students when I teach them about vaccines-from where can I download it please?? It illustrates the use of social media and how to deal with those who do not vaccinate their kids

    • Gary Finnegan

      Gary Finnegan

      April 17th, 2012

      Dear Kirsty,

      Delighted you’re interested in sharing the video. You can view it via YouTube and show it to students if you’ve got an internet connection in the lecture room. I’ll see if we can get a copy of the original file, although my IT colleagues suggest it might be quite large. Will get back to you during the week.

  2. corina


    September 9th, 2012

    Maybe more people would be interested in your social contract if the vaccine-injured were honored for their sacrifice, the way soldiers are honored. Instead, the vaccine-injured are mocked and dismissed, their injuries are down-played or denied, they never get their day in court, and the vaccine manufacturers don’t even so much as offer and apology. In an effort to not show any weakness or flaws in the vaccine program, there is a concerted effort to deny even the most obvious injuries and dismiss some very honest concerns. This attitude is backfiring. When doctors look a parent in the eyes and say “vaccines are completely safe” and that parent is aware of the U.S. Government’s own published classification of vaccines as “unavoidably unsafe” trust is eroded, and this, more than anything else, is what is undermining the vaccine social contract.

    • Gary Finnegan

      Gary Finnegan

      September 10th, 2012

      Hi Corina,
      Thanks for your comment. I think you’re right that it would erode trust for doctors or anyone else to claim that “vaccines are completely safe” but I honestly don’t know any doctors who would say that.
      Any doctor, health official or manufacturer I’ve spoken to explains that there are rare cases of adverse events and that this risk is lower than the risk posed by the vaccine-preventable disease in question.
      You mention the US system for dealing with compensation claims arising from vaccine-related adverse events. The WHO has posted a review of the issue which looks at the situation around the world and concludes that ‘no-fault compensation schemes’ should be maintained. That paper acknowledges that “vaccines are not without risks and it is commonly accepted that, regardless of proper design, manufacture and delivery, adverse events occur following vaccination although serious adverse events are rare”.
      The following paragraph is also relevant to the points you raise:
      “At a population level, it is considered that these small risks are balanced by the benefits of widespread population immunization. However this means that an individual occasionally bears a significant burden for the benefit provided to the rest of the population. Although these vaccine-related adverse events occur occasionally due to negligence, more often there is no clearly attributable fault.”
      I do take your point that transparency is important for public trust. Personally I hate to hear of adverse events just as I hate to hear of children affected by vaccine-preventable diseases. I would hope that being straight with people about the real but small risks associated with vaccines could further increase the credibility of the majority of health professionals, academics and international experts (e.g. WHO, ECDC, UNICEF and so on) which strongly advocate immunisation programmes to protect public health.