{"version":"1.0.0","segments":[{"startTime":0.0,"endTime":3.0,"body":"(swooshing sounds)"},{"startTime":6.54,"endTime":8.79,"body":"- Welcome, thanks very much coming today."},{"startTime":8.79,"endTime":11.31,"body":"I'm going to talk to you"},{"startTime":8.79,"endTime":11.31,"body":"today, I'm Imogen Goold."},{"startTime":11.31,"endTime":12.36,"body":"I'm from the University of Oxford."},{"startTime":12.36,"endTime":13.32,"body":"I'm going to talk to you today"},{"startTime":13.32,"endTime":14.43,"body":"about whether it would be right"},{"startTime":14.43,"endTime":16.602,"body":"to make vaccination mandatory."},{"startTime":16.602,"endTime":19.11,"body":"Now this is in the second"},{"startTime":16.602,"endTime":19.11,"body":"lecture in my series"},{"startTime":19.11,"endTime":21.247,"body":"of three lectures on medical"},{"startTime":19.11,"endTime":21.247,"body":"or on ethics' this term."},{"startTime":21.247,"endTime":23.55,"body":"And I wanted to talk"},{"startTime":21.247,"endTime":23.55,"body":"first about the approach"},{"startTime":23.55,"endTime":24.65,"body":"that I want to take"},{"startTime":24.65,"endTime":27.36,"body":"and I think it's important"},{"startTime":24.65,"endTime":27.36,"body":"to say at the outset"},{"startTime":27.36,"endTime":30.437,"body":"that vaccination debates are emotive"},{"startTime":30.437,"endTime":34.35,"body":"and I think it's really"},{"startTime":30.437,"endTime":34.35,"body":"important as a society"},{"startTime":34.35,"endTime":36.21,"body":"that we all think about"},{"startTime":34.35,"endTime":36.21,"body":"how we speak to one another"},{"startTime":36.21,"endTime":37.35,"body":"in these debates."},{"startTime":37.35,"endTime":39.24,"body":"And I don't think that we get anywhere"},{"startTime":39.24,"endTime":40.44,"body":"by denigrating people's views."},{"startTime":40.44,"endTime":42.54,"body":"And I don't think we get"},{"startTime":40.44,"endTime":42.54,"body":"anywhere by mocking people."},{"startTime":42.54,"endTime":44.4,"body":"And I certainly don't think"},{"startTime":42.54,"endTime":44.4,"body":"you change anybody's mind"},{"startTime":44.4,"endTime":45.93,"body":"by making fun of them"},{"startTime":44.4,"endTime":45.93,"body":"or calling them stupid."},{"startTime":45.93,"endTime":47.55,"body":"So my attitude to this is,"},{"startTime":47.55,"endTime":49.32,"body":"have an open mind and listen to people"},{"startTime":49.32,"endTime":51.48,"body":"and start from a position of"},{"startTime":49.32,"endTime":51.48,"body":"respect and thoughtfulness"},{"startTime":51.48,"endTime":52.92,"body":"about what other people might think."},{"startTime":52.92,"endTime":54.299,"body":"So I've got my own"},{"startTime":52.92,"endTime":54.299,"body":"views about vaccination,"},{"startTime":54.299,"endTime":56.246,"body":"that's true, of course,"},{"startTime":56.246,"endTime":58.14,"body":"but I'm really interested in your views."},{"startTime":58.14,"endTime":60.36,"body":"So I've left time at the end"},{"startTime":58.14,"endTime":60.36,"body":"so you can ask me questions"},{"startTime":60.36,"endTime":62.94,"body":"and tell me what you think as well."},{"startTime":62.94,"endTime":64.548,"body":"What I'm going to do today"},{"startTime":62.94,"endTime":64.548,"body":"is try to present you"},{"startTime":64.548,"endTime":67.473,"body":"with what I consider to be"},{"startTime":64.548,"endTime":67.473,"body":"some trustworthy information."},{"startTime":67.473,"endTime":69.87,"body":"Some of that will tell you"},{"startTime":67.473,"endTime":69.87,"body":"the vaccines have risks,"},{"startTime":69.87,"endTime":72.552,"body":"some of it will talk about"},{"startTime":69.87,"endTime":72.552,"body":"the benefits of vaccines."},{"startTime":72.552,"endTime":74.04,"body":"And I want to,"},{"startTime":74.04,"endTime":76.86,"body":"in this conversation try"},{"startTime":74.04,"endTime":76.86,"body":"to give you a framework"},{"startTime":76.86,"endTime":79.2,"body":"for thinking about how we"},{"startTime":76.86,"endTime":79.2,"body":"might arrive at a decision"},{"startTime":79.2,"endTime":81.653,"body":"about what to do in terms of vaccination."},{"startTime":81.653,"endTime":84.9,"body":"What I don't want to do is"},{"startTime":81.653,"endTime":84.9,"body":"delve into really detailed"},{"startTime":84.9,"endTime":88.403,"body":"technical debates about"},{"startTime":84.9,"endTime":88.403,"body":"diseases or every vaccine"},{"startTime":88.403,"endTime":90.345,"body":"or some of the really vexed debates"},{"startTime":90.345,"endTime":92.565,"body":"that have sort of dogged"},{"startTime":90.345,"endTime":92.565,"body":"this area for a time."},{"startTime":92.565,"endTime":94.56,"body":"But what I have done, however,"},{"startTime":94.56,"endTime":97.11,"body":"for those of you who want this"},{"startTime":94.56,"endTime":97.11,"body":"sort of detailed information,"},{"startTime":97.11,"endTime":99.9,"body":"I've put some links on my slides"},{"startTime":99.9,"endTime":101.326,"body":"which you'll be able to access,"},{"startTime":101.326,"endTime":104.43,"body":"and I've also put these in my transcript."},{"startTime":104.43,"endTime":107.16,"body":"The first is the Oxford"},{"startTime":104.43,"endTime":107.16,"body":"Vaccine Knowledge Project."},{"startTime":107.16,"endTime":109.038,"body":"There's lots and lots of"},{"startTime":107.16,"endTime":109.038,"body":"information about vaccinations,"},{"startTime":109.038,"endTime":112.105,"body":"what they do, their benefits,"},{"startTime":109.038,"endTime":112.105,"body":"their risks, and so on."},{"startTime":112.105,"endTime":113.16,"body":"People's attitudes,"},{"startTime":113.16,"endTime":115.367,"body":"people's stories about"},{"startTime":113.16,"endTime":115.367,"body":"their experiences of them."},{"startTime":115.367,"endTime":117.45,"body":"There's lots of data at"},{"startTime":115.367,"endTime":117.45,"body":"Public Health England"},{"startTime":117.45,"endTime":121.08,"body":"about what impacts vaccination has had,"},{"startTime":121.08,"endTime":122.79,"body":"but I've also put in a series of,"},{"startTime":122.79,"endTime":124.086,"body":"a link to a series of FOI requests"},{"startTime":124.086,"endTime":126.99,"body":"where you can find out about"},{"startTime":124.086,"endTime":126.99,"body":"the risks of vaccination."},{"startTime":126.99,"endTime":129.3,"body":"So in particular vaccine damage claims."},{"startTime":129.3,"endTime":130.56,"body":"So there's a really balanced picture"},{"startTime":130.56,"endTime":131.91,"body":"is what I want to give you."},{"startTime":133.14,"endTime":134.55,"body":"So, what I want to do in this lecture"},{"startTime":134.55,"endTime":138.81,"body":"is start by looking at some"},{"startTime":134.55,"endTime":138.81,"body":"vaccine success stories,"},{"startTime":138.81,"endTime":140.4,"body":"because I think it's"},{"startTime":138.81,"endTime":140.4,"body":"important to think about"},{"startTime":140.4,"endTime":142.77,"body":"why do we think vaccination is worth doing"},{"startTime":142.77,"endTime":144.36,"body":"in the first place?"},{"startTime":144.36,"endTime":146.129,"body":"And then I'll talk a bit"},{"startTime":144.36,"endTime":146.129,"body":"about some of the things"},{"startTime":146.129,"endTime":147.383,"body":"that we do vaccinate for."},{"startTime":147.383,"endTime":150.48,"body":"And then I'm going to explore"},{"startTime":147.383,"endTime":150.48,"body":"the concerns that people have"},{"startTime":150.48,"endTime":151.905,"body":"and the reasons people resist vaccination."},{"startTime":151.905,"endTime":154.77,"body":"And then I'll proceed to"},{"startTime":151.905,"endTime":154.77,"body":"thinking about what are we to do"},{"startTime":154.77,"endTime":156.66,"body":"and whether we should approach these"},{"startTime":156.66,"endTime":158.943,"body":"by having vaccinations be made mandatory."},{"startTime":159.87,"endTime":162.12,"body":"So the best way to see"},{"startTime":159.87,"endTime":162.12,"body":"what vaccination has done"},{"startTime":162.12,"endTime":163.08,"body":"that's been a big success"},{"startTime":163.08,"endTime":166.53,"body":"is to look at two big success"},{"startTime":163.08,"endTime":166.53,"body":"stories from the 20th century."},{"startTime":166.53,"endTime":167.37,"body":"And the first of these"},{"startTime":167.37,"endTime":169.77,"body":"with which you'll almost certainly"},{"startTime":167.37,"endTime":169.77,"body":"be familiar, is smallpox."},{"startTime":169.77,"endTime":171.6,"body":"So smallpox is an incurable disease"},{"startTime":171.6,"endTime":174.12,"body":"that has a fatality rate of 30%."},{"startTime":174.12,"endTime":175.74,"body":"And even if you survive it,"},{"startTime":175.74,"endTime":177.96,"body":"you might be left with"},{"startTime":175.74,"endTime":177.96,"body":"very severe scarring."},{"startTime":177.96,"endTime":181.443,"body":"So this was a scourge over"},{"startTime":177.96,"endTime":181.443,"body":"the centuries, smallpox."},{"startTime":182.73,"endTime":184.47,"body":"Early efforts to control the disease,"},{"startTime":184.47,"endTime":187.41,"body":"you'll be aware of these"},{"startTime":184.47,"endTime":187.41,"body":"probably involved variolization."},{"startTime":187.41,"endTime":189.93,"body":"And then Edward Jenner"},{"startTime":187.41,"endTime":189.93,"body":"developed his famous vaccine"},{"startTime":189.93,"endTime":193.35,"body":"based on cowpox at the"},{"startTime":189.93,"endTime":193.35,"body":"end of the 17th century,"},{"startTime":193.35,"endTime":195.0,"body":"end of the 18th century."},{"startTime":195.0,"endTime":195.99,"body":"And what we can see"},{"startTime":195.99,"endTime":198.42,"body":"is that the widespread use of that vaccine"},{"startTime":198.42,"endTime":201.63,"body":"led to a really dramatic"},{"startTime":198.42,"endTime":201.63,"body":"decline in cases of the disease."},{"startTime":201.63,"endTime":204.96,"body":"So what this shows you is this"},{"startTime":201.63,"endTime":204.96,"body":"is the percentage of deaths"},{"startTime":204.96,"endTime":208.14,"body":"caused by smallpox in London."},{"startTime":208.14,"endTime":211.17,"body":"And what you see is in"},{"startTime":208.14,"endTime":211.17,"body":"nearly 20% of deaths"},{"startTime":211.17,"endTime":213.27,"body":"were caused by smallpox at this time,"},{"startTime":213.27,"endTime":216.06,"body":"right at the late, at the"},{"startTime":213.27,"endTime":216.06,"body":"end of the the 18th century,"},{"startTime":216.06,"endTime":217.92,"body":"many of those were children."},{"startTime":217.92,"endTime":221.19,"body":"The vaccine is introduced at"},{"startTime":217.92,"endTime":221.19,"body":"around 1800, you see a drop."},{"startTime":221.19,"endTime":223.68,"body":"And then we see the point when"},{"startTime":221.19,"endTime":223.68,"body":"the vaccine becomes mandatory"},{"startTime":223.68,"endTime":224.877,"body":"in the mid 19th century here."},{"startTime":224.877,"endTime":227.979,"body":"So you see this even"},{"startTime":224.877,"endTime":227.979,"body":"further further decline."},{"startTime":227.979,"endTime":231.39,"body":"So vaccination was made"},{"startTime":227.979,"endTime":231.39,"body":"compulsory for smallpox"},{"startTime":231.39,"endTime":233.583,"body":"in this country in 1853."},{"startTime":234.699,"endTime":236.52,"body":"And so it's really clear"},{"startTime":236.52,"endTime":238.936,"body":"the vaccination in that"},{"startTime":236.52,"endTime":238.936,"body":"case reduced deaths."},{"startTime":238.936,"endTime":240.81,"body":"It remained however,"},{"startTime":240.81,"endTime":242.85,"body":"a disease that was"},{"startTime":240.81,"endTime":242.85,"body":"endemic in many countries."},{"startTime":242.85,"endTime":246.06,"body":"It's estimated that nearly"},{"startTime":242.85,"endTime":246.06,"body":"300 to 500 million people died"},{"startTime":246.06,"endTime":247.38,"body":"over the course of the 20th century."},{"startTime":247.38,"endTime":248.694,"body":"And the response to this worldwide"},{"startTime":248.694,"endTime":251.61,"body":"was the smallpox eradication program,"},{"startTime":251.61,"endTime":255.42,"body":"began in 1959 and by 1980"},{"startTime":251.61,"endTime":255.42,"body":"as an effect of this,"},{"startTime":255.42,"endTime":257.28,"body":"smallpox was declared eradicated."},{"startTime":257.28,"endTime":260.73,"body":"Now this was done by the WHO"},{"startTime":257.28,"endTime":260.73,"body":"working with local governments,"},{"startTime":260.73,"endTime":263.28,"body":"working with lots of organizations,"},{"startTime":263.28,"endTime":264.51,"body":"local healthcare workers."},{"startTime":264.51,"endTime":267.483,"body":"And the goal was widespread"},{"startTime":264.51,"endTime":267.483,"body":"vaccination and it worked."},{"startTime":268.408,"endTime":271.515,"body":"Another major success story is polio."},{"startTime":271.515,"endTime":273.93,"body":"So some of you may be"},{"startTime":271.515,"endTime":273.93,"body":"old enough to remember"},{"startTime":273.93,"endTime":276.57,"body":"before the pre-polio vaccination days"},{"startTime":276.57,"endTime":278.19,"body":"and how people felt about polio."},{"startTime":278.19,"endTime":281.58,"body":"Polio would sort of work its"},{"startTime":278.19,"endTime":281.58,"body":"way through towns and villages"},{"startTime":281.58,"endTime":283.17,"body":"and parents become very, very afraid"},{"startTime":283.17,"endTime":285.117,"body":"if polio was going to break out."},{"startTime":285.117,"endTime":288.18,"body":"Now the reason for this"},{"startTime":285.117,"endTime":288.18,"body":"is it is very contagious."},{"startTime":288.18,"endTime":291.0,"body":"It's spread through sneezing"},{"startTime":288.18,"endTime":291.0,"body":"and coughing, unclean hands,"},{"startTime":291.0,"endTime":291.93,"body":"and it's incurable."},{"startTime":291.93,"endTime":293.52,"body":"So it's still incurable."},{"startTime":293.52,"endTime":295.08,"body":"But we have therapies that we can use,"},{"startTime":295.08,"endTime":297.161,"body":"ventilators and physical therapy."},{"startTime":297.161,"endTime":300.87,"body":"And the reason it's so dangerous"},{"startTime":297.161,"endTime":300.87,"body":"is, it causes meningitis,"},{"startTime":300.87,"endTime":302.76,"body":"but in particular it"},{"startTime":300.87,"endTime":302.76,"body":"causes paralytic disease."},{"startTime":302.76,"endTime":304.8,"body":"So your muscles stop working."},{"startTime":304.8,"endTime":306.63,"body":"And the impact of this was"},{"startTime":306.63,"endTime":308.04,"body":"that you would stop being able to breathe."},{"startTime":308.04,"endTime":309.51,"body":"So this is a really familiar image"},{"startTime":309.51,"endTime":311.25,"body":"of a little boy in an iron lung."},{"startTime":311.25,"endTime":313.53,"body":"Iron lungs were developed"},{"startTime":311.25,"endTime":313.53,"body":"in the early 20th century,"},{"startTime":313.53,"endTime":315.06,"body":"but they became more available"},{"startTime":315.06,"endTime":316.284,"body":"as we moved to the mid 20th century."},{"startTime":316.284,"endTime":318.96,"body":"And what it did was is it"},{"startTime":316.284,"endTime":318.96,"body":"enabled them to breathe."},{"startTime":318.96,"endTime":321.45,"body":"So it kept them breathing"},{"startTime":318.96,"endTime":321.45,"body":"while they could recover"},{"startTime":321.45,"endTime":324.0,"body":"from their paralyzed muscles."},{"startTime":324.0,"endTime":325.95,"body":"So it saved lives."},{"startTime":325.95,"endTime":328.32,"body":"But it has a nearly 10% death rate,"},{"startTime":328.32,"endTime":330.324,"body":"if you had paralytic disease."},{"startTime":330.324,"endTime":332.16,"body":"And even if you survived polio,"},{"startTime":332.16,"endTime":334.86,"body":"you could be left with"},{"startTime":332.16,"endTime":334.86,"body":"muscle pain, weakness."},{"startTime":334.86,"endTime":337.022,"body":"And you can still see people"},{"startTime":334.86,"endTime":337.022,"body":"today who suffered polio"},{"startTime":337.022,"endTime":338.13,"body":"when they were children."},{"startTime":338.13,"endTime":339.45,"body":"Mary Berry is a good example"},{"startTime":339.45,"endTime":341.7,"body":"of someone you might have"},{"startTime":339.45,"endTime":341.7,"body":"heard of who had polio"},{"startTime":341.7,"endTime":344.28,"body":"and it left her with permanent"},{"startTime":341.7,"endTime":344.28,"body":"curvature of her spine"},{"startTime":344.28,"endTime":346.47,"body":"and one of her hands are still affected."},{"startTime":346.47,"endTime":347.82,"body":"So it had long-term impacts,"},{"startTime":347.82,"endTime":350.7,"body":"as well as causing numerous deaths."},{"startTime":350.7,"endTime":353.67,"body":"And vaccines were the key"},{"startTime":350.7,"endTime":353.67,"body":"thing that dealt with this."},{"startTime":353.67,"endTime":355.994,"body":"So two vaccines were"},{"startTime":353.67,"endTime":355.994,"body":"developed in the 1950s."},{"startTime":355.994,"endTime":357.513,"body":"This is data from the United States,"},{"startTime":357.513,"endTime":360.587,"body":"but what you can see here is"},{"startTime":357.513,"endTime":360.587,"body":"there's an epidemic of polio"},{"startTime":360.587,"endTime":363.39,"body":"that happens in sort of the early fifties,"},{"startTime":363.39,"endTime":365.22,"body":"that's this big spike in cases."},{"startTime":365.22,"endTime":367.5,"body":"This is cases, this is deaths."},{"startTime":367.5,"endTime":370.006,"body":"The vaccines come in 1955"},{"startTime":370.006,"endTime":373.513,"body":"and we see this drop and it stays low."},{"startTime":373.513,"endTime":375.01,"body":"And in many countries"},{"startTime":375.87,"endTime":377.67,"body":"polio have been declared polio free."},{"startTime":377.67,"endTime":381.057,"body":"So Europe's an area"},{"startTime":377.67,"endTime":381.057,"body":"where we are polio free."},{"startTime":381.057,"endTime":382.86,"body":"And what we also see"},{"startTime":382.86,"endTime":386.322,"body":"is the impact of vaccinations worldwide."},{"startTime":386.322,"endTime":390.36,"body":"So polio remained endemic"},{"startTime":386.322,"endTime":390.36,"body":"in many other countries"},{"startTime":390.36,"endTime":391.409,"body":"for a long time."},{"startTime":391.409,"endTime":395.31,"body":"And the polio eradication"},{"startTime":391.409,"endTime":395.31,"body":"initiative began in 1988"},{"startTime":395.31,"endTime":397.38,"body":"and its goal was to"},{"startTime":395.31,"endTime":397.38,"body":"eradicate polio elsewhere."},{"startTime":397.38,"endTime":399.744,"body":"So following in the footsteps"},{"startTime":397.38,"endTime":399.744,"body":"of the smallpox program,"},{"startTime":399.744,"endTime":401.61,"body":"a similar approach."},{"startTime":401.61,"endTime":404.61,"body":"This was led by the WHO"},{"startTime":401.61,"endTime":404.61,"body":"working with the CDC and UNICEF"},{"startTime":404.61,"endTime":406.31,"body":"and the Gates Foundation."},{"startTime":406.31,"endTime":407.67,"body":"And what has it done?"},{"startTime":407.67,"endTime":408.9,"body":"Well, similarly,"},{"startTime":408.9,"endTime":412.86,"body":"it's pursued programs of"},{"startTime":408.9,"endTime":412.86,"body":"vaccination and the impact has been"},{"startTime":412.86,"endTime":415.8,"body":"a huge reduction in"},{"startTime":412.86,"endTime":415.8,"body":"cases of polio worldwide."},{"startTime":415.8,"endTime":416.955,"body":"So 1988 when it began,"},{"startTime":416.955,"endTime":420.54,"body":"you can see there are 350,000"},{"startTime":416.955,"endTime":420.54,"body":"cases of polio a year."},{"startTime":420.54,"endTime":423.45,"body":"Now we're at less than 700 cases."},{"startTime":423.45,"endTime":424.518,"body":"And it's estimated to have prevented"},{"startTime":424.518,"endTime":426.766,"body":"at least 2.2 million cases."},{"startTime":426.766,"endTime":428.73,"body":"So when you think about"},{"startTime":426.766,"endTime":428.73,"body":"the fatality rates,"},{"startTime":428.73,"endTime":430.62,"body":"you can see that that's a lot of deaths"},{"startTime":430.62,"endTime":431.943,"body":"have also been prevented."},{"startTime":433.229,"endTime":437.04,"body":"So these are successes of"},{"startTime":433.229,"endTime":437.04,"body":"vaccination, this is what it does."},{"startTime":437.04,"endTime":438.7,"body":"But these were big global diseases."},{"startTime":438.7,"endTime":440.259,"body":"They were really terrible diseases."},{"startTime":440.259,"endTime":442.529,"body":"What do we vaccinate for now?"},{"startTime":442.529,"endTime":444.66,"body":"What I want to do is"},{"startTime":442.529,"endTime":444.66,"body":"briefly take you through"},{"startTime":444.66,"endTime":445.89,"body":"the schedule of vaccination"},{"startTime":445.89,"endTime":448.59,"body":"but not spend a lot of time looking at it,"},{"startTime":448.59,"endTime":450.75,"body":"but to think about what kinds of diseases"},{"startTime":450.75,"endTime":452.463,"body":"we vaccinate against and why."},{"startTime":454.695,"endTime":459.42,"body":"So we vaccinate very young"},{"startTime":454.695,"endTime":459.42,"body":"children for a lot of conditions,"},{"startTime":459.42,"endTime":460.98,"body":"and this is in fact one of the concerns"},{"startTime":460.98,"endTime":463.89,"body":"that people who have"},{"startTime":460.98,"endTime":463.89,"body":"concerns of vaccination have,"},{"startTime":463.89,"endTime":467.97,"body":"is that we give too many"},{"startTime":463.89,"endTime":467.97,"body":"vaccinations too soon altogether."},{"startTime":467.97,"endTime":470.685,"body":"So, babies will be given"},{"startTime":467.97,"endTime":470.685,"body":"these 8, 12 and 16 weeks,"},{"startTime":470.685,"endTime":472.92,"body":"and there's a whole series of vaccinations"},{"startTime":472.92,"endTime":474.42,"body":"and they protect against a lot of disease."},{"startTime":474.42,"endTime":477.93,"body":"So polio remains one, tetanus,"},{"startTime":474.42,"endTime":477.93,"body":"whooping cough, rotavirus,"},{"startTime":477.93,"endTime":482.072,"body":"pneumococcal infections, and"},{"startTime":477.93,"endTime":482.072,"body":"meningococcal infections."},{"startTime":482.072,"endTime":484.034,"body":"We continue these through childhood."},{"startTime":484.034,"endTime":487.5,"body":"Some are boosters, some"},{"startTime":484.034,"endTime":487.5,"body":"are other vaccinations."},{"startTime":487.5,"endTime":489.63,"body":"That's because some of them"},{"startTime":487.5,"endTime":489.63,"body":"can't be given as early."},{"startTime":489.63,"endTime":491.25,"body":"So things like the MMR works better"},{"startTime":491.25,"endTime":492.72,"body":"if you give it slightly later."},{"startTime":492.72,"endTime":494.67,"body":"Some are yearly, some are boosters."},{"startTime":494.67,"endTime":496.5,"body":"So this whole range of them that we give"},{"startTime":496.5,"endTime":497.973,"body":"over the course of childhood."},{"startTime":500.64,"endTime":504.15,"body":"We also continue to"},{"startTime":500.64,"endTime":504.15,"body":"vaccinate into adulthood."},{"startTime":504.15,"endTime":505.8,"body":"So obviously some people will have things"},{"startTime":505.8,"endTime":508.59,"body":"like COVID vaccines or they"},{"startTime":505.8,"endTime":508.59,"body":"have flu vaccines yearly."},{"startTime":508.59,"endTime":510.66,"body":"You'll have a tetanus booster."},{"startTime":510.66,"endTime":512.19,"body":"We also vaccinate people"},{"startTime":512.19,"endTime":515.01,"body":"against whooping cough to protect babies."},{"startTime":515.01,"endTime":516.03,"body":"And as you get older,"},{"startTime":516.03,"endTime":517.92,"body":"you might be offered things"},{"startTime":516.03,"endTime":517.92,"body":"like a shingles vaccine"},{"startTime":517.92,"endTime":519.36,"body":"and some immunocompromised people"},{"startTime":519.36,"endTime":522.03,"body":"might be offered certain vaccines as well."},{"startTime":522.03,"endTime":523.95,"body":"So we continue to"},{"startTime":522.03,"endTime":523.95,"body":"vaccinate throughout life"},{"startTime":523.95,"endTime":526.203,"body":"and we do it for lots"},{"startTime":523.95,"endTime":526.203,"body":"and lots of diseases."},{"startTime":527.374,"endTime":529.239,"body":"Now, I don't want to go"},{"startTime":527.374,"endTime":529.239,"body":"through the whole schedule."},{"startTime":529.239,"endTime":532.846,"body":"What I want to do is pick"},{"startTime":529.239,"endTime":532.846,"body":"out the four key reasons"},{"startTime":532.846,"endTime":534.63,"body":"why we vaccinate."},{"startTime":534.63,"endTime":535.88,"body":"And the the reason to do this is that"},{"startTime":535.88,"endTime":538.8,"body":"when we want to think about"},{"startTime":535.88,"endTime":538.8,"body":"why should we vaccinate,"},{"startTime":538.8,"endTime":540.986,"body":"how should we respond to"},{"startTime":538.8,"endTime":540.986,"body":"concerns about vaccinations"},{"startTime":540.986,"endTime":542.67,"body":"and whether we should make it mandatory,"},{"startTime":542.67,"endTime":544.53,"body":"it's really important to understand"},{"startTime":544.53,"endTime":546.06,"body":"why you're doing it in the first place"},{"startTime":546.06,"endTime":548.25,"body":"because actually there"},{"startTime":546.06,"endTime":548.25,"body":"are multiple reasons"},{"startTime":548.25,"endTime":550.44,"body":"why we vaccinate and"},{"startTime":548.25,"endTime":550.44,"body":"they differ by disease"},{"startTime":550.44,"endTime":553.233,"body":"and they differ by who we"},{"startTime":550.44,"endTime":553.233,"body":"give the vaccinations to."},{"startTime":555.63,"endTime":559.14,"body":"So the first reason is to"},{"startTime":555.63,"endTime":559.14,"body":"protect vaccinated individuals"},{"startTime":559.14,"endTime":561.75,"body":"from non-communicable diseases."},{"startTime":561.75,"endTime":564.637,"body":"So this is a really"},{"startTime":561.75,"endTime":564.637,"body":"famous image of tetanus"},{"startTime":564.637,"endTime":567.93,"body":"and this is what tetanus does"},{"startTime":564.637,"endTime":567.93,"body":"to you when it's untreated."},{"startTime":567.93,"endTime":571.17,"body":"What it does is it causes"},{"startTime":567.93,"endTime":571.17,"body":"really painful muscle spasms"},{"startTime":571.17,"endTime":573.96,"body":"and they can be so strong that"},{"startTime":571.17,"endTime":573.96,"body":"they can break your bones."},{"startTime":573.96,"endTime":575.31,"body":"It's why it's also called lock jaw."},{"startTime":575.31,"endTime":577.32,"body":"It locks your jaw up."},{"startTime":577.32,"endTime":580.11,"body":"It's incredibly painful"},{"startTime":577.32,"endTime":580.11,"body":"and they last for weeks."},{"startTime":580.11,"endTime":582.06,"body":"And the way you get tetanus"},{"startTime":582.06,"endTime":584.31,"body":"is not communicated from"},{"startTime":582.06,"endTime":584.31,"body":"other people, but it actually,"},{"startTime":584.31,"endTime":587.85,"body":"it's a bacteria that lives"},{"startTime":584.31,"endTime":587.85,"body":"in soil, manure, dust."},{"startTime":587.85,"endTime":589.77,"body":"So that's why your worry"},{"startTime":587.85,"endTime":589.77,"body":"would always have been"},{"startTime":589.77,"endTime":592.337,"body":"getting, having it coming through a cut."},{"startTime":592.337,"endTime":594.51,"body":"Or it would be you pierce the skin"},{"startTime":594.51,"endTime":596.19,"body":"with something that's"},{"startTime":594.51,"endTime":596.19,"body":"got the bacteria on it."},{"startTime":596.19,"endTime":598.08,"body":"So, a rusty nail in your foot,"},{"startTime":598.08,"endTime":599.88,"body":"that's a classic thing you would worry"},{"startTime":599.88,"endTime":601.203,"body":"might give you tetanus."},{"startTime":602.1,"endTime":605.04,"body":"But tetanus is a disease that"},{"startTime":602.1,"endTime":605.04,"body":"can be really easily prevented"},{"startTime":605.04,"endTime":605.873,"body":"with a vaccine"},{"startTime":606.87,"endTime":609.48,"body":"and that's why children are"},{"startTime":606.87,"endTime":609.48,"body":"vaccinated against tetanus."},{"startTime":609.48,"endTime":611.61,"body":"Your protection against"},{"startTime":609.48,"endTime":611.61,"body":"tetanus wanes over time"},{"startTime":611.61,"endTime":613.98,"body":"and that's why you might have a booster."},{"startTime":613.98,"endTime":615.841,"body":"Now we can treat it to a degree,"},{"startTime":615.841,"endTime":617.52,"body":"but if it's not treated quickly,"},{"startTime":617.52,"endTime":620.07,"body":"it is really painful and"},{"startTime":617.52,"endTime":620.07,"body":"really, really unpleasant."},{"startTime":622.38,"endTime":624.54,"body":"The other reason that we vaccinate people"},{"startTime":624.54,"endTime":626.58,"body":"is probably the one that's most familiar"},{"startTime":626.58,"endTime":627.93,"body":"and this is that we vaccinate"},{"startTime":627.93,"endTime":629.73,"body":"against communicable diseases."},{"startTime":629.73,"endTime":632.097,"body":"So diseases that are"},{"startTime":629.73,"endTime":632.097,"body":"spread between people."},{"startTime":632.097,"endTime":634.8,"body":"Now we spread diseases"},{"startTime":632.097,"endTime":634.8,"body":"in all sorts of ways,"},{"startTime":634.8,"endTime":636.42,"body":"coughing, showing bodily fluids,"},{"startTime":636.42,"endTime":638.28,"body":"touching things and then touching them."},{"startTime":638.28,"endTime":641.07,"body":"And different diseases are"},{"startTime":638.28,"endTime":641.07,"body":"more or less communicable."},{"startTime":641.07,"endTime":643.95,"body":"So measles is one of the most"},{"startTime":641.07,"endTime":643.95,"body":"contagious diseases there is,"},{"startTime":643.95,"endTime":646.8,"body":"that if you walk into a room"},{"startTime":643.95,"endTime":646.8,"body":"and someone has measles,"},{"startTime":646.8,"endTime":650.279,"body":"really high chance that you"},{"startTime":646.8,"endTime":650.279,"body":"will catch measles from them."},{"startTime":650.279,"endTime":651.112,"body":"And what we,"},{"startTime":651.112,"endTime":653.82,"body":"the reason we do this is to protect people"},{"startTime":653.82,"endTime":655.92,"body":"against either severe illness or death"},{"startTime":655.92,"endTime":657.78,"body":"or lifetime disability that can result"},{"startTime":657.78,"endTime":659.25,"body":"from some of these diseases."},{"startTime":659.25,"endTime":661.627,"body":"So a really good example"},{"startTime":659.25,"endTime":661.627,"body":"of one of these diseases"},{"startTime":661.627,"endTime":664.32,"body":"is meningococcal disease."},{"startTime":664.32,"endTime":666.956,"body":"So, this is a picture of"},{"startTime":664.32,"endTime":666.956,"body":"Charlotte Cleverley-Bisman."},{"startTime":666.956,"endTime":670.86,"body":"She's a little girl who"},{"startTime":666.956,"endTime":670.86,"body":"became the face of vaccination"},{"startTime":670.86,"endTime":672.66,"body":"in New Zealand for a while."},{"startTime":672.66,"endTime":675.27,"body":"And that's because she"},{"startTime":672.66,"endTime":675.27,"body":"caught meningococcal disease"},{"startTime":675.27,"endTime":677.04,"body":"when she was very young as a baby."},{"startTime":677.04,"endTime":678.09,"body":"And as a result of that"},{"startTime":678.09,"endTime":680.687,"body":"she had to have all four limbs amputated."},{"startTime":680.687,"endTime":683.01,"body":"And that's because meningococcal diseases,"},{"startTime":683.01,"endTime":686.04,"body":"infections cause all sorts"},{"startTime":683.01,"endTime":686.04,"body":"of damage to your tissue"},{"startTime":686.04,"endTime":687.93,"body":"and the treatment is"},{"startTime":686.04,"endTime":687.93,"body":"to essentially amputate"},{"startTime":687.93,"endTime":691.32,"body":"to prevent the spread of"},{"startTime":687.93,"endTime":691.32,"body":"that damage into your body."},{"startTime":691.32,"endTime":693.99,"body":"It can also cause deafness, brain damage,"},{"startTime":693.99,"endTime":696.33,"body":"nervous system problems"},{"startTime":693.99,"endTime":696.33,"body":"and all sorts of things."},{"startTime":696.33,"endTime":698.01,"body":"It's a really terrible disease."},{"startTime":698.01,"endTime":700.95,"body":"It's rare, but when you"},{"startTime":698.01,"endTime":700.95,"body":"get it, it's severe."},{"startTime":700.95,"endTime":702.09,"body":"And that's the thing to think about"},{"startTime":702.09,"endTime":703.32,"body":"when you're thinking about diseases."},{"startTime":703.32,"endTime":706.2,"body":"Some happen to a lot of people"},{"startTime":703.32,"endTime":706.2,"body":"but they aren't that severe."},{"startTime":706.2,"endTime":707.94,"body":"Some happen very rarely,"},{"startTime":706.2,"endTime":707.94,"body":"but when they happen,"},{"startTime":707.94,"endTime":709.35,"body":"they're catastrophically bad."},{"startTime":709.35,"endTime":711.09,"body":"And that's part of what"},{"startTime":709.35,"endTime":711.09,"body":"we need to be doing"},{"startTime":711.09,"endTime":712.65,"body":"when we're thinking about what to do,"},{"startTime":712.65,"endTime":715.982,"body":"is having a sense of, what"},{"startTime":712.65,"endTime":715.982,"body":"does this particular disease do"},{"startTime":715.982,"endTime":719.403,"body":"and to how many people and"},{"startTime":715.982,"endTime":719.403,"body":"to what level of severity?"},{"startTime":722.19,"endTime":724.65,"body":"It's also happily though"},{"startTime":722.19,"endTime":724.65,"body":"an example of a disease"},{"startTime":724.65,"endTime":727.17,"body":"that's very well"},{"startTime":724.65,"endTime":727.17,"body":"controlled by vaccination."},{"startTime":727.17,"endTime":730.56,"body":"So you can see the impact of"},{"startTime":727.17,"endTime":730.56,"body":"the introduction of MenC and B"},{"startTime":730.56,"endTime":734.67,"body":"on cases of meningococcal"},{"startTime":730.56,"endTime":734.67,"body":"disease, a huge decline in cases."},{"startTime":734.67,"endTime":737.253,"body":"It is a disease that vaccination stops."},{"startTime":740.31,"endTime":742.56,"body":"The third reason that we vaccinate"},{"startTime":742.56,"endTime":744.06,"body":"is to protect other people"},{"startTime":744.06,"endTime":747.24,"body":"from contracting communicable diseases."},{"startTime":747.24,"endTime":749.67,"body":"And whooping cough is a"},{"startTime":747.24,"endTime":749.67,"body":"really good example of this."},{"startTime":749.67,"endTime":752.91,"body":"Now of course the way people"},{"startTime":749.67,"endTime":752.91,"body":"catch diseases from us,"},{"startTime":752.91,"endTime":756.75,"body":"we should all be familiar with"},{"startTime":752.91,"endTime":756.75,"body":"that, is that we spread it."},{"startTime":756.75,"endTime":758.4,"body":"And the way vaccinations stop that"},{"startTime":758.4,"endTime":760.47,"body":"is it stops me having the disease."},{"startTime":760.47,"endTime":763.374,"body":"So it means I can't have"},{"startTime":760.47,"endTime":763.374,"body":"it, so I don't pass it on."},{"startTime":763.374,"endTime":766.08,"body":"It also might reduce my symptoms."},{"startTime":766.08,"endTime":767.897,"body":"So some vaccinations just"},{"startTime":766.08,"endTime":767.897,"body":"reduce your symptoms."},{"startTime":767.897,"endTime":768.754,"body":"You might still have it,"},{"startTime":768.754,"endTime":770.52,"body":"but you have it less severely,"},{"startTime":770.52,"endTime":772.08,"body":"so you are less likely to cough."},{"startTime":772.08,"endTime":774.24,"body":"You're less likely to spread"},{"startTime":772.08,"endTime":774.24,"body":"bodily fluids in that way."},{"startTime":774.24,"endTime":776.67,"body":"And so people don't catch it from you."},{"startTime":776.67,"endTime":778.38,"body":"And that's partly how"},{"startTime":776.67,"endTime":778.38,"body":"the COVID vaccine works."},{"startTime":778.38,"endTime":780.57,"body":"It reduces the severity"},{"startTime":778.38,"endTime":780.57,"body":"so you are less likely"},{"startTime":780.57,"endTime":781.403,"body":"to pass it on."},{"startTime":781.403,"endTime":782.94,"body":"You won't be ill for as long either."},{"startTime":784.05,"endTime":786.39,"body":"We can also use things"},{"startTime":784.05,"endTime":786.39,"body":"like ring vaccination"},{"startTime":786.39,"endTime":788.013,"body":"where you find a person"},{"startTime":786.39,"endTime":788.013,"body":"who has the disease"},{"startTime":788.013,"endTime":790.83,"body":"and you surround them"},{"startTime":788.013,"endTime":790.83,"body":"with vaccinated people,"},{"startTime":790.83,"endTime":791.824,"body":"you find all their contacts"},{"startTime":791.824,"endTime":793.68,"body":"and you surround them"},{"startTime":791.824,"endTime":793.68,"body":"with vaccinated people"},{"startTime":793.68,"endTime":796.56,"body":"and it isolates the case and"},{"startTime":793.68,"endTime":796.56,"body":"it doesn't spread any further."},{"startTime":796.56,"endTime":799.47,"body":"And that's one of the"},{"startTime":796.56,"endTime":799.47,"body":"strategies that WHO now uses"},{"startTime":799.47,"endTime":802.41,"body":"to deal with isolated cases of polio"},{"startTime":802.41,"endTime":805.86,"body":"and it's what they also use to"},{"startTime":802.41,"endTime":805.86,"body":"deal with cases of smallpox."},{"startTime":805.86,"endTime":808.44,"body":"What's also really crucial to understand"},{"startTime":808.44,"endTime":811.26,"body":"is that some people can't be vaccinated."},{"startTime":811.26,"endTime":813.93,"body":"Very young children can't be vaccinated."},{"startTime":813.93,"endTime":815.37,"body":"And those with conditions"},{"startTime":815.37,"endTime":817.59,"body":"that mean they might"},{"startTime":815.37,"endTime":817.59,"body":"have adverse reactions."},{"startTime":817.59,"endTime":819.75,"body":"And also people who have"},{"startTime":817.59,"endTime":819.75,"body":"weakened immune systems,"},{"startTime":819.75,"endTime":821.55,"body":"these are all people"},{"startTime":819.75,"endTime":821.55,"body":"who we would consider,"},{"startTime":821.55,"endTime":824.01,"body":"ought to consider vulnerable."},{"startTime":824.01,"endTime":826.26,"body":"And we protect them from disease"},{"startTime":826.26,"endTime":828.003,"body":"by vaccinating other people."},{"startTime":828.93,"endTime":831.57,"body":"So that's why whooping cough"},{"startTime":828.93,"endTime":831.57,"body":"is a really good example."},{"startTime":831.57,"endTime":833.58,"body":"So we don't give the"},{"startTime":831.57,"endTime":833.58,"body":"whooping cough vaccination"},{"startTime":833.58,"endTime":835.35,"body":"until eight weeks."},{"startTime":835.35,"endTime":837.15,"body":"But very young babies"},{"startTime":835.35,"endTime":837.15,"body":"are really vulnerable"},{"startTime":837.15,"endTime":837.983,"body":"to whooping cough."},{"startTime":837.983,"endTime":839.94,"body":"And before vaccination began,"},{"startTime":839.94,"endTime":842.13,"body":"there were thousands of cases every year"},{"startTime":842.13,"endTime":843.807,"body":"and as many and sometimes thousands of,"},{"startTime":843.807,"endTime":845.97,"body":"there were hundreds of thousands of cases"},{"startTime":845.97,"endTime":847.72,"body":"and there were thousands of deaths."},{"startTime":849.06,"endTime":851.61,"body":"Now, we cannot protect"},{"startTime":849.06,"endTime":851.61,"body":"them by vaccinating them."},{"startTime":851.61,"endTime":854.28,"body":"So what we do instead is we protect them"},{"startTime":854.28,"endTime":856.89,"body":"by making sure the prevalence"},{"startTime":854.28,"endTime":856.89,"body":"of whooping cough is very low."},{"startTime":856.89,"endTime":859.14,"body":"And we do that by"},{"startTime":856.89,"endTime":859.14,"body":"vaccinating everybody else."},{"startTime":859.14,"endTime":860.49,"body":"So the less whooping cough there is"},{"startTime":860.49,"endTime":862.2,"body":"circulating in the community,"},{"startTime":862.2,"endTime":865.025,"body":"the more protected these babies will be."},{"startTime":865.025,"endTime":869.4,"body":"We also do this now by"},{"startTime":865.025,"endTime":869.4,"body":"vaccinating pregnant women."},{"startTime":869.4,"endTime":872.4,"body":"So we make sure we offer"},{"startTime":869.4,"endTime":872.4,"body":"whooping cough vaccinations"},{"startTime":872.4,"endTime":875.49,"body":"to women who are having babies"},{"startTime":872.4,"endTime":875.49,"body":"and other family members"},{"startTime":875.49,"endTime":878.46,"body":"potentially because that means"},{"startTime":875.49,"endTime":878.46,"body":"they also won't pass it on"},{"startTime":878.46,"endTime":879.293,"body":"to their babies."},{"startTime":879.293,"endTime":882.63,"body":"And it gives these babies"},{"startTime":879.293,"endTime":882.63,"body":"time to get old enough"},{"startTime":882.63,"endTime":883.525,"body":"and make it to eight weeks essentially"},{"startTime":883.525,"endTime":885.21,"body":"when they can have the vaccination"},{"startTime":885.21,"endTime":886.14,"body":"and they can be protected."},{"startTime":886.14,"endTime":888.3,"body":"So this is an example of where vaccination"},{"startTime":888.3,"endTime":890.64,"body":"is not just protecting the"},{"startTime":888.3,"endTime":890.64,"body":"individual who's vaccinated,"},{"startTime":890.64,"endTime":892.86,"body":"but it's protecting other people."},{"startTime":892.86,"endTime":894.51,"body":"And we know that it works."},{"startTime":894.51,"endTime":897.51,"body":"The NHS reports that babies"},{"startTime":894.51,"endTime":897.51,"body":"born to women who are vaccinated"},{"startTime":897.51,"endTime":901.5,"body":"at least a week before birth"},{"startTime":897.51,"endTime":901.5,"body":"had a 91% reduction of risk"},{"startTime":901.5,"endTime":902.85,"body":"of becoming ill with whooping cough"},{"startTime":902.85,"endTime":904.29,"body":"in the first weeks of life,"},{"startTime":904.29,"endTime":906.96,"body":"compared to babies whose"},{"startTime":904.29,"endTime":906.96,"body":"mothers had not been vaccinated."},{"startTime":906.96,"endTime":909.493,"body":"So while whooping cough"},{"startTime":906.96,"endTime":909.493,"body":"remains in our community,"},{"startTime":909.493,"endTime":911.421,"body":"this is a way that we protect"},{"startTime":911.421,"endTime":914.133,"body":"those very vulnerable"},{"startTime":911.421,"endTime":914.133,"body":"members of our society."},{"startTime":916.71,"endTime":920.04,"body":"The fourth reason is similar,"},{"startTime":920.04,"endTime":921.81,"body":"but it's subtly different"},{"startTime":921.81,"endTime":923.49,"body":"and it also gives me an opportunity"},{"startTime":923.49,"endTime":924.33,"body":"to talk about another disease"},{"startTime":924.33,"endTime":925.35,"body":"that I think is really interesting"},{"startTime":925.35,"endTime":927.87,"body":"and one that's important to talk about."},{"startTime":927.87,"endTime":930.78,"body":"And there are diseases"},{"startTime":927.87,"endTime":930.78,"body":"which if you catch them"},{"startTime":930.78,"endTime":932.31,"body":"they can harm your baby."},{"startTime":932.31,"endTime":933.143,"body":"So if you are,"},{"startTime":933.143,"endTime":936.72,"body":"if a person is pregnant"},{"startTime":933.143,"endTime":936.72,"body":"and they catch rubella,"},{"startTime":936.72,"endTime":937.71,"body":"it can cause what's called"},{"startTime":937.71,"endTime":940.59,"body":"rubella congenital rubella syndrome."},{"startTime":940.59,"endTime":944.64,"body":"Now, rubella itself is quite"},{"startTime":940.59,"endTime":944.64,"body":"a mild disease in most cases."},{"startTime":944.64,"endTime":947.31,"body":"It can in rare cases lead"},{"startTime":944.64,"endTime":947.31,"body":"to things like encephalitis"},{"startTime":947.31,"endTime":949.8,"body":"and pneumonia and bronchitis,"},{"startTime":947.31,"endTime":949.8,"body":"but generally it's rare."},{"startTime":949.8,"endTime":952.92,"body":"It's a bit of a rash, joint"},{"startTime":949.8,"endTime":952.92,"body":"pain and some headache."},{"startTime":952.92,"endTime":955.26,"body":"But what's really"},{"startTime":952.92,"endTime":955.26,"body":"problematic about rubella"},{"startTime":955.26,"endTime":957.63,"body":"and one of the main reasons"},{"startTime":955.26,"endTime":957.63,"body":"that we vaccinate against it"},{"startTime":957.63,"endTime":959.91,"body":"is that if you catch it"},{"startTime":957.63,"endTime":959.91,"body":"when you are pregnant,"},{"startTime":959.91,"endTime":963.081,"body":"it can cause this syndrome"},{"startTime":959.91,"endTime":963.081,"body":"in the unborn fetus."},{"startTime":963.081,"endTime":967.02,"body":"Now, the most common symptoms"},{"startTime":963.081,"endTime":967.02,"body":"of congenital rubella syndrome"},{"startTime":967.02,"endTime":969.9,"body":"are hearing loss, eye"},{"startTime":967.02,"endTime":969.9,"body":"problems, heart problems."},{"startTime":969.9,"endTime":973.83,"body":"So babies can be born blind,"},{"startTime":969.9,"endTime":973.83,"body":"they can be born deaf."},{"startTime":973.83,"endTime":976.5,"body":"It can also cause miscarriage, stillbirth,"},{"startTime":976.5,"endTime":978.75,"body":"neurological problems"},{"startTime":976.5,"endTime":978.75,"body":"and lots of other issues"},{"startTime":978.75,"endTime":980.31,"body":"in unborn babies."},{"startTime":980.31,"endTime":984.04,"body":"So preventing rubella is as"},{"startTime":980.31,"endTime":984.04,"body":"much or if not more about"},{"startTime":984.04,"endTime":987.6,"body":"protecting fetuses in utero as"},{"startTime":984.04,"endTime":987.6,"body":"it is about protecting people"},{"startTime":987.6,"endTime":990.21,"body":"from getting rubella themselves."},{"startTime":990.21,"endTime":991.62,"body":"And this is another example"},{"startTime":991.62,"endTime":994.26,"body":"where we can see the"},{"startTime":991.62,"endTime":994.26,"body":"impact of vaccination."},{"startTime":994.26,"endTime":996.21,"body":"So this is the impact of vaccination"},{"startTime":996.21,"endTime":998.73,"body":"on congenital rubella itself."},{"startTime":998.73,"endTime":1001.97,"body":"And you can see when the"},{"startTime":998.73,"endTime":1001.97,"body":"vaccine is introduced,"},{"startTime":1001.97,"endTime":1003.833,"body":"we see this huge drop in cases."},{"startTime":1005.18,"endTime":1008.78,"body":"So this is another beneficial"},{"startTime":1005.18,"endTime":1008.78,"body":"thing that vaccines do."},{"startTime":1008.78,"endTime":1011.84,"body":"They protect us and they"},{"startTime":1008.78,"endTime":1011.84,"body":"protect people around us."},{"startTime":1011.84,"endTime":1013.406,"body":"So they have both an individual benefit"},{"startTime":1013.406,"endTime":1015.873,"body":"and they have a collective benefit"},{"startTime":1015.873,"endTime":1017.87,"body":"and they benefit vulnerable people"},{"startTime":1017.87,"endTime":1019.94,"body":"as well as people who are healthy."},{"startTime":1019.94,"endTime":1023.3,"body":"So we gain as a community"},{"startTime":1019.94,"endTime":1023.3,"body":"when we reduce disease,"},{"startTime":1023.3,"endTime":1025.37,"body":"partly because we ourselves"},{"startTime":1023.3,"endTime":1025.37,"body":"are protected against it,"},{"startTime":1025.37,"endTime":1028.883,"body":"but also we protect other"},{"startTime":1025.37,"endTime":1028.883,"body":"people in our society."},{"startTime":1029.96,"endTime":1030.86,"body":"So given that,"},{"startTime":1030.86,"endTime":1032.3,"body":"it seems like vaccinations"},{"startTime":1032.3,"endTime":1034.25,"body":"seem like a really,"},{"startTime":1032.3,"endTime":1034.25,"body":"really good thing to do"},{"startTime":1034.25,"endTime":1037.001,"body":"and demonstrably they"},{"startTime":1034.25,"endTime":1037.001,"body":"are very well accepted"},{"startTime":1037.001,"endTime":1039.77,"body":"and highly regarded public"},{"startTime":1037.001,"endTime":1039.77,"body":"health intervention."},{"startTime":1039.77,"endTime":1043.07,"body":"They're regarded as a very"},{"startTime":1039.77,"endTime":1043.07,"body":"effective way of saving lives"},{"startTime":1043.07,"endTime":1044.393,"body":"and reducing illness."},{"startTime":1045.32,"endTime":1048.164,"body":"However, people refuse them."},{"startTime":1048.164,"endTime":1050.3,"body":"So I think the first"},{"startTime":1048.164,"endTime":1050.3,"body":"thing to think about then"},{"startTime":1050.3,"endTime":1052.88,"body":"is to interrogate why do they refuse them?"},{"startTime":1052.88,"endTime":1054.62,"body":"And in fact, there are a lot of reasons"},{"startTime":1054.62,"endTime":1057.86,"body":"why people either refuse vaccinations"},{"startTime":1057.86,"endTime":1060.433,"body":"or are hesitant about vaccinations."},{"startTime":1060.433,"endTime":1063.38,"body":"And it's not that this is new."},{"startTime":1063.38,"endTime":1065.63,"body":"So this is a really famous picture"},{"startTime":1065.63,"endTime":1068.69,"body":"that came out just after"},{"startTime":1065.63,"endTime":1068.69,"body":"Jenner's vaccination"},{"startTime":1068.69,"endTime":1069.71,"body":"started to be used"},{"startTime":1069.71,"endTime":1072.29,"body":"and it's making fun of the vaccination."},{"startTime":1072.29,"endTime":1074.63,"body":"It's suggesting that because"},{"startTime":1072.29,"endTime":1074.63,"body":"it's based on cowpox,"},{"startTime":1074.63,"endTime":1076.58,"body":"that people who have the vaccination"},{"startTime":1076.58,"endTime":1079.413,"body":"will start to develop"},{"startTime":1076.58,"endTime":1079.413,"body":"characteristics of cows."},{"startTime":1079.413,"endTime":1082.926,"body":"And this is actually one"},{"startTime":1079.413,"endTime":1082.926,"body":"of the pieces of propaganda"},{"startTime":1082.926,"endTime":1085.25,"body":"that relates to the"},{"startTime":1082.926,"endTime":1085.25,"body":"anti-vaccination movement,"},{"startTime":1085.25,"endTime":1087.508,"body":"which begins in the"},{"startTime":1085.25,"endTime":1087.508,"body":"very early 20th century."},{"startTime":1087.508,"endTime":1090.339,"body":"And now there were protests"},{"startTime":1087.508,"endTime":1090.339,"body":"in the United Kingdom"},{"startTime":1090.339,"endTime":1092.51,"body":"and elsewhere throughout the 19th century,"},{"startTime":1092.51,"endTime":1094.7,"body":"anti-vaccination leagues formed,"},{"startTime":1094.7,"endTime":1096.11,"body":"and there was pressure to repeal"},{"startTime":1096.11,"endTime":1098.54,"body":"the compulsory vaccination acts."},{"startTime":1098.54,"endTime":1100.4,"body":"And so it is not a new phenomenon"},{"startTime":1100.4,"endTime":1104.27,"body":"for people to be concerned"},{"startTime":1100.4,"endTime":1104.27,"body":"about vaccination."},{"startTime":1104.27,"endTime":1105.98,"body":"It's particularly interesting"},{"startTime":1104.27,"endTime":1105.98,"body":"that this is a point"},{"startTime":1105.98,"endTime":1110.45,"body":"when smallpox is causing"},{"startTime":1105.98,"endTime":1110.45,"body":"hundreds of thousands of deaths"},{"startTime":1110.45,"endTime":1112.823,"body":"and still people are resisting it."},{"startTime":1113.69,"endTime":1115.37,"body":"And so it's important to wonder"},{"startTime":1115.37,"endTime":1117.14,"body":"why would they feel this way?"},{"startTime":1117.14,"endTime":1118.46,"body":"And it's also important to wonder,"},{"startTime":1118.46,"endTime":1119.99,"body":"not just so we can understand it,"},{"startTime":1119.99,"endTime":1121.28,"body":"but so we can think about"},{"startTime":1121.28,"endTime":1124.1,"body":"if we want to increase vaccination rates,"},{"startTime":1124.1,"endTime":1125.93,"body":"we should listen to their concerns"},{"startTime":1125.93,"endTime":1128.63,"body":"and see if some of them can be addressed."},{"startTime":1128.63,"endTime":1132.38,"body":"Now there is a lot of research"},{"startTime":1128.63,"endTime":1132.38,"body":"about anti-vaccination views"},{"startTime":1132.38,"endTime":1134.719,"body":"and I will try to give"},{"startTime":1132.38,"endTime":1134.719,"body":"you the major strands"},{"startTime":1134.719,"endTime":1137.84,"body":"of the views that we can"},{"startTime":1134.719,"endTime":1137.84,"body":"identify and tease them out."},{"startTime":1137.84,"endTime":1139.1,"body":"And it's important to understand as well"},{"startTime":1139.1,"endTime":1141.14,"body":"that some of these views interrelate."},{"startTime":1141.14,"endTime":1143.307,"body":"So they're not necessarily isolated."},{"startTime":1143.307,"endTime":1145.28,"body":"And when we look at them you can see that"},{"startTime":1145.28,"endTime":1148.79,"body":"they contain both claims of about fact"},{"startTime":1148.79,"endTime":1150.62,"body":"and they contain normative positions."},{"startTime":1150.62,"endTime":1153.53,"body":"And what I mean there is"},{"startTime":1150.62,"endTime":1153.53,"body":"that people will make claims"},{"startTime":1153.53,"endTime":1155.93,"body":"that they say are true of vaccination"},{"startTime":1155.93,"endTime":1158.66,"body":"and they will also on"},{"startTime":1155.93,"endTime":1158.66,"body":"the basis of those claims"},{"startTime":1158.66,"endTime":1159.65,"body":"about vaccinations,"},{"startTime":1159.65,"endTime":1162.02,"body":"may take particular normative positions,"},{"startTime":1162.02,"endTime":1163.763,"body":"what they feel ought to happen."},{"startTime":1165.11,"endTime":1167.81,"body":"And this has implications"},{"startTime":1165.11,"endTime":1167.81,"body":"for how we respond,"},{"startTime":1167.81,"endTime":1169.37,"body":"because we should think partly about"},{"startTime":1169.37,"endTime":1171.74,"body":"responding to the factual claims,"},{"startTime":1171.74,"endTime":1174.44,"body":"but we need to also respond"},{"startTime":1171.74,"endTime":1174.44,"body":"to the moral dimension."},{"startTime":1174.44,"endTime":1176.39,"body":"To say, well, even if this is true,"},{"startTime":1176.39,"endTime":1179.167,"body":"we might not agree with your"},{"startTime":1176.39,"endTime":1179.167,"body":"normative position about it."},{"startTime":1179.167,"endTime":1181.85,"body":"So we might say, yes, vaccines have risks,"},{"startTime":1181.85,"endTime":1184.22,"body":"but I still don't agree that"},{"startTime":1181.85,"endTime":1184.22,"body":"that's a good enough reason"},{"startTime":1184.22,"endTime":1185.51,"body":"for you to opt out of having them."},{"startTime":1185.51,"endTime":1187.7,"body":"So these are distinct"},{"startTime":1185.51,"endTime":1187.7,"body":"things that we can do"},{"startTime":1187.7,"endTime":1190.4,"body":"when we respond to these"},{"startTime":1187.7,"endTime":1190.4,"body":"concerns if we wish to."},{"startTime":1190.4,"endTime":1191.9,"body":"And I think it's really important"},{"startTime":1191.9,"endTime":1195.29,"body":"to be clear about what it is"},{"startTime":1191.9,"endTime":1195.29,"body":"that you are responding to."},{"startTime":1195.29,"endTime":1197.87,"body":"And this is also where people begin,"},{"startTime":1197.87,"endTime":1201.77,"body":"and if you've ever seen an"},{"startTime":1197.87,"endTime":1201.77,"body":"anti-vaccination kind of pile on,"},{"startTime":1201.77,"endTime":1203.75,"body":"this is the bit where people will begin to"},{"startTime":1203.75,"endTime":1206.57,"body":"make fun of people who take"},{"startTime":1203.75,"endTime":1206.57,"body":"anti-vaccination perspectives"},{"startTime":1206.57,"endTime":1208.97,"body":"because they will say you're wrong."},{"startTime":1208.97,"endTime":1211.91,"body":"And I think it's important"},{"startTime":1208.97,"endTime":1211.91,"body":"actually to take pause"},{"startTime":1211.91,"endTime":1213.29,"body":"and think about partly"},{"startTime":1213.29,"endTime":1215.24,"body":"why does someone believe this to be true?"},{"startTime":1215.24,"endTime":1217.203,"body":"Why do you think it's not true?"},{"startTime":1217.203,"endTime":1220.523,"body":"And what you might respond with and how."},{"startTime":1221.51,"endTime":1223.73,"body":"Now I can't pretend to do justice"},{"startTime":1223.73,"endTime":1225.35,"body":"to the range or the"},{"startTime":1223.73,"endTime":1225.35,"body":"nuance of their arguments,"},{"startTime":1225.35,"endTime":1228.713,"body":"but I shall do my best to"},{"startTime":1225.35,"endTime":1228.713,"body":"give the strands of them."},{"startTime":1229.73,"endTime":1233.27,"body":"Now, one of these is that"},{"startTime":1229.73,"endTime":1233.27,"body":"vaccinations are not risk free,"},{"startTime":1233.27,"endTime":1234.696,"body":"that they can be harmful."},{"startTime":1234.696,"endTime":1236.84,"body":"Now I think it is true that very often"},{"startTime":1236.84,"endTime":1240.05,"body":"when we are presented with,"},{"startTime":1236.84,"endTime":1240.05,"body":"we're offered vaccinations,"},{"startTime":1240.05,"endTime":1241.22,"body":"we will be told some of the risks."},{"startTime":1241.22,"endTime":1242.417,"body":"But if you go on the NH website,"},{"startTime":1242.417,"endTime":1244.4,"body":"you will see that they do"},{"startTime":1242.417,"endTime":1244.4,"body":"give you some of the risks."},{"startTime":1244.4,"endTime":1246.98,"body":"But if you want to see the more"},{"startTime":1244.4,"endTime":1246.98,"body":"detailed, more severe risks,"},{"startTime":1246.98,"endTime":1247.82,"body":"they are there."},{"startTime":1247.82,"endTime":1250.292,"body":"But you can drill down"},{"startTime":1247.82,"endTime":1250.292,"body":"and find more cases."},{"startTime":1250.292,"endTime":1253.31,"body":"But because vaccinations are regarded"},{"startTime":1253.31,"endTime":1256.01,"body":"as on balance worth any risk"},{"startTime":1256.01,"endTime":1259.19,"body":"from a public health and"},{"startTime":1256.01,"endTime":1259.19,"body":"community-wide perspective,"},{"startTime":1259.19,"endTime":1261.659,"body":"the benefits hugely outweigh the risks"},{"startTime":1261.659,"endTime":1263.656,"body":"at a community level,"},{"startTime":1263.656,"endTime":1266.87,"body":"they are regarded as safe"},{"startTime":1263.656,"endTime":1266.87,"body":"or sufficiently safe."},{"startTime":1266.87,"endTime":1269.9,"body":"That doesn't necessarily"},{"startTime":1266.87,"endTime":1269.9,"body":"mean that they're risk free."},{"startTime":1269.9,"endTime":1271.88,"body":"And this is one of the"},{"startTime":1269.9,"endTime":1271.88,"body":"arguments that people raise"},{"startTime":1271.88,"endTime":1276.08,"body":"is that actually,"},{"startTime":1271.88,"endTime":1276.08,"body":"vaccines can be dangerous."},{"startTime":1276.08,"endTime":1278.18,"body":"Now, when they say that,"},{"startTime":1278.18,"endTime":1280.67,"body":"they may say it's because vaccines contain"},{"startTime":1280.67,"endTime":1281.84,"body":"dangerous substances,"},{"startTime":1281.84,"endTime":1284.213,"body":"substances they consider to be harmful."},{"startTime":1285.225,"endTime":1288.77,"body":"It may be that they think that"},{"startTime":1285.225,"endTime":1288.77,"body":"vaccinations cause disease"},{"startTime":1288.77,"endTime":1290.859,"body":"in the vaccinated individual."},{"startTime":1290.859,"endTime":1295.28,"body":"It might be that they think"},{"startTime":1290.859,"endTime":1295.28,"body":"they will cause disease"},{"startTime":1295.28,"endTime":1298.67,"body":"in people who come near them,"},{"startTime":1295.28,"endTime":1298.67,"body":"so the idea of shedding."},{"startTime":1298.67,"endTime":1301.28,"body":"They may say that vaccinations"},{"startTime":1298.67,"endTime":1301.28,"body":"cause dangerous side effects"},{"startTime":1301.28,"endTime":1304.37,"body":"and that they might"},{"startTime":1301.28,"endTime":1304.37,"body":"produce allergic reactions."},{"startTime":1304.37,"endTime":1307.16,"body":"Now some of these things are true,"},{"startTime":1307.16,"endTime":1309.29,"body":"vaccines do have side effects,"},{"startTime":1309.29,"endTime":1313.52,"body":"mostly in most cases"},{"startTime":1309.29,"endTime":1313.52,"body":"those risks are very mild"},{"startTime":1313.52,"endTime":1315.68,"body":"and they don't happen very often."},{"startTime":1315.68,"endTime":1317.6,"body":"But there are definitely"},{"startTime":1315.68,"endTime":1317.6,"body":"reported major risks"},{"startTime":1317.6,"endTime":1321.11,"body":"that are associated with"},{"startTime":1317.6,"endTime":1321.11,"body":"all of these vaccinations."},{"startTime":1321.11,"endTime":1324.83,"body":"From blood clotting,"},{"startTime":1321.11,"endTime":1324.83,"body":"anaphylaxis, fits and seizures,"},{"startTime":1324.83,"endTime":1326.81,"body":"encephalitis, chronic arthritis."},{"startTime":1326.81,"endTime":1327.98,"body":"And in fact the OPV,"},{"startTime":1327.98,"endTime":1330.617,"body":"the oral polio vaccine"},{"startTime":1327.98,"endTime":1330.617,"body":"can in fact in some cases"},{"startTime":1330.617,"endTime":1332.993,"body":"lead to paralytic polio."},{"startTime":1333.89,"endTime":1336.263,"body":"So it's not true that they are risk free."},{"startTime":1337.37,"endTime":1339.8,"body":"And so if you wanted to respond to this,"},{"startTime":1339.8,"endTime":1343.76,"body":"you would think about"},{"startTime":1339.8,"endTime":1343.76,"body":"whether the balance is right."},{"startTime":1343.76,"endTime":1344.99,"body":"There are risks,"},{"startTime":1344.99,"endTime":1348.38,"body":"but is that risk benefit"},{"startTime":1344.99,"endTime":1348.38,"body":"balance to such a degree"},{"startTime":1348.38,"endTime":1349.46,"body":"that we shouldn't vaccinate?"},{"startTime":1349.46,"endTime":1351.23,"body":"The public health view is no,"},{"startTime":1351.23,"endTime":1353.66,"body":"nothing becomes a vaccination"},{"startTime":1351.23,"endTime":1353.66,"body":"that is rolled out publicly"},{"startTime":1353.66,"endTime":1357.372,"body":"unless the benefits outweigh the risks."},{"startTime":1357.372,"endTime":1359.18,"body":"Other concerns people might raise"},{"startTime":1359.18,"endTime":1360.26,"body":"are that there are long-term risks"},{"startTime":1360.26,"endTime":1361.88,"body":"that we just don't know about."},{"startTime":1361.88,"endTime":1363.41,"body":"So these are identified risks"},{"startTime":1363.41,"endTime":1364.88,"body":"that somebody may not want to run."},{"startTime":1364.88,"endTime":1368.36,"body":"They may not feel it's personally"},{"startTime":1364.88,"endTime":1368.36,"body":"right for them to run it."},{"startTime":1368.36,"endTime":1371.24,"body":"They might also say there's"},{"startTime":1368.36,"endTime":1371.24,"body":"just limits to what we can know."},{"startTime":1371.24,"endTime":1373.1,"body":"Science hasn't caught up yet."},{"startTime":1373.1,"endTime":1375.35,"body":"They might say there are"},{"startTime":1373.1,"endTime":1375.35,"body":"limits on safety trials."},{"startTime":1375.35,"endTime":1378.113,"body":"The ways we test vaccines"},{"startTime":1375.35,"endTime":1378.113,"body":"just aren't good enough."},{"startTime":1379.07,"endTime":1381.5,"body":"And then the position"},{"startTime":1379.07,"endTime":1381.5,"body":"that follows from this"},{"startTime":1381.5,"endTime":1383.99,"body":"is that individuals should"},{"startTime":1381.5,"endTime":1383.99,"body":"weigh these risks themselves."},{"startTime":1383.99,"endTime":1387.14,"body":"So an autonomy argument that"},{"startTime":1383.99,"endTime":1387.14,"body":"will look out a bit more later"},{"startTime":1387.14,"endTime":1389.84,"body":"and that then they may"},{"startTime":1387.14,"endTime":1389.84,"body":"decide to refuse vaccination"},{"startTime":1389.84,"endTime":1390.946,"body":"because they say the risk to themselves"},{"startTime":1390.946,"endTime":1392.99,"body":"outweighs the benefits."},{"startTime":1392.99,"endTime":1394.49,"body":"Now it might be because"},{"startTime":1392.99,"endTime":1394.49,"body":"they think the risks"},{"startTime":1394.49,"endTime":1397.46,"body":"are generally so great that"},{"startTime":1394.49,"endTime":1397.46,"body":"we shouldn't have vaccination,"},{"startTime":1397.46,"endTime":1398.99,"body":"or it might be they think,"},{"startTime":1398.99,"endTime":1401.21,"body":"I personally don't want"},{"startTime":1398.99,"endTime":1401.21,"body":"to have the vaccination"},{"startTime":1401.21,"endTime":1404.138,"body":"because my evaluation of"},{"startTime":1401.21,"endTime":1404.138,"body":"this is that the risks to me"},{"startTime":1404.138,"endTime":1407.273,"body":"aren't risks I want to run"},{"startTime":1404.138,"endTime":1407.273,"body":"relative to the benefits."},{"startTime":1408.89,"endTime":1410.63,"body":"Now we know these risks exist."},{"startTime":1410.63,"endTime":1412.16,"body":"In fact, we know it to such degree"},{"startTime":1412.16,"endTime":1412.993,"body":"that there is a thing"},{"startTime":1412.993,"endTime":1415.163,"body":"called the Vaccine Damage Payment scheme."},{"startTime":1416.0,"endTime":1417.5,"body":"So in fact, the government runs a scheme"},{"startTime":1417.5,"endTime":1418.76,"body":"that if you are severely disabled"},{"startTime":1418.76,"endTime":1420.637,"body":"as a result of a vaccination,"},{"startTime":1420.637,"endTime":1424.7,"body":"you will get a one-off tax-free"},{"startTime":1420.637,"endTime":1424.7,"body":"payment of 120,000 pounds."},{"startTime":1424.7,"endTime":1426.41,"body":"It's recognizing the fact"},{"startTime":1424.7,"endTime":1426.41,"body":"that we have rolled out"},{"startTime":1426.41,"endTime":1428.69,"body":"a public health measure"},{"startTime":1426.41,"endTime":1428.69,"body":"that is damaging potentially"},{"startTime":1428.69,"endTime":1429.533,"body":"to some people."},{"startTime":1430.43,"endTime":1434.022,"body":"But what is also true is that"},{"startTime":1430.43,"endTime":1434.022,"body":"over the course of 43 years,"},{"startTime":1434.022,"endTime":1437.033,"body":"only 946 awards have been made."},{"startTime":1438.02,"endTime":1440.622,"body":"So yes, it is true that there is damage,"},{"startTime":1440.622,"endTime":1444.05,"body":"but when there have been"},{"startTime":1440.622,"endTime":1444.05,"body":"claims in actual fact,"},{"startTime":1444.05,"endTime":1446.06,"body":"over the course of that many years,"},{"startTime":1446.06,"endTime":1449.48,"body":"that is not a very large amount of claims."},{"startTime":1449.48,"endTime":1451.52,"body":"It's not a large amount"},{"startTime":1449.48,"endTime":1451.52,"body":"of harms that are reported"},{"startTime":1451.52,"endTime":1454.52,"body":"and regarded as having"},{"startTime":1451.52,"endTime":1454.52,"body":"led to such severe damage"},{"startTime":1454.52,"endTime":1456.8,"body":"relative to the levels of benefit"},{"startTime":1456.8,"endTime":1459.35,"body":"that we see and the"},{"startTime":1456.8,"endTime":1459.35,"body":"lives that we see saved."},{"startTime":1459.35,"endTime":1461.6,"body":"And so that's why on balance we can,"},{"startTime":1461.6,"endTime":1463.729,"body":"we do recognize that there are risks,"},{"startTime":1463.729,"endTime":1467.483,"body":"but on balance it is in"},{"startTime":1463.729,"endTime":1467.483,"body":"favor of vaccination."},{"startTime":1468.52,"endTime":1471.704,"body":"It's also true that even though"},{"startTime":1468.52,"endTime":1471.704,"body":"vaccines do have some risks,"},{"startTime":1471.704,"endTime":1473.84,"body":"they go through very rigorous testing,"},{"startTime":1473.84,"endTime":1475.31,"body":"they go through small initial trials,"},{"startTime":1475.31,"endTime":1476.867,"body":"they go through larger trials,"},{"startTime":1476.867,"endTime":1480.56,"body":"we review trial data and"},{"startTime":1476.867,"endTime":1480.56,"body":"we ongoingly monitor them."},{"startTime":1480.56,"endTime":1482.33,"body":"So there is the yellow card scheme,"},{"startTime":1482.33,"endTime":1485.96,"body":"where you can report an"},{"startTime":1482.33,"endTime":1485.96,"body":"adverse reaction to a vaccine"},{"startTime":1485.96,"endTime":1489.29,"body":"and that data is constantly"},{"startTime":1485.96,"endTime":1489.29,"body":"maintained and evaluated"},{"startTime":1489.29,"endTime":1492.383,"body":"as part of ongoingly"},{"startTime":1489.29,"endTime":1492.383,"body":"reviewing vaccination."},{"startTime":1494.764,"endTime":1496.542,"body":"So the second argument,"},{"startTime":1496.542,"endTime":1499.244,"body":"the second concern that people often raise"},{"startTime":1499.244,"endTime":1500.69,"body":"when they want to,"},{"startTime":1500.69,"endTime":1502.31,"body":"when they, that might leave them to"},{"startTime":1502.31,"endTime":1503.29,"body":"not want to have a vaccination,"},{"startTime":1503.29,"endTime":1505.4,"body":"it has to relate to the first one, right?"},{"startTime":1505.4,"endTime":1506.233,"body":"They have risks,"},{"startTime":1506.233,"endTime":1509.09,"body":"but also the diseases"},{"startTime":1506.233,"endTime":1509.09,"body":"that they protect against"},{"startTime":1509.09,"endTime":1510.5,"body":"aren't that severe."},{"startTime":1510.5,"endTime":1512.06,"body":"So this, I'm not sure if you can read it,"},{"startTime":1512.06,"endTime":1514.19,"body":"this is a comment from a Reddit thread"},{"startTime":1514.19,"endTime":1517.107,"body":"discussing vaccinations and she says,"},{"startTime":1517.107,"endTime":1518.45,"body":"\"Measles isn't dangerous."},{"startTime":1518.45,"endTime":1519.89,"body":"It's an integral part of childhood."},{"startTime":1519.89,"endTime":1523.19,"body":"How do you think people"},{"startTime":1519.89,"endTime":1523.19,"body":"back in the 1700S survived?\""},{"startTime":1523.19,"endTime":1524.72,"body":"Well, what we can actually see"},{"startTime":1524.72,"endTime":1525.95,"body":"is lots of them didn't survive."},{"startTime":1525.95,"endTime":1528.35,"body":"That they died is partly true,"},{"startTime":1528.35,"endTime":1529.97,"body":"but it's also true that many many people"},{"startTime":1529.97,"endTime":1531.59,"body":"had measles and they did survive."},{"startTime":1531.59,"endTime":1533.78,"body":"I had measles as a child and it was mild"},{"startTime":1533.78,"endTime":1534.89,"body":"and I'm absolutely fine."},{"startTime":1534.89,"endTime":1536.57,"body":"I was fine then and I'm still fine."},{"startTime":1536.57,"endTime":1538.61,"body":"So of course that is true."},{"startTime":1538.61,"endTime":1541.13,"body":"But what is also true is"},{"startTime":1538.61,"endTime":1541.13,"body":"that some of these diseases"},{"startTime":1541.13,"endTime":1543.623,"body":"are often mild but can be severe."},{"startTime":1544.52,"endTime":1546.29,"body":"But essentially the normative claim here"},{"startTime":1546.29,"endTime":1548.319,"body":"is that if the disease isn't that severe"},{"startTime":1548.319,"endTime":1550.25,"body":"and there are risks,"},{"startTime":1550.25,"endTime":1552.26,"body":"that the balance tips in"},{"startTime":1550.25,"endTime":1552.26,"body":"favor of them saying, well,"},{"startTime":1552.26,"endTime":1554.87,"body":"it's not necessary for"},{"startTime":1552.26,"endTime":1554.87,"body":"me to get vaccinated."},{"startTime":1554.87,"endTime":1557.318,"body":"Or, I don't want to run"},{"startTime":1554.87,"endTime":1557.318,"body":"that particular risk"},{"startTime":1557.318,"endTime":1560.033,"body":"because I don't think"},{"startTime":1557.318,"endTime":1560.033,"body":"it's personally worth it."},{"startTime":1561.53,"endTime":1564.56,"body":"So again, there are some"},{"startTime":1561.53,"endTime":1564.56,"body":"claims of fact in here"},{"startTime":1564.56,"endTime":1567.8,"body":"and that leads to some"},{"startTime":1564.56,"endTime":1567.8,"body":"normative arguments."},{"startTime":1567.8,"endTime":1570.11,"body":"Now, one of the ways you"},{"startTime":1567.8,"endTime":1570.11,"body":"could respond to this"},{"startTime":1570.11,"endTime":1571.7,"body":"is to interrogate each disease,"},{"startTime":1571.7,"endTime":1573.588,"body":"which I don't intend to do here."},{"startTime":1573.588,"endTime":1575.33,"body":"But if we take two diseases"},{"startTime":1575.33,"endTime":1577.25,"body":"that people do often say this about,"},{"startTime":1577.25,"endTime":1579.86,"body":"we can look at whether this claim is true."},{"startTime":1579.86,"endTime":1581.66,"body":"So one of them is rubella."},{"startTime":1581.66,"endTime":1583.94,"body":"Yes, it is largely mild,"},{"startTime":1581.66,"endTime":1583.94,"body":"sometimes it is severe,"},{"startTime":1583.94,"endTime":1587.506,"body":"but almost invariably"},{"startTime":1583.94,"endTime":1587.506,"body":"it isn't very severe."},{"startTime":1587.506,"endTime":1590.36,"body":"But we could also respond"},{"startTime":1587.506,"endTime":1590.36,"body":"to that normatively to say,"},{"startTime":1590.36,"endTime":1593.66,"body":"even though that disease will"},{"startTime":1590.36,"endTime":1593.66,"body":"not be severe if you catch it,"},{"startTime":1593.66,"endTime":1595.58,"body":"it has other implications"},{"startTime":1593.66,"endTime":1595.58,"body":"for other people."},{"startTime":1595.58,"endTime":1597.02,"body":"So we come back to the reason"},{"startTime":1597.02,"endTime":1598.76,"body":"why we vaccinate against rubella partly,"},{"startTime":1598.76,"endTime":1602.096,"body":"which is to protect pregnant people."},{"startTime":1602.096,"endTime":1604.16,"body":"And so, the normative claim"},{"startTime":1604.16,"endTime":1606.83,"body":"may not be the only normative"},{"startTime":1604.16,"endTime":1606.83,"body":"position we need to consider"},{"startTime":1606.83,"endTime":1608.93,"body":"when we think whether or"},{"startTime":1606.83,"endTime":1608.93,"body":"not we should vaccinate"},{"startTime":1608.93,"endTime":1612.02,"body":"and whether or not people"},{"startTime":1608.93,"endTime":1612.02,"body":"should be required to vaccinate."},{"startTime":1612.02,"endTime":1613.67,"body":"And we'll come back to that later."},{"startTime":1613.67,"endTime":1615.56,"body":"But that's why it's"},{"startTime":1613.67,"endTime":1615.56,"body":"important to understand"},{"startTime":1615.56,"endTime":1617.69,"body":"the different reasons why we vaccinate"},{"startTime":1617.69,"endTime":1619.703,"body":"and the particular concerns people have."},{"startTime":1620.715,"endTime":1622.34,"body":"The other way we could look at this"},{"startTime":1622.34,"endTime":1624.95,"body":"is we could challenge the"},{"startTime":1622.34,"endTime":1624.95,"body":"factual claim and say,"},{"startTime":1624.95,"endTime":1627.11,"body":"actually measles is dangerous."},{"startTime":1627.11,"endTime":1630.38,"body":"So, measles can be mild, that is true."},{"startTime":1630.38,"endTime":1634.01,"body":"But we also know that there"},{"startTime":1630.38,"endTime":1634.01,"body":"is a death rate to measles"},{"startTime":1634.01,"endTime":1636.77,"body":"of between 0.1 and 0.3% of cases,"},{"startTime":1636.77,"endTime":1638.72,"body":"even with good treatment now."},{"startTime":1638.72,"endTime":1642.32,"body":"So, sometimes measles"},{"startTime":1638.72,"endTime":1642.32,"body":"leads to encephalitis,"},{"startTime":1642.32,"endTime":1643.79,"body":"that can cause deafness,"},{"startTime":1643.79,"endTime":1646.88,"body":"it can cause intellectual"},{"startTime":1643.79,"endTime":1646.88,"body":"disability, can lead to pneumonia."},{"startTime":1646.88,"endTime":1649.19,"body":"And that is why there"},{"startTime":1646.88,"endTime":1649.19,"body":"were thousands of deaths"},{"startTime":1649.19,"endTime":1650.96,"body":"from measles in the past."},{"startTime":1650.96,"endTime":1652.581,"body":"And if any you've ever heard"},{"startTime":1650.96,"endTime":1652.581,"body":"of the really famous story"},{"startTime":1652.581,"endTime":1655.07,"body":"of Roald Dahl's daughter"},{"startTime":1652.581,"endTime":1655.07,"body":"who died of measles."},{"startTime":1655.07,"endTime":1656.39,"body":"And he wrote a letter,"},{"startTime":1656.39,"endTime":1658.82,"body":"a public letter afterwards"},{"startTime":1656.39,"endTime":1658.82,"body":"to express what had happened"},{"startTime":1658.82,"endTime":1660.56,"body":"because he was so, so distressed"},{"startTime":1660.56,"endTime":1662.3,"body":"that his daughter went from well one day"},{"startTime":1662.3,"endTime":1666.276,"body":"to essentially she died"},{"startTime":1662.3,"endTime":1666.276,"body":"very soon after measles"},{"startTime":1666.276,"endTime":1668.783,"body":"because of the impact that it had on her."},{"startTime":1669.833,"endTime":1672.44,"body":"The third argument is that"},{"startTime":1669.833,"endTime":1672.44,"body":"we don't actually need"},{"startTime":1672.44,"endTime":1674.813,"body":"vaccinations to reduce disease."},{"startTime":1675.65,"endTime":1677.12,"body":"And this is the idea"},{"startTime":1677.12,"endTime":1680.75,"body":"that actually either the"},{"startTime":1677.12,"endTime":1680.75,"body":"diseases are treatable,"},{"startTime":1680.75,"endTime":1682.64,"body":"or if we're healthy enough"},{"startTime":1680.75,"endTime":1682.64,"body":"that we can resist them."},{"startTime":1682.64,"endTime":1684.95,"body":"So the better way is not"},{"startTime":1682.64,"endTime":1684.95,"body":"to put things into our body"},{"startTime":1684.95,"endTime":1689.3,"body":"like vaccinations, but to think,"},{"startTime":1684.95,"endTime":1689.3,"body":"well, I'm a healthy person,"},{"startTime":1689.3,"endTime":1692.3,"body":"I eat well, I'm fit and"},{"startTime":1689.3,"endTime":1692.3,"body":"so on and I can resist it."},{"startTime":1692.3,"endTime":1695.03,"body":"And we saw some of that"},{"startTime":1692.3,"endTime":1695.03,"body":"in the public discourse"},{"startTime":1695.03,"endTime":1697.79,"body":"around COVID vaccinations,"},{"startTime":1695.03,"endTime":1697.79,"body":"is some people saying, well,"},{"startTime":1697.79,"endTime":1701.69,"body":"I don't think I need it and"},{"startTime":1697.79,"endTime":1701.69,"body":"my body will fight it off"},{"startTime":1701.69,"endTime":1703.34,"body":"or will build natural resistance."},{"startTime":1703.34,"endTime":1706.13,"body":"And that is what people argue"},{"startTime":1703.34,"endTime":1706.13,"body":"about a range of diseases."},{"startTime":1706.13,"endTime":1707.18,"body":"And some people even argue"},{"startTime":1707.18,"endTime":1709.444,"body":"that you'll be more able"},{"startTime":1707.18,"endTime":1709.444,"body":"to resist the disease."},{"startTime":1709.444,"endTime":1711.89,"body":"You'll be stronger if you"},{"startTime":1709.444,"endTime":1711.89,"body":"naturally fight it off"},{"startTime":1711.89,"endTime":1714.11,"body":"and develop natural resistance,"},{"startTime":1714.11,"endTime":1718.16,"body":"and argue that is better than"},{"startTime":1714.11,"endTime":1718.16,"body":"vaccine induced resistance."},{"startTime":1718.16,"endTime":1720.29,"body":"Now one of the ways we see this manifest"},{"startTime":1720.29,"endTime":1722.24,"body":"is people pointing out that"},{"startTime":1720.29,"endTime":1722.24,"body":"actually there are some diseases"},{"startTime":1722.24,"endTime":1724.463,"body":"that declined without vaccination."},{"startTime":1725.3,"endTime":1727.97,"body":"So this is a good"},{"startTime":1725.3,"endTime":1727.97,"body":"example, this is measles."},{"startTime":1727.97,"endTime":1731.81,"body":"So measles at vaccination"},{"startTime":1727.97,"endTime":1731.81,"body":"isn't introduced until 1968,"},{"startTime":1731.81,"endTime":1734.78,"body":"but you can see this really"},{"startTime":1731.81,"endTime":1734.78,"body":"big decline in measles anyway."},{"startTime":1734.78,"endTime":1736.369,"body":"So it's declining before we hit the point"},{"startTime":1736.369,"endTime":1738.2,"body":"when the vaccine's introduced."},{"startTime":1738.2,"endTime":1742.053,"body":"And by the time the MMR is"},{"startTime":1738.2,"endTime":1742.053,"body":"introduced, it's very rare."},{"startTime":1742.053,"endTime":1743.93,"body":"Now one argument that people,"},{"startTime":1743.93,"endTime":1746.36,"body":"so what we know is that"},{"startTime":1743.93,"endTime":1746.36,"body":"Public Health England"},{"startTime":1746.36,"endTime":1747.35,"body":"says that, well actually,"},{"startTime":1747.35,"endTime":1749.383,"body":"we've prevented lots and lots of deaths"},{"startTime":1749.383,"endTime":1751.884,"body":"from having the vaccination."},{"startTime":1751.884,"endTime":1755.78,"body":"But what other people argue"},{"startTime":1751.884,"endTime":1755.78,"body":"is that it's not true."},{"startTime":1755.78,"endTime":1758.12,"body":"That it isn't true that"},{"startTime":1755.78,"endTime":1758.12,"body":"the vaccine is necessary"},{"startTime":1758.12,"endTime":1759.219,"body":"to reduce measles."},{"startTime":1759.219,"endTime":1760.052,"body":"So they're saying,"},{"startTime":1760.052,"endTime":1762.5,"body":"well actually we don't"},{"startTime":1760.052,"endTime":1762.5,"body":"need the vaccinations"},{"startTime":1762.5,"endTime":1765.593,"body":"because the disease can be"},{"startTime":1762.5,"endTime":1765.593,"body":"dealt with in other ways."},{"startTime":1766.43,"endTime":1767.93,"body":"Now, to some degree,"},{"startTime":1767.93,"endTime":1771.71,"body":"this is actually true and"},{"startTime":1767.93,"endTime":1771.71,"body":"it's partly true with measles."},{"startTime":1771.71,"endTime":1773.03,"body":"And the reason it's partly true"},{"startTime":1773.03,"endTime":1775.73,"body":"is actually other things"},{"startTime":1773.03,"endTime":1775.73,"body":"happened at that point."},{"startTime":1775.73,"endTime":1779.1,"body":"The reason measles declines"},{"startTime":1775.73,"endTime":1779.1,"body":"in the 1940s and 1950s"},{"startTime":1779.1,"endTime":1781.43,"body":"is because we develop antibiotics"},{"startTime":1781.43,"endTime":1784.94,"body":"that are very good at treating"},{"startTime":1781.43,"endTime":1784.94,"body":"the bacterial pneumonia"},{"startTime":1784.94,"endTime":1788.57,"body":"that comes from having measles,"},{"startTime":1784.94,"endTime":1788.57,"body":"which is a cause of death."},{"startTime":1788.57,"endTime":1790.61,"body":"We also see an increase in sanitation,"},{"startTime":1790.61,"endTime":1791.57,"body":"an increase in nutrition."},{"startTime":1791.57,"endTime":1795.56,"body":"So actually people did get"},{"startTime":1791.57,"endTime":1795.56,"body":"better at fighting off measles"},{"startTime":1795.56,"endTime":1797.344,"body":"and also we got better"},{"startTime":1795.56,"endTime":1797.344,"body":"at treating measles."},{"startTime":1797.344,"endTime":1799.073,"body":"These things are true."},{"startTime":1800.96,"endTime":1803.201,"body":"But what isn't true is that"},{"startTime":1800.96,"endTime":1803.201,"body":"we don't need the vaccines."},{"startTime":1803.201,"endTime":1806.72,"body":"And the way I think about"},{"startTime":1803.201,"endTime":1806.72,"body":"this is, this can all be true,"},{"startTime":1806.72,"endTime":1810.727,"body":"but what is also true is that"},{"startTime":1806.72,"endTime":1810.727,"body":"there is a set of deaths here"},{"startTime":1810.727,"endTime":1814.19,"body":"that are deaths that happen"},{"startTime":1810.727,"endTime":1814.19,"body":"even when all of that is true."},{"startTime":1814.19,"endTime":1816.68,"body":"So even with all of this treatment,"},{"startTime":1816.68,"endTime":1818.169,"body":"there is still a death rate from measles."},{"startTime":1818.169,"endTime":1821.15,"body":"But what we also know is that"},{"startTime":1818.169,"endTime":1821.15,"body":"when we eradicate measles,"},{"startTime":1821.15,"endTime":1822.95,"body":"those deaths will be eliminated."},{"startTime":1822.95,"endTime":1824.47,"body":"So part of the question here is"},{"startTime":1824.47,"endTime":1827.672,"body":"to interrogate the"},{"startTime":1824.47,"endTime":1827.672,"body":"evidence really carefully."},{"startTime":1827.672,"endTime":1829.34,"body":"It's also to respect the fact"},{"startTime":1829.34,"endTime":1831.298,"body":"that someone has looked at that data"},{"startTime":1831.298,"endTime":1833.27,"body":"and in fact this person"},{"startTime":1831.298,"endTime":1833.27,"body":"has looked at that data"},{"startTime":1833.27,"endTime":1834.77,"body":"and he does make the arguments that I make"},{"startTime":1834.77,"endTime":1836.9,"body":"about nutrition and sanitation."},{"startTime":1836.9,"endTime":1838.073,"body":"But someone can easily look"},{"startTime":1836.9,"endTime":1838.073,"body":"at that data and think,"},{"startTime":1838.073,"endTime":1839.0,"body":"do you know what?"},{"startTime":1839.0,"endTime":1840.334,"body":"It does look like vaccines don't do this."},{"startTime":1840.334,"endTime":1842.315,"body":"And this is what I mean"},{"startTime":1840.334,"endTime":1842.315,"body":"about being respectful"},{"startTime":1842.315,"endTime":1844.25,"body":"and thoughtful when you're thinking about"},{"startTime":1844.25,"endTime":1846.38,"body":"why somebody might resist vaccinations"},{"startTime":1846.38,"endTime":1848.96,"body":"and taking seriously"},{"startTime":1846.38,"endTime":1848.96,"body":"people's positions about this"},{"startTime":1848.96,"endTime":1852.17,"body":"is that there may be an"},{"startTime":1848.96,"endTime":1852.17,"body":"understandable basis."},{"startTime":1852.17,"endTime":1853.61,"body":"In fact they might also be right."},{"startTime":1853.61,"endTime":1856.52,"body":"It is true measles was"},{"startTime":1853.61,"endTime":1856.52,"body":"reduced in this way,"},{"startTime":1856.52,"endTime":1857.665,"body":"but it is also true"},{"startTime":1857.665,"endTime":1860.9,"body":"that there remain vaccine"},{"startTime":1857.665,"endTime":1860.9,"body":"preventable deaths."},{"startTime":1860.9,"endTime":1862.43,"body":"So what that does is it sets you up"},{"startTime":1862.43,"endTime":1864.466,"body":"to think about the moral"},{"startTime":1862.43,"endTime":1864.466,"body":"question, which is,"},{"startTime":1864.466,"endTime":1866.703,"body":"what are the risks and the balances here?"},{"startTime":1866.703,"endTime":1868.52,"body":"What are the risks and the benefits"},{"startTime":1868.52,"endTime":1869.96,"body":"and what should we do"},{"startTime":1868.52,"endTime":1869.96,"body":"in the face of those?"},{"startTime":1869.96,"endTime":1871.36,"body":"Which is what we'll come to."},{"startTime":1872.75,"endTime":1873.68,"body":"The fourth reason"},{"startTime":1873.68,"endTime":1877.282,"body":"that people resist"},{"startTime":1873.68,"endTime":1877.282,"body":"vaccinations is mistrust."},{"startTime":1877.282,"endTime":1881.732,"body":"And there's a lot of reasons"},{"startTime":1877.282,"endTime":1881.732,"body":"why people might mistrust"},{"startTime":1881.732,"endTime":1884.918,"body":"the claim or mistrust"},{"startTime":1881.732,"endTime":1884.918,"body":"pro vaccination policies"},{"startTime":1884.918,"endTime":1886.58,"body":"from the government."},{"startTime":1886.58,"endTime":1888.17,"body":"One is they think that the"},{"startTime":1886.58,"endTime":1888.17,"body":"information that they have"},{"startTime":1888.17,"endTime":1889.767,"body":"is misleading or false."},{"startTime":1889.767,"endTime":1892.94,"body":"Another is the idea that"},{"startTime":1889.767,"endTime":1892.94,"body":"there is some conspiracy."},{"startTime":1892.94,"endTime":1894.845,"body":"So this is another Reddit post"},{"startTime":1894.845,"endTime":1895.969,"body":"where he's essentially saying,"},{"startTime":1895.969,"endTime":1898.61,"body":"\"Have we been poisoned"},{"startTime":1895.969,"endTime":1898.61,"body":"from the very beginning?"},{"startTime":1898.61,"endTime":1901.19,"body":"What makes us think big"},{"startTime":1898.61,"endTime":1901.19,"body":"pharma only started harming us"},{"startTime":1901.19,"endTime":1902.023,"body":"in the last three years?"},{"startTime":1902.023,"endTime":1903.4,"body":"The rabbit hole goes deeper than that.\""},{"startTime":1903.4,"endTime":1905.285,"body":"So it's a classic conspiracy theory."},{"startTime":1905.285,"endTime":1907.52,"body":"And the idea is that they"},{"startTime":1905.285,"endTime":1907.52,"body":"think that governments"},{"startTime":1907.52,"endTime":1911.288,"body":"have agendas, harmful agendas."},{"startTime":1911.288,"endTime":1913.16,"body":"They also think that"},{"startTime":1911.288,"endTime":1913.16,"body":"governments might be influenced"},{"startTime":1913.16,"endTime":1914.87,"body":"by pharmaceutical companies."},{"startTime":1914.87,"endTime":1917.45,"body":"Now these are empirical"},{"startTime":1914.87,"endTime":1917.45,"body":"claims, these ones,"},{"startTime":1917.45,"endTime":1919.49,"body":"and they may be true,"},{"startTime":1917.45,"endTime":1919.49,"body":"they may not be true."},{"startTime":1919.49,"endTime":1921.912,"body":"So, we can understand those claims,"},{"startTime":1921.912,"endTime":1926.15,"body":"we may disagree with them and"},{"startTime":1921.912,"endTime":1926.15,"body":"that is a different matter."},{"startTime":1926.15,"endTime":1928.16,"body":"It might be that somebody"},{"startTime":1926.15,"endTime":1928.16,"body":"has access to information"},{"startTime":1928.16,"endTime":1929.861,"body":"which is inaccurate."},{"startTime":1929.861,"endTime":1931.37,"body":"That's true."},{"startTime":1931.37,"endTime":1932.72,"body":"But the other things"},{"startTime":1931.37,"endTime":1932.72,"body":"that are particularly,"},{"startTime":1932.72,"endTime":1934.34,"body":"these are kind of small dimensions."},{"startTime":1934.34,"endTime":1935.87,"body":"The really interesting things"},{"startTime":1935.87,"endTime":1939.016,"body":"are generalized mistrust"},{"startTime":1935.87,"endTime":1939.016,"body":"of healthcare systems."},{"startTime":1939.016,"endTime":1941.42,"body":"So what you can see is"},{"startTime":1939.016,"endTime":1941.42,"body":"that there are people"},{"startTime":1941.42,"endTime":1943.64,"body":"who mistrust healthcare systems"},{"startTime":1943.64,"endTime":1946.85,"body":"and they might have"},{"startTime":1943.64,"endTime":1946.85,"body":"intelligible reasons for this."},{"startTime":1946.85,"endTime":1949.16,"body":"One is that they may have"},{"startTime":1946.85,"endTime":1949.16,"body":"had problematic experiences"},{"startTime":1949.16,"endTime":1950.267,"body":"in the healthcare system themselves."},{"startTime":1950.267,"endTime":1952.29,"body":"And so they may have a lack of trust"},{"startTime":1952.29,"endTime":1954.26,"body":"in healthcare providers."},{"startTime":1954.26,"endTime":1956.06,"body":"Another is they might"},{"startTime":1954.26,"endTime":1956.06,"body":"be a member of a group"},{"startTime":1956.06,"endTime":1959.15,"body":"that has a history of mistreatment"},{"startTime":1956.06,"endTime":1959.15,"body":"in healthcare systems."},{"startTime":1959.15,"endTime":1960.38,"body":"And so a really good example"},{"startTime":1960.38,"endTime":1962.66,"body":"is the impact of the"},{"startTime":1960.38,"endTime":1962.66,"body":"Tuskegee Syphilis Study"},{"startTime":1962.66,"endTime":1964.16,"body":"on African-American people"},{"startTime":1964.16,"endTime":1965.846,"body":"and the implications"},{"startTime":1964.16,"endTime":1965.846,"body":"for those people's trust"},{"startTime":1965.846,"endTime":1968.633,"body":"in the healthcare system,"},{"startTime":1965.846,"endTime":1968.633,"body":"which were well-founded."},{"startTime":1969.74,"endTime":1971.18,"body":"And we see that still,"},{"startTime":1971.18,"endTime":1973.04,"body":"that there are different"},{"startTime":1971.18,"endTime":1973.04,"body":"groups that collectively"},{"startTime":1973.04,"endTime":1974.51,"body":"have been failed and mistreated,"},{"startTime":1974.51,"endTime":1976.883,"body":"and therefore they have"},{"startTime":1974.51,"endTime":1976.883,"body":"a collective mistrust."},{"startTime":1977.717,"endTime":1979.37,"body":"And what I think we need to do"},{"startTime":1979.37,"endTime":1980.69,"body":"when we think about this reason"},{"startTime":1980.69,"endTime":1983.45,"body":"is partly the response"},{"startTime":1980.69,"endTime":1983.45,"body":"to this is good data,"},{"startTime":1983.45,"endTime":1986.09,"body":"but partly it's thinking"},{"startTime":1983.45,"endTime":1986.09,"body":"about the reasons why"},{"startTime":1986.09,"endTime":1988.16,"body":"somebody may mistrust systems"},{"startTime":1988.16,"endTime":1990.413,"body":"and addressing those"},{"startTime":1988.16,"endTime":1990.413,"body":"and working with those."},{"startTime":1992.33,"endTime":1994.1,"body":"The final reason is the idea"},{"startTime":1994.1,"endTime":1995.66,"body":"that there are moral objections."},{"startTime":1995.66,"endTime":1997.31,"body":"So particular moral"},{"startTime":1995.66,"endTime":1997.31,"body":"claims that people make"},{"startTime":1997.31,"endTime":1998.9,"body":"about vaccines themselves."},{"startTime":1998.9,"endTime":2001.629,"body":"So not about the implications"},{"startTime":1998.9,"endTime":2001.629,"body":"of vaccines so much,"},{"startTime":2001.629,"endTime":2003.28,"body":"that they raise concerns."},{"startTime":2003.28,"endTime":2005.98,"body":"So one of these is they"},{"startTime":2003.28,"endTime":2005.98,"body":"believe that it's problematic"},{"startTime":2005.98,"endTime":2008.32,"body":"that they're made from human cell lines."},{"startTime":2008.32,"endTime":2010.6,"body":"A more popular one is that the cell lines"},{"startTime":2010.6,"endTime":2012.631,"body":"that are used to"},{"startTime":2010.6,"endTime":2012.631,"body":"manufacture some vaccines,"},{"startTime":2012.631,"endTime":2015.97,"body":"so the AstraZeneca COVID"},{"startTime":2012.631,"endTime":2015.97,"body":"vaccine is an example of this,"},{"startTime":2015.97,"endTime":2016.99,"body":"are made from cell lines"},{"startTime":2016.99,"endTime":2018.7,"body":"that are derived from aborted fetuses."},{"startTime":2018.7,"endTime":2019.533,"body":"And this is true,"},{"startTime":2019.533,"endTime":2021.58,"body":"that that cell line is derived"},{"startTime":2021.58,"endTime":2023.38,"body":"from a therapeutically aborted fetus"},{"startTime":2023.38,"endTime":2025.09,"body":"from the 1970s."},{"startTime":2025.09,"endTime":2028.18,"body":"Some people have concerns about"},{"startTime":2025.09,"endTime":2028.18,"body":"the use of animal products."},{"startTime":2028.18,"endTime":2029.013,"body":"So if you are vegan,"},{"startTime":2029.013,"endTime":2031.93,"body":"you may have an understandable"},{"startTime":2029.013,"endTime":2031.93,"body":"concern about a vaccine"},{"startTime":2031.93,"endTime":2032.763,"body":"that's produced in a way"},{"startTime":2032.763,"endTime":2034.763,"body":"that you think is morally problematic."},{"startTime":2034.763,"endTime":2037.197,"body":"Or you might have concerns about GMOs."},{"startTime":2037.197,"endTime":2039.43,"body":"So GMOs are used in the nasal flu vaccine."},{"startTime":2039.43,"endTime":2040.521,"body":"So there are a range of bases"},{"startTime":2040.521,"endTime":2042.07,"body":"on which somebody may subscribe"},{"startTime":2042.07,"endTime":2043.63,"body":"to a particular moral position,"},{"startTime":2043.63,"endTime":2044.798,"body":"and then that makes it difficult"},{"startTime":2044.798,"endTime":2046.51,"body":"for them to accept vaccinations"},{"startTime":2046.51,"endTime":2048.81,"body":"because they're committed"},{"startTime":2046.51,"endTime":2048.81,"body":"to a prior position."},{"startTime":2049.886,"endTime":2051.67,"body":"And in this situation,"},{"startTime":2051.67,"endTime":2054.4,"body":"taking those ethical positions"},{"startTime":2051.67,"endTime":2054.4,"body":"people might have seriously"},{"startTime":2054.4,"endTime":2055.796,"body":"and understanding them is really important"},{"startTime":2055.796,"endTime":2057.64,"body":"in the way that we respond to the reasons"},{"startTime":2057.64,"endTime":2061.183,"body":"why they may be hesitant or"},{"startTime":2057.64,"endTime":2061.183,"body":"objective to vaccinations."},{"startTime":2062.83,"endTime":2064.39,"body":"So the next question is think well,"},{"startTime":2064.39,"endTime":2066.133,"body":"why do we need to do anything?"},{"startTime":2067.036,"endTime":2068.997,"body":"It's really clear that vaccination"},{"startTime":2068.997,"endTime":2071.65,"body":"is beneficial on balance,"},{"startTime":2071.65,"endTime":2072.847,"body":"but why would we even consider"},{"startTime":2072.847,"endTime":2076.12,"body":"whether we need to make"},{"startTime":2072.847,"endTime":2076.12,"body":"vaccination mandatory?"},{"startTime":2076.12,"endTime":2077.757,"body":"Why do we need to do anything at all?"},{"startTime":2077.757,"endTime":2080.62,"body":"Well, what we see is"},{"startTime":2077.757,"endTime":2080.62,"body":"sometimes there is a drop off"},{"startTime":2080.62,"endTime":2082.21,"body":"in vaccination rates."},{"startTime":2082.21,"endTime":2085.15,"body":"And when that happens"},{"startTime":2082.21,"endTime":2085.15,"body":"we see harms to people."},{"startTime":2085.15,"endTime":2087.91,"body":"So, good examples are"},{"startTime":2085.15,"endTime":2087.91,"body":"recent measles outbreaks"},{"startTime":2087.91,"endTime":2089.86,"body":"that I'll talk to you about in a moment."},{"startTime":2089.86,"endTime":2092.02,"body":"The WHO has named vaccine hesitancy"},{"startTime":2092.02,"endTime":2094.822,"body":"as one of the top 10"},{"startTime":2092.02,"endTime":2094.822,"body":"global threats to health."},{"startTime":2094.822,"endTime":2097.543,"body":"So it is considered to be a real problem."},{"startTime":2098.894,"endTime":2101.866,"body":"We also need to think about the fact that"},{"startTime":2101.866,"endTime":2104.74,"body":"when vaccine rates drop"},{"startTime":2101.866,"endTime":2104.74,"body":"to a particular level,"},{"startTime":2104.74,"endTime":2106.81,"body":"vulnerable people may be harmed."},{"startTime":2106.81,"endTime":2109.0,"body":"People may be harmed themselves"},{"startTime":2106.81,"endTime":2109.0,"body":"because they get the disease"},{"startTime":2109.0,"endTime":2110.26,"body":"and other people may be harmed"},{"startTime":2110.26,"endTime":2113.47,"body":"if the disease is passed onto"},{"startTime":2110.26,"endTime":2113.47,"body":"them by unvaccinated people"},{"startTime":2113.47,"endTime":2116.061,"body":"when they themselves can't be vaccinated."},{"startTime":2116.061,"endTime":2118.72,"body":"And we can see what this looks like"},{"startTime":2118.72,"endTime":2121.06,"body":"when we have a drop in vaccination rates."},{"startTime":2121.06,"endTime":2123.88,"body":"Now this is data from Public Health Wales"},{"startTime":2123.88,"endTime":2126.09,"body":"as they've been trying to explore"},{"startTime":2126.09,"endTime":2128.015,"body":"why they had recent outbreaks of measles."},{"startTime":2128.015,"endTime":2130.66,"body":"And what's really clear from their data is"},{"startTime":2130.66,"endTime":2131.5,"body":"that the cases,"},{"startTime":2131.5,"endTime":2134.68,"body":"this has confirmed cases"},{"startTime":2131.5,"endTime":2134.68,"body":"of measles in Wales,"},{"startTime":2134.68,"endTime":2137.71,"body":"and what they did was is they"},{"startTime":2134.68,"endTime":2137.71,"body":"look at the year of of birth"},{"startTime":2137.71,"endTime":2138.64,"body":"of the children who,"},{"startTime":2138.64,"endTime":2140.59,"body":"or the people who are"},{"startTime":2138.64,"endTime":2140.59,"body":"experiencing measles."},{"startTime":2140.59,"endTime":2144.003,"body":"And what you can see is that"},{"startTime":2140.59,"endTime":2144.003,"body":"it tracks with when people,"},{"startTime":2144.003,"endTime":2147.13,"body":"when there was a reduction"},{"startTime":2144.003,"endTime":2147.13,"body":"in uptake of the MMR"},{"startTime":2147.13,"endTime":2150.49,"body":"in the wake of concerns about"},{"startTime":2147.13,"endTime":2150.49,"body":"its association with autism."},{"startTime":2150.49,"endTime":2153.73,"body":"So there's a direct correlation"},{"startTime":2150.49,"endTime":2153.73,"body":"there, whether it's causal,"},{"startTime":2153.73,"endTime":2154.9,"body":"it's not what I'm saying."},{"startTime":2154.9,"endTime":2156.97,"body":"But what they were saying"},{"startTime":2154.9,"endTime":2156.97,"body":"is there is a correlation"},{"startTime":2156.97,"endTime":2161.209,"body":"that many of the children"},{"startTime":2156.97,"endTime":2161.209,"body":"and people who had measles"},{"startTime":2161.209,"endTime":2164.362,"body":"were from the period when there was a drop"},{"startTime":2164.362,"endTime":2166.947,"body":"in vaccination uptake."},{"startTime":2166.947,"endTime":2167.923,"body":"And so what we can see is"},{"startTime":2167.923,"endTime":2170.8,"body":"that when vaccination levels decrease,"},{"startTime":2170.8,"endTime":2173.2,"body":"we may see an increase in disease."},{"startTime":2173.2,"endTime":2175.18,"body":"So we lose the benefits."},{"startTime":2175.18,"endTime":2176.26,"body":"And there are arguments"},{"startTime":2176.26,"endTime":2178.36,"body":"that we need to hit particular levels."},{"startTime":2178.36,"endTime":2180.7,"body":"So what is sometimes called herd immunity,"},{"startTime":2180.7,"endTime":2181.75,"body":"it's probably better to think of it"},{"startTime":2181.75,"endTime":2183.82,"body":"as collective protection,"},{"startTime":2183.82,"endTime":2185.65,"body":"that we need to hit a certain level"},{"startTime":2185.65,"endTime":2187.72,"body":"to enable us all to be protected."},{"startTime":2187.72,"endTime":2188.89,"body":"And that the vulnerable people"},{"startTime":2188.89,"endTime":2190.78,"body":"can tolerate not being vaccinated"},{"startTime":2190.78,"endTime":2193.38,"body":"because enough of us are"},{"startTime":2190.78,"endTime":2193.38,"body":"vaccinated to protect them."},{"startTime":2194.29,"endTime":2196.14,"body":"So the question is what should we do?"},{"startTime":2197.037,"endTime":2199.75,"body":"Well, it's a difficult one"},{"startTime":2199.75,"endTime":2201.01,"body":"and there are a lot of different ways"},{"startTime":2201.01,"endTime":2202.99,"body":"into thinking about this question."},{"startTime":2202.99,"endTime":2204.19,"body":"And I think the first thing to do"},{"startTime":2204.19,"endTime":2206.019,"body":"is to think about what kinds"},{"startTime":2204.19,"endTime":2206.019,"body":"of principles and values"},{"startTime":2206.019,"endTime":2209.98,"body":"might be at stake and then I'm"},{"startTime":2206.019,"endTime":2209.98,"body":"going to unpack some of them."},{"startTime":2209.98,"endTime":2212.26,"body":"So one of those is the idea of autonomy."},{"startTime":2212.26,"endTime":2215.38,"body":"Another is parental"},{"startTime":2212.26,"endTime":2215.38,"body":"responsibility for children."},{"startTime":2215.38,"endTime":2218.2,"body":"So not only are people"},{"startTime":2215.38,"endTime":2218.2,"body":"making individual decisions,"},{"startTime":2218.2,"endTime":2220.81,"body":"they're also making decisions"},{"startTime":2218.2,"endTime":2220.81,"body":"on behalf of other people."},{"startTime":2220.81,"endTime":2222.28,"body":"So particularly children"},{"startTime":2222.28,"endTime":2225.31,"body":"and whether or not the"},{"startTime":2222.28,"endTime":2225.31,"body":"risks and benefits are right"},{"startTime":2225.31,"endTime":2226.693,"body":"in relation to their child."},{"startTime":2227.71,"endTime":2228.61,"body":"We might also,"},{"startTime":2228.61,"endTime":2229.87,"body":"and I think rightly should think"},{"startTime":2229.87,"endTime":2231.05,"body":"that there are questions of beneficence"},{"startTime":2231.05,"endTime":2233.56,"body":"in whether we ought to"},{"startTime":2231.05,"endTime":2233.56,"body":"protect vulnerable people."},{"startTime":2233.56,"endTime":2236.14,"body":"So not thinking about"},{"startTime":2233.56,"endTime":2236.14,"body":"what do I want to do,"},{"startTime":2236.14,"endTime":2239.8,"body":"but rather what ought I to do"},{"startTime":2236.14,"endTime":2239.8,"body":"for the sake of other people?"},{"startTime":2239.8,"endTime":2241.87,"body":"We could think about it"},{"startTime":2239.8,"endTime":2241.87,"body":"in terms of ethic of care."},{"startTime":2241.87,"endTime":2244.66,"body":"We could think about it"},{"startTime":2241.87,"endTime":2244.66,"body":"in terms of beneficence."},{"startTime":2244.66,"endTime":2246.94,"body":"We might also wonder whether"},{"startTime":2244.66,"endTime":2246.94,"body":"we ought to be paternalistic,"},{"startTime":2246.94,"endTime":2249.294,"body":"protect people from themselves."},{"startTime":2249.294,"endTime":2251.079,"body":"And we need to think"},{"startTime":2249.294,"endTime":2251.079,"body":"about the relationship"},{"startTime":2251.079,"endTime":2252.123,"body":"between state and individuals"},{"startTime":2252.123,"endTime":2254.137,"body":"and what is the right role for government?"},{"startTime":2254.137,"endTime":2257.29,"body":"And what is it the government"},{"startTime":2254.137,"endTime":2257.29,"body":"could or should do?"},{"startTime":2257.29,"endTime":2259.09,"body":"Now there are different ethical frameworks"},{"startTime":2259.09,"endTime":2260.2,"body":"for which you might think about this."},{"startTime":2260.2,"endTime":2261.321,"body":"You might think that respect for autonomy"},{"startTime":2261.321,"endTime":2262.81,"body":"should be the dominant value"},{"startTime":2262.81,"endTime":2264.22,"body":"and we start from that as a position."},{"startTime":2264.22,"endTime":2265.66,"body":"And that's one of the"},{"startTime":2264.22,"endTime":2265.66,"body":"ways I'll think about this"},{"startTime":2265.66,"endTime":2266.71,"body":"in a moment."},{"startTime":2266.71,"endTime":2268.39,"body":"You might be a utilitarian,"},{"startTime":2266.71,"endTime":2268.39,"body":"you might think,"},{"startTime":2268.39,"endTime":2269.673,"body":"well actually what we"},{"startTime":2268.39,"endTime":2269.673,"body":"need to do is look at"},{"startTime":2269.673,"endTime":2271.78,"body":"which is the strategy"},{"startTime":2271.78,"endTime":2275.14,"body":"that gets us to the best overall benefits."},{"startTime":2275.14,"endTime":2276.1,"body":"But another way to think about it"},{"startTime":2276.1,"endTime":2277.84,"body":"is in terms of the concept of fairness."},{"startTime":2277.84,"endTime":2280.06,"body":"And that's what I'll"},{"startTime":2277.84,"endTime":2280.06,"body":"also look at in a moment."},{"startTime":2280.06,"endTime":2281.44,"body":"And when we do this,"},{"startTime":2281.44,"endTime":2284.17,"body":"we also need to weave in"},{"startTime":2281.44,"endTime":2284.17,"body":"ideas about proportionality"},{"startTime":2284.17,"endTime":2287.23,"body":"and the right role of the"},{"startTime":2284.17,"endTime":2287.23,"body":"law in relation to citizens."},{"startTime":2287.23,"endTime":2288.063,"body":"And the question of just because"},{"startTime":2288.063,"endTime":2290.14,"body":"someone ought morally to do something"},{"startTime":2290.14,"endTime":2291.28,"body":"doesn't mean it's right for the law"},{"startTime":2291.28,"endTime":2292.78,"body":"to make them to do it necessarily."},{"startTime":2292.78,"endTime":2294.82,"body":"It might be, but it might not."},{"startTime":2294.82,"endTime":2296.47,"body":"So the way I'm going to do this"},{"startTime":2296.47,"endTime":2298.27,"body":"is I'm going to look first at autonomy."},{"startTime":2298.27,"endTime":2300.76,"body":"I'm going to look at it through"},{"startTime":2298.27,"endTime":2300.76,"body":"the lens of autonomy first"},{"startTime":2300.76,"endTime":2303.703,"body":"and then I'll look at it"},{"startTime":2300.76,"endTime":2303.703,"body":"through the idea of fairness."},{"startTime":2305.41,"endTime":2307.33,"body":"So starting with autonomy,"},{"startTime":2307.33,"endTime":2310.12,"body":"this is the kind of claim"},{"startTime":2307.33,"endTime":2310.12,"body":"that people will make,"},{"startTime":2310.12,"endTime":2311.543,"body":"is that it's my choice."},{"startTime":2311.543,"endTime":2312.76,"body":"And what they're doing there"},{"startTime":2312.76,"endTime":2314.116,"body":"is they're asserting that autonomy"},{"startTime":2314.116,"endTime":2315.94,"body":"should be the driving value here,"},{"startTime":2315.94,"endTime":2317.68,"body":"that this is the big one"},{"startTime":2317.68,"endTime":2320.26,"body":"and that this should"},{"startTime":2317.68,"endTime":2320.26,"body":"be the starting point."},{"startTime":2320.26,"endTime":2322.494,"body":"And so therefore it's"},{"startTime":2320.26,"endTime":2322.494,"body":"my body, it's my choice."},{"startTime":2322.494,"endTime":2326.2,"body":"And that's invoking a"},{"startTime":2322.494,"endTime":2326.2,"body":"particular aspect of autonomy,"},{"startTime":2326.2,"endTime":2327.49,"body":"the idea of bodily integrity."},{"startTime":2327.49,"endTime":2329.38,"body":"That you shouldn't put things into my body"},{"startTime":2329.38,"endTime":2331.045,"body":"without my permission."},{"startTime":2331.045,"endTime":2334.57,"body":"And this is often invokes quite"},{"startTime":2331.045,"endTime":2334.57,"body":"a strong autonomy argument,"},{"startTime":2334.57,"endTime":2335.83,"body":"that there are lots of ways"},{"startTime":2335.83,"endTime":2337.66,"body":"in which our autonomy is constrained,"},{"startTime":2337.66,"endTime":2339.46,"body":"but constraints on our body integrity,"},{"startTime":2339.46,"endTime":2342.373,"body":"invasions that are particularly egregious."},{"startTime":2343.365,"endTime":2346.96,"body":"So if you start from this"},{"startTime":2343.365,"endTime":2346.96,"body":"position, your question will be,"},{"startTime":2346.96,"endTime":2351.313,"body":"well, when can we justify"},{"startTime":2346.96,"endTime":2351.313,"body":"overriding someone's autonomy?"},{"startTime":2352.33,"endTime":2353.59,"body":"And the answer would be,"},{"startTime":2353.59,"endTime":2356.117,"body":"well when you might"},{"startTime":2353.59,"endTime":2356.117,"body":"think paternalistically,"},{"startTime":2356.117,"endTime":2358.75,"body":"you might think to do"},{"startTime":2356.117,"endTime":2358.75,"body":"good for other people."},{"startTime":2358.75,"endTime":2360.85,"body":"But the big question you'd be asking is,"},{"startTime":2360.85,"endTime":2362.98,"body":"what is a sufficient amount of vaccination"},{"startTime":2362.98,"endTime":2366.94,"body":"to achieve our goals, would"},{"startTime":2362.98,"endTime":2366.94,"body":"be part of that question."},{"startTime":2366.94,"endTime":2369.1,"body":"And actually that's a really"},{"startTime":2366.94,"endTime":2369.1,"body":"difficult question to answer."},{"startTime":2369.1,"endTime":2370.319,"body":"You might just mean herd immunity."},{"startTime":2370.319,"endTime":2372.716,"body":"You might mean enough to be protective."},{"startTime":2372.716,"endTime":2376.93,"body":"You might mean no vaccine"},{"startTime":2372.716,"endTime":2376.93,"body":"preventable deaths are tolerable."},{"startTime":2376.93,"endTime":2378.277,"body":"So there's different ways"},{"startTime":2376.93,"endTime":2378.277,"body":"to answer that question."},{"startTime":2378.277,"endTime":2380.44,"body":"You might say any death that happens,"},{"startTime":2380.44,"endTime":2382.45,"body":"that could have been"},{"startTime":2380.44,"endTime":2382.45,"body":"prevented by vaccination,"},{"startTime":2382.45,"endTime":2383.922,"body":"where the vaccination is safe,"},{"startTime":2383.922,"endTime":2387.73,"body":"is a death that is wrong and"},{"startTime":2383.922,"endTime":2387.73,"body":"it shouldn't have happened."},{"startTime":2387.73,"endTime":2389.65,"body":"And if you thought that, your"},{"startTime":2387.73,"endTime":2389.65,"body":"goal would be eradication."},{"startTime":2389.65,"endTime":2392.153,"body":"That's exactly what"},{"startTime":2389.65,"endTime":2392.153,"body":"happened with smallpox."},{"startTime":2392.153,"endTime":2396.28,"body":"And so these are difficult"},{"startTime":2392.153,"endTime":2396.28,"body":"questions partly 'cause as we saw"},{"startTime":2396.28,"endTime":2397.84,"body":"there are different reasons to vaccinate"},{"startTime":2397.84,"endTime":2398.86,"body":"for different diseases."},{"startTime":2398.86,"endTime":2401.92,"body":"Some are just individually"},{"startTime":2398.86,"endTime":2401.92,"body":"protective, tetanus."},{"startTime":2401.92,"endTime":2404.26,"body":"Some protect both"},{"startTime":2401.92,"endTime":2404.26,"body":"ourselves and other people."},{"startTime":2404.26,"endTime":2407.14,"body":"And some really are more"},{"startTime":2404.26,"endTime":2407.14,"body":"about protecting others"},{"startTime":2407.14,"endTime":2408.374,"body":"rather than ourselves."},{"startTime":2408.374,"endTime":2410.98,"body":"And that should play"},{"startTime":2408.374,"endTime":2410.98,"body":"into your thinking about"},{"startTime":2410.98,"endTime":2414.49,"body":"when you think overriding"},{"startTime":2410.98,"endTime":2414.49,"body":"autonomy is legitimate."},{"startTime":2414.49,"endTime":2417.07,"body":"So if it's a vaccination"},{"startTime":2414.49,"endTime":2417.07,"body":"that's really protective"},{"startTime":2417.07,"endTime":2419.414,"body":"of the individual, so tetanus,"},{"startTime":2419.414,"endTime":2421.33,"body":"then you would really be saying"},{"startTime":2421.33,"endTime":2423.52,"body":"we should override your"},{"startTime":2421.33,"endTime":2423.52,"body":"autonomous position"},{"startTime":2423.52,"endTime":2427.621,"body":"for more beneficent or"},{"startTime":2423.52,"endTime":2427.621,"body":"paternalistic reasons."},{"startTime":2427.621,"endTime":2429.91,"body":"And so you would pause there."},{"startTime":2429.91,"endTime":2432.76,"body":"It is a less good reason"},{"startTime":2429.91,"endTime":2432.76,"body":"to override autonomy"},{"startTime":2432.76,"endTime":2434.302,"body":"when somebody says to you,"},{"startTime":2434.302,"endTime":2436.81,"body":"well I personally disagree"},{"startTime":2434.302,"endTime":2436.81,"body":"with your evaluation"},{"startTime":2436.81,"endTime":2437.92,"body":"of what should be done for me."},{"startTime":2437.92,"endTime":2441.163,"body":"I will bear that risk because"},{"startTime":2437.92,"endTime":2441.163,"body":"the risk only applies to me."},{"startTime":2442.03,"endTime":2444.85,"body":"That's quite different if"},{"startTime":2442.03,"endTime":2444.85,"body":"you're trying to protect"},{"startTime":2444.85,"endTime":2447.61,"body":"vulnerable people, 'cause"},{"startTime":2444.85,"endTime":2447.61,"body":"that implicates other values."},{"startTime":2447.61,"endTime":2450.97,"body":"And so you might have stronger"},{"startTime":2447.61,"endTime":2450.97,"body":"reasons to override autonomy."},{"startTime":2450.97,"endTime":2452.89,"body":"And the way you might ground those"},{"startTime":2452.89,"endTime":2455.5,"body":"is that we might have obligations"},{"startTime":2452.89,"endTime":2455.5,"body":"to protect the vulnerable,"},{"startTime":2455.5,"endTime":2457.69,"body":"or we might have collective obligations,"},{"startTime":2457.69,"endTime":2459.637,"body":"or there might be some"},{"startTime":2457.69,"endTime":2459.637,"body":"idea of social contract."},{"startTime":2459.637,"endTime":2463.54,"body":"That we all participate"},{"startTime":2459.637,"endTime":2463.54,"body":"collectively in this project"},{"startTime":2463.54,"endTime":2465.052,"body":"of eradicating disease"},{"startTime":2463.54,"endTime":2465.052,"body":"for our own benefit,"},{"startTime":2465.052,"endTime":2467.293,"body":"for the benefit of those around us."},{"startTime":2468.25,"endTime":2470.35,"body":"And if that's the case,"},{"startTime":2468.25,"endTime":2470.35,"body":"then you might say,"},{"startTime":2470.35,"endTime":2472.84,"body":"well this is a reason to"},{"startTime":2470.35,"endTime":2472.84,"body":"override some people's autonomy"},{"startTime":2472.84,"endTime":2474.193,"body":"in relation to vaccination."},{"startTime":2475.274,"endTime":2477.1,"body":"The third way to think about this"},{"startTime":2477.1,"endTime":2480.04,"body":"is that some diseases however"},{"startTime":2477.1,"endTime":2480.04,"body":"are more severe than others"},{"startTime":2480.04,"endTime":2482.8,"body":"and that might shift the position here."},{"startTime":2482.8,"endTime":2485.23,"body":"And some are also diseases"},{"startTime":2482.8,"endTime":2485.23,"body":"that can be easily prevented"},{"startTime":2485.23,"endTime":2486.67,"body":"and some aren't."},{"startTime":2486.67,"endTime":2489.52,"body":"So something like smallpox"},{"startTime":2486.67,"endTime":2489.52,"body":"was a very difficult disease"},{"startTime":2489.52,"endTime":2492.88,"body":"to prevent being carried to"},{"startTime":2489.52,"endTime":2492.88,"body":"other people and it was severe."},{"startTime":2492.88,"endTime":2495.601,"body":"So that seemed to be stronger reasons,"},{"startTime":2495.601,"endTime":2498.13,"body":"fairly strong reasons"},{"startTime":2495.601,"endTime":2498.13,"body":"and demonstrably regarded"},{"startTime":2498.13,"endTime":2499.51,"body":"sufficiently strong reasons"},{"startTime":2499.51,"endTime":2501.7,"body":"to move towards overriding autonomy."},{"startTime":2501.7,"endTime":2503.02,"body":"But that might be quite different"},{"startTime":2503.02,"endTime":2505.24,"body":"for something like the HPV vaccination,"},{"startTime":2505.24,"endTime":2507.55,"body":"which protects against"},{"startTime":2505.24,"endTime":2507.55,"body":"human papillomavirus."},{"startTime":2507.55,"endTime":2509.92,"body":"Now that is a condition"},{"startTime":2507.55,"endTime":2509.92,"body":"that's only passed on"},{"startTime":2509.92,"endTime":2511.84,"body":"really through intimate"},{"startTime":2509.92,"endTime":2511.84,"body":"skin to skin contact."},{"startTime":2511.84,"endTime":2513.126,"body":"So sexual relations."},{"startTime":2513.126,"endTime":2514.81,"body":"And so it's only going to be passed"},{"startTime":2514.81,"endTime":2518.102,"body":"between sexually active teens"},{"startTime":2514.81,"endTime":2518.102,"body":"and adults for one thing."},{"startTime":2518.102,"endTime":2520.33,"body":"And also you can be regularly screened,"},{"startTime":2520.33,"endTime":2521.83,"body":"you can detect whether you have it."},{"startTime":2521.83,"endTime":2525.46,"body":"And so it is much less problematic"},{"startTime":2525.46,"endTime":2527.35,"body":"from a contagion perspective."},{"startTime":2527.35,"endTime":2530.293,"body":"And so that might shift"},{"startTime":2527.35,"endTime":2530.293,"body":"the way you think about it."},{"startTime":2531.61,"endTime":2533.944,"body":"So that's kind of your background to it."},{"startTime":2533.944,"endTime":2535.18,"body":"Then you might think,"},{"startTime":2535.18,"endTime":2537.64,"body":"well, alright if I have some reservations"},{"startTime":2537.64,"endTime":2539.407,"body":"about overriding people's autonomy,"},{"startTime":2539.407,"endTime":2542.86,"body":"I might think, are there other"},{"startTime":2539.407,"endTime":2542.86,"body":"ways to get to the same goal"},{"startTime":2542.86,"endTime":2545.53,"body":"or at least sufficiently close to it?"},{"startTime":2545.53,"endTime":2546.61,"body":"And there are lots of ways"},{"startTime":2546.61,"endTime":2549.032,"body":"that we can increase vaccination uptake."},{"startTime":2549.032,"endTime":2551.44,"body":"and I've arranged them in order of"},{"startTime":2551.44,"endTime":2554.886,"body":"in terms of how autonomy"},{"startTime":2551.44,"endTime":2554.886,"body":"affecting they are."},{"startTime":2554.886,"endTime":2558.49,"body":"So you could start with"},{"startTime":2554.886,"endTime":2558.49,"body":"public health campaigns,"},{"startTime":2558.49,"endTime":2560.53,"body":"education campaigns,"},{"startTime":2558.49,"endTime":2560.53,"body":"they could be compulsory,"},{"startTime":2560.53,"endTime":2561.363,"body":"they could be in schools."},{"startTime":2561.363,"endTime":2563.106,"body":"So you just try to build knowledge."},{"startTime":2563.106,"endTime":2564.19,"body":"And what you're doing there"},{"startTime":2564.19,"endTime":2567.04,"body":"is you're addressing one of the"},{"startTime":2564.19,"endTime":2567.04,"body":"things that I raised earlier"},{"startTime":2567.04,"endTime":2569.02,"body":"about people's resistance to vaccinations."},{"startTime":2569.02,"endTime":2570.34,"body":"It might be that you think some people"},{"startTime":2570.34,"endTime":2572.65,"body":"have false information, they're in error,"},{"startTime":2572.65,"endTime":2576.52,"body":"or their perception of the"},{"startTime":2572.65,"endTime":2576.52,"body":"risks and benefits is skewed."},{"startTime":2576.52,"endTime":2578.62,"body":"And therefore you would think"},{"startTime":2576.52,"endTime":2578.62,"body":"those are good things to do"},{"startTime":2578.62,"endTime":2580.57,"body":"because they will address that problem."},{"startTime":2581.743,"endTime":2584.53,"body":"You might think you could"},{"startTime":2581.743,"endTime":2584.53,"body":"go so far as nudging."},{"startTime":2584.53,"endTime":2587.14,"body":"So that is sort of doing"},{"startTime":2584.53,"endTime":2587.14,"body":"things that push people"},{"startTime":2587.14,"endTime":2589.99,"body":"into or sort of move them towards it"},{"startTime":2589.99,"endTime":2591.76,"body":"without them noticing it."},{"startTime":2591.76,"endTime":2592.762,"body":"So a good example of a nudge"},{"startTime":2592.762,"endTime":2595.256,"body":"is when you stand at"},{"startTime":2592.762,"endTime":2595.256,"body":"the crossing on a road"},{"startTime":2595.256,"endTime":2598.323,"body":"and the sign that shows you"},{"startTime":2595.256,"endTime":2598.323,"body":"whether you can cross or not"},{"startTime":2598.323,"endTime":2600.068,"body":"is actually you have to"},{"startTime":2598.323,"endTime":2600.068,"body":"turn in the direction"},{"startTime":2600.068,"endTime":2602.62,"body":"that the traffic is coming"},{"startTime":2600.068,"endTime":2602.62,"body":"towards you to look at that"},{"startTime":2602.62,"endTime":2605.38,"body":"and it makes you look to"},{"startTime":2602.62,"endTime":2605.38,"body":"see if cars are coming."},{"startTime":2605.38,"endTime":2606.88,"body":"That's a nudge."},{"startTime":2606.88,"endTime":2608.77,"body":"You could move up to incentives"},{"startTime":2608.77,"endTime":2610.96,"body":"and I'll talk about some"},{"startTime":2608.77,"endTime":2610.96,"body":"of these in a moment,"},{"startTime":2610.96,"endTime":2612.814,"body":"all the way through to it's compulsory"},{"startTime":2612.814,"endTime":2616.271,"body":"before you can access education,"},{"startTime":2612.814,"endTime":2616.271,"body":"you can't get to services,"},{"startTime":2616.271,"endTime":2618.283,"body":"fines and incarceration."},{"startTime":2619.163,"endTime":2621.07,"body":"So when we think about these,"},{"startTime":2621.07,"endTime":2622.761,"body":"think about the reasons"},{"startTime":2621.07,"endTime":2622.761,"body":"why people were resisting"},{"startTime":2622.761,"endTime":2624.335,"body":"in the first place."},{"startTime":2624.335,"endTime":2627.79,"body":"Vaccines are risky, the"},{"startTime":2624.335,"endTime":2627.79,"body":"disease aren't that severe."},{"startTime":2627.79,"endTime":2631.6,"body":"Vaccines aren't necessary,"},{"startTime":2627.79,"endTime":2631.6,"body":"mistrust and moral reasons."},{"startTime":2631.6,"endTime":2633.55,"body":"And when you evaluate these strategies,"},{"startTime":2633.55,"endTime":2634.66,"body":"you need to think about that,"},{"startTime":2634.66,"endTime":2636.37,"body":"because some of them may"},{"startTime":2634.66,"endTime":2636.37,"body":"work better than others"},{"startTime":2636.37,"endTime":2637.96,"body":"depending on the reason."},{"startTime":2637.96,"endTime":2639.64,"body":"And different strategies work better"},{"startTime":2639.64,"endTime":2642.13,"body":"for different diseases"},{"startTime":2639.64,"endTime":2642.13,"body":"in different groups,"},{"startTime":2642.13,"endTime":2645.37,"body":"and some of them might be"},{"startTime":2642.13,"endTime":2645.37,"body":"counterproductive as well."},{"startTime":2645.37,"endTime":2648.462,"body":"So if you think that"},{"startTime":2645.37,"endTime":2648.462,"body":"mistrust of health systems"},{"startTime":2648.462,"endTime":2650.844,"body":"is a real, is a big reason,"},{"startTime":2650.844,"endTime":2652.89,"body":"then forcing people to do things,"},{"startTime":2652.89,"endTime":2654.94,"body":"is probably not going to"},{"startTime":2652.89,"endTime":2654.94,"body":"be very helpful, is it?"},{"startTime":2654.94,"endTime":2657.4,"body":"Because it might make"},{"startTime":2654.94,"endTime":2657.4,"body":"people more concerned"},{"startTime":2657.4,"endTime":2660.28,"body":"or it will lead to polarization"},{"startTime":2657.4,"endTime":2660.28,"body":"or entrenching of positions"},{"startTime":2660.28,"endTime":2663.28,"body":"because the very"},{"startTime":2660.28,"endTime":2663.28,"body":"organization they don't trust"},{"startTime":2663.28,"endTime":2664.99,"body":"is now not taking their concerns seriously"},{"startTime":2664.99,"endTime":2666.13,"body":"and forcing them to do something."},{"startTime":2666.13,"endTime":2670.549,"body":"That is not a particularly"},{"startTime":2666.13,"endTime":2670.549,"body":"trust building way to behave."},{"startTime":2670.549,"endTime":2671.93,"body":"So you might instead think,"},{"startTime":2671.93,"endTime":2676.36,"body":"well the way to address that"},{"startTime":2671.93,"endTime":2676.36,"body":"concern is to build trust."},{"startTime":2676.36,"endTime":2678.7,"body":"And we don't do that by"},{"startTime":2676.36,"endTime":2678.7,"body":"forcing things on people."},{"startTime":2678.7,"endTime":2681.4,"body":"We do that by talking to them,"},{"startTime":2678.7,"endTime":2681.4,"body":"listen to their concerns."},{"startTime":2681.4,"endTime":2684.187,"body":"And that's why we would use"},{"startTime":2681.4,"endTime":2684.187,"body":"things like GP to do that."},{"startTime":2684.187,"endTime":2686.23,"body":"And that's why there are"},{"startTime":2684.187,"endTime":2686.23,"body":"high profile campaigns"},{"startTime":2686.23,"endTime":2688.63,"body":"where famous people and"},{"startTime":2686.23,"endTime":2688.63,"body":"people who work in communities"},{"startTime":2688.63,"endTime":2690.454,"body":"are used to help build that trust"},{"startTime":2690.454,"endTime":2692.893,"body":"and bring people into the system."},{"startTime":2693.94,"endTime":2696.13,"body":"There are other strategies you could use."},{"startTime":2696.13,"endTime":2698.8,"body":"So you might actually respond"},{"startTime":2696.13,"endTime":2698.8,"body":"to some of the concerns."},{"startTime":2698.8,"endTime":2700.327,"body":"So one of those would"},{"startTime":2698.8,"endTime":2700.327,"body":"be the moral concerns"},{"startTime":2700.327,"endTime":2704.23,"body":"about animal products or using"},{"startTime":2700.327,"endTime":2704.23,"body":"fetal cell based cell lines."},{"startTime":2704.23,"endTime":2705.812,"body":"You could just stop doing that"},{"startTime":2705.812,"endTime":2707.89,"body":"and actually then you"},{"startTime":2705.812,"endTime":2707.89,"body":"would bring in people"},{"startTime":2707.89,"endTime":2710.62,"body":"who had those concerns"},{"startTime":2707.89,"endTime":2710.62,"body":"if this were possible."},{"startTime":2710.62,"endTime":2713.89,"body":"But the key thing is that"},{"startTime":2710.62,"endTime":2713.89,"body":"you need to be sensitive"},{"startTime":2713.89,"endTime":2716.564,"body":"to the social and"},{"startTime":2713.89,"endTime":2716.564,"body":"psychological elements of these"},{"startTime":2716.564,"endTime":2719.68,"body":"and recognize that vaccination"},{"startTime":2716.564,"endTime":2719.68,"body":"is an emotive topic"},{"startTime":2719.68,"endTime":2721.81,"body":"and you don't necessarily"},{"startTime":2719.68,"endTime":2721.81,"body":"solve it with blunt tools."},{"startTime":2721.81,"endTime":2723.523,"body":"So you have to start with belief."},{"startTime":2724.613,"endTime":2727.42,"body":"But the question is, what"},{"startTime":2724.613,"endTime":2727.42,"body":"if that's not enough?"},{"startTime":2727.42,"endTime":2730.24,"body":"Well then the next position"},{"startTime":2727.42,"endTime":2730.24,"body":"that you would consider"},{"startTime":2730.24,"endTime":2731.71,"body":"is the idea of the principle"},{"startTime":2731.71,"endTime":2733.42,"body":"of the least restrictive alternative."},{"startTime":2733.42,"endTime":2735.55,"body":"And this is a public health principle,"},{"startTime":2735.55,"endTime":2737.2,"body":"which is the idea that you should presume"},{"startTime":2737.2,"endTime":2738.762,"body":"that autonomy is very important"},{"startTime":2738.762,"endTime":2740.811,"body":"and that then when you're"},{"startTime":2738.762,"endTime":2740.811,"body":"choosing between policies,"},{"startTime":2740.811,"endTime":2743.53,"body":"as long as they're equal"},{"startTime":2740.811,"endTime":2743.53,"body":"in all other respects,"},{"startTime":2743.53,"endTime":2745.93,"body":"you pick the one that"},{"startTime":2743.53,"endTime":2745.93,"body":"least restricts liberty."},{"startTime":2745.93,"endTime":2747.76,"body":"That's your way of"},{"startTime":2745.93,"endTime":2747.76,"body":"thinking, that's your goal."},{"startTime":2747.76,"endTime":2749.794,"body":"And so then what you would do,"},{"startTime":2749.794,"endTime":2752.06,"body":"is you would only move"},{"startTime":2749.794,"endTime":2752.06,"body":"to mandatory vaccination,"},{"startTime":2752.06,"endTime":2755.515,"body":"if it was really the only"},{"startTime":2752.06,"endTime":2755.515,"body":"way to achieve the same goal."},{"startTime":2755.515,"endTime":2757.055,"body":"And that's why working"},{"startTime":2755.515,"endTime":2757.055,"body":"out what is sufficient"},{"startTime":2757.055,"endTime":2760.213,"body":"and what your goal is is really important."},{"startTime":2761.53,"endTime":2763.84,"body":"Now, if you had got to the"},{"startTime":2761.53,"endTime":2763.84,"body":"position where you thought"},{"startTime":2763.84,"endTime":2766.36,"body":"even in the face of a particular disease"},{"startTime":2766.36,"endTime":2768.683,"body":"with particular severity"},{"startTime":2766.36,"endTime":2768.683,"body":"in particular prevalence,"},{"startTime":2768.683,"endTime":2772.053,"body":"that mandatory vaccination"},{"startTime":2768.683,"endTime":2772.053,"body":"is beginning to seem like"},{"startTime":2772.053,"endTime":2773.428,"body":"it needs to be,"},{"startTime":2773.428,"endTime":2776.719,"body":"that's what we need to achieve the goal,"},{"startTime":2776.719,"endTime":2779.669,"body":"then the next way to think"},{"startTime":2776.719,"endTime":2779.669,"body":"about it is to think, well,"},{"startTime":2779.669,"endTime":2780.599,"body":"if I've got to that point"},{"startTime":2780.599,"endTime":2782.108,"body":"where I'm considering it's on the table,"},{"startTime":2782.108,"endTime":2784.573,"body":"I need to think about the pros and cons."},{"startTime":2785.41,"endTime":2788.98,"body":"Now the pros of mandatory"},{"startTime":2785.41,"endTime":2788.98,"body":"vaccination are quite clear,"},{"startTime":2788.98,"endTime":2791.35,"body":"you will promote the interests"},{"startTime":2788.98,"endTime":2791.35,"body":"of vaccinated people,"},{"startTime":2791.35,"endTime":2793.6,"body":"you protect vulnerable third parties,"},{"startTime":2793.6,"endTime":2796.63,"body":"fulfills our obligations to"},{"startTime":2793.6,"endTime":2796.63,"body":"protect vulnerable children."},{"startTime":2796.63,"endTime":2798.52,"body":"And which the state"},{"startTime":2796.63,"endTime":2798.52,"body":"regards as its obligation,"},{"startTime":2798.52,"endTime":2800.397,"body":"it's quite clearly reflected in the law,"},{"startTime":2800.397,"endTime":2803.02,"body":"prevents free-riding, which"},{"startTime":2800.397,"endTime":2803.02,"body":"we'll talk about in a moment,"},{"startTime":2803.02,"endTime":2804.913,"body":"and it shares the burden fairly."},{"startTime":2806.2,"endTime":2809.47,"body":"But the cons are partly this"},{"startTime":2806.2,"endTime":2809.47,"body":"infringement of liberty,"},{"startTime":2809.47,"endTime":2812.74,"body":"but also the concern that"},{"startTime":2809.47,"endTime":2812.74,"body":"mandatory vaccination"},{"startTime":2812.74,"endTime":2816.43,"body":"might contribute to social"},{"startTime":2812.74,"endTime":2816.43,"body":"and political polarization."},{"startTime":2816.43,"endTime":2818.11,"body":"That if you think that"},{"startTime":2816.43,"endTime":2818.11,"body":"people are resistant,"},{"startTime":2818.11,"endTime":2820.54,"body":"forcing them to do"},{"startTime":2818.11,"endTime":2820.54,"body":"something that they resist"},{"startTime":2820.54,"endTime":2823.27,"body":"is a way to make them even more unhappy."},{"startTime":2823.27,"endTime":2825.16,"body":"And that might be problematic."},{"startTime":2825.16,"endTime":2827.26,"body":"It might discourage"},{"startTime":2825.16,"endTime":2827.26,"body":"people from participating"},{"startTime":2827.26,"endTime":2828.28,"body":"in healthcare systems."},{"startTime":2828.28,"endTime":2830.68,"body":"So if you already didn't"},{"startTime":2828.28,"endTime":2830.68,"body":"trust a healthcare system,"},{"startTime":2830.68,"endTime":2832.99,"body":"or you thought if you move"},{"startTime":2830.68,"endTime":2832.99,"body":"into that healthcare system,"},{"startTime":2832.99,"endTime":2834.473,"body":"someone will try to make"},{"startTime":2832.99,"endTime":2834.473,"body":"you have a vaccination"},{"startTime":2834.473,"endTime":2837.76,"body":"that you think is wrong,"},{"startTime":2834.473,"endTime":2837.76,"body":"that might make you think,"},{"startTime":2837.76,"endTime":2840.34,"body":"well I will opt out of the"},{"startTime":2837.76,"endTime":2840.34,"body":"healthcare system altogether."},{"startTime":2840.34,"endTime":2842.2,"body":"And that might be particularly problematic"},{"startTime":2842.2,"endTime":2843.802,"body":"if you have children being opted out."},{"startTime":2843.802,"endTime":2846.94,"body":"What you don't want is families"},{"startTime":2846.94,"endTime":2848.62,"body":"not bringing their children to the doctor"},{"startTime":2848.62,"endTime":2849.55,"body":"or to hospital systems"},{"startTime":2849.55,"endTime":2851.157,"body":"for fear that they'll be"},{"startTime":2849.55,"endTime":2851.157,"body":"forced to have a vaccination."},{"startTime":2851.157,"endTime":2854.26,"body":"'Cause that might be a really bad impact."},{"startTime":2854.26,"endTime":2855.85,"body":"You will reduce trust"},{"startTime":2855.85,"endTime":2858.007,"body":"and you will also fail to"},{"startTime":2855.85,"endTime":2858.007,"body":"respect value pluralism."},{"startTime":2858.007,"endTime":2860.38,"body":"And all of these things"},{"startTime":2858.007,"endTime":2860.38,"body":"might be problematic."},{"startTime":2860.38,"endTime":2862.917,"body":"So that needs to bear on your thinking."},{"startTime":2862.917,"endTime":2864.46,"body":"You might also think about,"},{"startTime":2864.46,"endTime":2867.22,"body":"well, when we talk about"},{"startTime":2864.46,"endTime":2867.22,"body":"mandatory vaccination,"},{"startTime":2867.22,"endTime":2868.69,"body":"there are lots of different ways"},{"startTime":2868.69,"endTime":2871.63,"body":"in which you can encourage people"},{"startTime":2871.63,"endTime":2874.18,"body":"through mandatory mechanisms"},{"startTime":2871.63,"endTime":2874.18,"body":"to have vaccination."},{"startTime":2874.18,"endTime":2875.5,"body":"And these have varying degrees"},{"startTime":2875.5,"endTime":2878.369,"body":"of severity on liberty as well."},{"startTime":2878.369,"endTime":2882.04,"body":"So the top level is going"},{"startTime":2878.369,"endTime":2882.04,"body":"to be forceful vaccination."},{"startTime":2882.04,"endTime":2885.01,"body":"Now that is highly liberty restricting,"},{"startTime":2885.01,"endTime":2886.69,"body":"it's going to have extremely problematic"},{"startTime":2886.69,"endTime":2889.69,"body":"psychological implications for people."},{"startTime":2889.69,"endTime":2891.13,"body":"There's no real examples of this."},{"startTime":2891.13,"endTime":2893.021,"body":"It infringes bodily integrity"},{"startTime":2893.021,"endTime":2894.76,"body":"and demonstrably regarded"},{"startTime":2894.76,"endTime":2898.21,"body":"as something that's really"},{"startTime":2894.76,"endTime":2898.21,"body":"not, shouldn't be on the table."},{"startTime":2898.21,"endTime":2899.95,"body":"Similarly, incarceration."},{"startTime":2899.95,"endTime":2901.87,"body":"But there are examples of criminalization."},{"startTime":2901.87,"endTime":2904.755,"body":"So there are examples at"},{"startTime":2901.87,"endTime":2904.755,"body":"that end of the spectrum."},{"startTime":2904.755,"endTime":2906.88,"body":"But there are things that are problematic"},{"startTime":2906.88,"endTime":2909.67,"body":"with things like criminalizing"},{"startTime":2906.88,"endTime":2909.67,"body":"failure to vaccinate,"},{"startTime":2909.67,"endTime":2911.89,"body":"is that it has this expressive force."},{"startTime":2911.89,"endTime":2914.38,"body":"That what it does is it says"},{"startTime":2911.89,"endTime":2914.38,"body":"that this person is bad,"},{"startTime":2914.38,"endTime":2917.77,"body":"it puts them in a category of"},{"startTime":2914.38,"endTime":2917.77,"body":"wrongdoer and it's shaming."},{"startTime":2917.77,"endTime":2919.15,"body":"And that has social consequences"},{"startTime":2919.15,"endTime":2921.79,"body":"as well as polarizing consequences."},{"startTime":2921.79,"endTime":2925.783,"body":"You could use levers,"},{"startTime":2921.79,"endTime":2925.783,"body":"financial levers like fines,"},{"startTime":2925.783,"endTime":2927.64,"body":"withdrawing benefits."},{"startTime":2927.64,"endTime":2929.38,"body":"That's the approach in Australia,"},{"startTime":2929.38,"endTime":2930.55,"body":"No Jab, No Pay."},{"startTime":2930.55,"endTime":2933.07,"body":"So you can't access"},{"startTime":2930.55,"endTime":2933.07,"body":"particular financial benefits"},{"startTime":2933.07,"endTime":2933.967,"body":"unless you've had vac-"},{"startTime":2933.967,"endTime":2936.26,"body":"your children have vaccinations."},{"startTime":2936.26,"endTime":2939.503,"body":"Fines are used in countries like Italy."},{"startTime":2939.503,"endTime":2942.4,"body":"They do work in the sense"},{"startTime":2939.503,"endTime":2942.4,"body":"that there has been uptake."},{"startTime":2942.4,"endTime":2944.08,"body":"And what is interesting"},{"startTime":2942.4,"endTime":2944.08,"body":"is there's lots of reports"},{"startTime":2944.08,"endTime":2945.313,"body":"that show that they haven't really caused"},{"startTime":2945.313,"endTime":2948.407,"body":"the kind of backlash that"},{"startTime":2945.313,"endTime":2948.407,"body":"you might worry about."},{"startTime":2948.407,"endTime":2950.62,"body":"The other one that's popular"},{"startTime":2950.62,"endTime":2952.63,"body":"is the idea of exclusion from services."},{"startTime":2952.63,"endTime":2954.94,"body":"And this I think is possibly"},{"startTime":2952.63,"endTime":2954.94,"body":"one of the most palatable."},{"startTime":2954.94,"endTime":2958.81,"body":"It's the idea that you"},{"startTime":2954.94,"endTime":2958.81,"body":"can't access social goods,"},{"startTime":2958.81,"endTime":2961.36,"body":"like education or access"},{"startTime":2958.81,"endTime":2961.36,"body":"to particular jobs,"},{"startTime":2961.36,"endTime":2964.81,"body":"or particular settings"},{"startTime":2961.36,"endTime":2964.81,"body":"unless you also participate"},{"startTime":2964.81,"endTime":2966.34,"body":"in the social good of vaccinations."},{"startTime":2966.34,"endTime":2968.2,"body":"So in one sense it's more intelligible"},{"startTime":2968.2,"endTime":2970.3,"body":"because it is actually,"},{"startTime":2970.3,"endTime":2973.93,"body":"it is about the thing that"},{"startTime":2970.3,"endTime":2973.93,"body":"the person is free-riding on."},{"startTime":2973.93,"endTime":2975.88,"body":"Another is it's only"},{"startTime":2973.93,"endTime":2975.88,"body":"about removing somebody"},{"startTime":2975.88,"endTime":2977.86,"body":"from the place where they"},{"startTime":2975.88,"endTime":2977.86,"body":"might create the risk."},{"startTime":2977.86,"endTime":2979.39,"body":"So it's about keeping people"},{"startTime":2979.39,"endTime":2981.04,"body":"who've decided not to be vaccinated,"},{"startTime":2981.04,"endTime":2982.54,"body":"not have their children vaccinated,"},{"startTime":2982.54,"endTime":2984.4,"body":"out of the space where"},{"startTime":2982.54,"endTime":2984.4,"body":"they can cause harm."},{"startTime":2984.4,"endTime":2986.5,"body":"It's protective of the vulnerable."},{"startTime":2986.5,"endTime":2989.23,"body":"So in that sense, you might"},{"startTime":2986.5,"endTime":2989.23,"body":"think there's a difference"},{"startTime":2989.23,"endTime":2990.97,"body":"between the different ways to be mandatory"},{"startTime":2990.97,"endTime":2992.07,"body":"and that might matter."},{"startTime":2993.414,"endTime":2995.29,"body":"The final thing I want to talk about"},{"startTime":2995.29,"endTime":2997.69,"body":"is the idea of fairness instead"},{"startTime":2997.69,"endTime":3000.54,"body":"as a different way of thinking about this."},{"startTime":3000.54,"endTime":3004.17,"body":"And what this means is"},{"startTime":3000.54,"endTime":3004.17,"body":"the idea that it is unfair"},{"startTime":3004.17,"endTime":3006.99,"body":"for people to take the benefits"},{"startTime":3004.17,"endTime":3006.99,"body":"of vaccination programs"},{"startTime":3006.99,"endTime":3008.85,"body":"but not take on the risks."},{"startTime":3008.85,"endTime":3013.11,"body":"So the free rider-problem"},{"startTime":3008.85,"endTime":3013.11,"body":"is an element of this."},{"startTime":3013.11,"endTime":3015.75,"body":"Now one of you might just think"},{"startTime":3013.11,"endTime":3015.75,"body":"it's just a bit irritating,"},{"startTime":3015.75,"endTime":3016.662,"body":"Free-riding might be a bit tedious"},{"startTime":3016.662,"endTime":3019.385,"body":"and you might think it's"},{"startTime":3016.662,"endTime":3019.385,"body":"just wrong in that sense,"},{"startTime":3019.385,"endTime":3021.11,"body":"but actually it's a bit more than that."},{"startTime":3021.11,"endTime":3023.76,"body":"What it's doing is it's putting"},{"startTime":3021.11,"endTime":3023.76,"body":"the burdens on other people."},{"startTime":3023.76,"endTime":3025.83,"body":"And so if those burdens come to bear"},{"startTime":3025.83,"endTime":3026.663,"body":"so that you suffer an injury"},{"startTime":3026.663,"endTime":3028.53,"body":"or your child suffers an injury,"},{"startTime":3028.53,"endTime":3029.88,"body":"they have been harmed,"},{"startTime":3029.88,"endTime":3032.49,"body":"partly because that harm hasn't"},{"startTime":3029.88,"endTime":3032.49,"body":"happened to someone else,"},{"startTime":3032.49,"endTime":3033.63,"body":"but also because we haven't"},{"startTime":3033.63,"endTime":3034.87,"body":"collectively removed this disease."},{"startTime":3034.87,"endTime":3037.89,"body":"'Cause if you think the"},{"startTime":3034.87,"endTime":3037.89,"body":"ultimate goal is eradication,"},{"startTime":3037.89,"endTime":3039.54,"body":"then that won't happen."},{"startTime":3039.54,"endTime":3042.03,"body":"It's also the case that we"},{"startTime":3039.54,"endTime":3042.03,"body":"see there's correlations"},{"startTime":3042.03,"endTime":3045.634,"body":"between affluence and not"},{"startTime":3042.03,"endTime":3045.634,"body":"vaccinating in some context."},{"startTime":3045.634,"endTime":3048.39,"body":"And what that means is actually"},{"startTime":3045.634,"endTime":3048.39,"body":"some people are opting out"},{"startTime":3048.39,"endTime":3050.01,"body":"and the burden is left on those"},{"startTime":3050.01,"endTime":3051.57,"body":"who are potentially less able to bear it"},{"startTime":3051.57,"endTime":3053.348,"body":"because they have less good healthcare"},{"startTime":3053.348,"endTime":3057.27,"body":"and they might face other"},{"startTime":3053.348,"endTime":3057.27,"body":"barriers and burdens."},{"startTime":3057.27,"endTime":3059.67,"body":"It also can undermine"},{"startTime":3057.27,"endTime":3059.67,"body":"the collective benefit."},{"startTime":3059.67,"endTime":3062.73,"body":"The idea that we need to get"},{"startTime":3059.67,"endTime":3062.73,"body":"vaccines to a particular level"},{"startTime":3062.73,"endTime":3063.99,"body":"to all achieve the benefit"},{"startTime":3063.99,"endTime":3066.363,"body":"and opting out of that can be problematic."},{"startTime":3067.8,"endTime":3070.11,"body":"And so this is the theory"},{"startTime":3067.8,"endTime":3070.11,"body":"of Alberto Gibellini"},{"startTime":3070.11,"endTime":3072.33,"body":"and he argues that actually"},{"startTime":3070.11,"endTime":3072.33,"body":"fairness is the key thing here."},{"startTime":3072.33,"endTime":3075.72,"body":"It's not just about balancing"},{"startTime":3072.33,"endTime":3075.72,"body":"liberty and utility,"},{"startTime":3075.72,"endTime":3078.33,"body":"but actually we should"},{"startTime":3075.72,"endTime":3078.33,"body":"think of fairness as a goal"},{"startTime":3078.33,"endTime":3079.62,"body":"and fairness as an end."},{"startTime":3079.62,"endTime":3080.97,"body":"So the goal should not just be"},{"startTime":3080.97,"endTime":3082.92,"body":"to achieve enough vaccination,"},{"startTime":3082.92,"endTime":3085.245,"body":"it should to be achieved fairly."},{"startTime":3085.245,"endTime":3088.14,"body":"And he says fairness is"},{"startTime":3085.245,"endTime":3088.14,"body":"important instrumentally."},{"startTime":3088.14,"endTime":3091.08,"body":"What it means is you get a"},{"startTime":3088.14,"endTime":3091.08,"body":"fair distribution of risks,"},{"startTime":3091.08,"endTime":3093.78,"body":"but what that does is it"},{"startTime":3091.08,"endTime":3093.78,"body":"increases reasons to comply."},{"startTime":3093.78,"endTime":3096.24,"body":"So if you know everybody"},{"startTime":3093.78,"endTime":3096.24,"body":"else has to do it,"},{"startTime":3096.24,"endTime":3098.79,"body":"it seems worth doing it"},{"startTime":3096.24,"endTime":3098.79,"body":"if you do it as well,"},{"startTime":3098.79,"endTime":3101.25,"body":"because you know everybody"},{"startTime":3098.79,"endTime":3101.25,"body":"else will have to do it."},{"startTime":3101.25,"endTime":3103.05,"body":"So you don't have that"},{"startTime":3101.25,"endTime":3103.05,"body":"problem of feeling like,"},{"startTime":3103.05,"endTime":3104.85,"body":"well I should opt out as well."},{"startTime":3104.85,"endTime":3107.1,"body":"And it has psychological"},{"startTime":3104.85,"endTime":3107.1,"body":"and social benefits"},{"startTime":3107.1,"endTime":3108.6,"body":"that you think everybody will participate,"},{"startTime":3108.6,"endTime":3110.31,"body":"so it's worth doing."},{"startTime":3110.31,"endTime":3112.47,"body":"So you have less problems with people"},{"startTime":3112.47,"endTime":3114.264,"body":"not wanting to cooperate"},{"startTime":3114.264,"endTime":3116.79,"body":"and it doesn't appear to actually backfire"},{"startTime":3116.79,"endTime":3119.04,"body":"precisely for that reason."},{"startTime":3119.04,"endTime":3120.48,"body":"You might also as Gibellini argued,"},{"startTime":3120.48,"endTime":3122.61,"body":"say that actually the"},{"startTime":3120.48,"endTime":3122.61,"body":"collective benefit we all take"},{"startTime":3122.61,"endTime":3124.86,"body":"actually creates an obligation honest,"},{"startTime":3124.86,"endTime":3126.48,"body":"that because we take this benefit,"},{"startTime":3126.48,"endTime":3129.153,"body":"we have some sense of obligation as well."},{"startTime":3130.93,"endTime":3133.05,"body":"The final thing to think about is that"},{"startTime":3133.05,"endTime":3134.79,"body":"if you move to a mandatory model,"},{"startTime":3134.79,"endTime":3135.87,"body":"you would have to think about,"},{"startTime":3135.87,"endTime":3138.39,"body":"there may still be"},{"startTime":3135.87,"endTime":3138.39,"body":"reasons that people have"},{"startTime":3138.39,"endTime":3141.652,"body":"for not wanting to have"},{"startTime":3138.39,"endTime":3141.652,"body":"vaccinations that are legitimate,"},{"startTime":3141.652,"endTime":3143.88,"body":"or that you think need to be respected,"},{"startTime":3143.88,"endTime":3146.13,"body":"or that would avoid"},{"startTime":3143.88,"endTime":3146.13,"body":"the backfiring problem."},{"startTime":3146.13,"endTime":3146.963,"body":"And one of those will be people"},{"startTime":3146.963,"endTime":3149.06,"body":"who have medical health reasons."},{"startTime":3149.06,"endTime":3151.26,"body":"So someone who is immunocompromised,"},{"startTime":3151.26,"endTime":3154.29,"body":"someone has allergic reactions,"},{"startTime":3151.26,"endTime":3154.29,"body":"they would need exemptions."},{"startTime":3154.29,"endTime":3155.34,"body":"But you would also,"},{"startTime":3155.34,"endTime":3158.43,"body":"unless you had taken a"},{"startTime":3155.34,"endTime":3158.43,"body":"particularly hard line position,"},{"startTime":3158.43,"endTime":3159.96,"body":"want to accept that there should be space"},{"startTime":3159.96,"endTime":3161.61,"body":"for conscientious objection"},{"startTime":3161.61,"endTime":3163.83,"body":"so that you could still"},{"startTime":3161.61,"endTime":3163.83,"body":"respect some degree"},{"startTime":3163.83,"endTime":3164.663,"body":"of value pluralism."},{"startTime":3164.663,"endTime":3167.52,"body":"You could still respect people's reasons."},{"startTime":3167.52,"endTime":3168.787,"body":"You would want to do this in tandem"},{"startTime":3168.787,"endTime":3170.76,"body":"with things like education programs"},{"startTime":3170.76,"endTime":3172.38,"body":"and building trust and so on."},{"startTime":3172.38,"endTime":3173.574,"body":"But this would be the way,"},{"startTime":3173.574,"endTime":3175.98,"body":"if you had concerns about moving to"},{"startTime":3175.98,"endTime":3177.72,"body":"some sort of mandatory system,"},{"startTime":3177.72,"endTime":3179.763,"body":"this can ameliorate those concerns."},{"startTime":3181.217,"endTime":3182.28,"body":"All right."},{"startTime":3182.28,"endTime":3183.603,"body":"Thank you very much."},{"startTime":3184.71,"endTime":3187.877,"body":"(audience applauds)"}]}