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Obligation de vaccination : opinion des libéraux
La position des libéraux sur l'obligation de vaccination n'est pas unique.
- Pour certains[1], il est impensable d'imposer à quelqu'un une telle pratique invasive : chacun dispose de son corps comme il veut, et doit pouvoir décider lui-même quels risques il encourt (risque de la maladie ou de la vaccination).
- Pour d'autres, le phénomène de contagion peut justifier l'obligation de la vaccination : pour certaines maladies, le malade est ignorant de son état et du risque qu'il peut faire courir à d'autres personnes. Le principe de non-agression peut donc être évoqué pour justifier cette obligation. L'altruisme apparent de la vaccination doit cependant être relativisé : pendant des décennies, en France, les trois seuls vaccins obligatoires étaient le tétanos, la diphtérie et la poliomyélite (vaccin DTP) ; or, le premier n’est pas contagieux, et pour les deux autres, la vaccination n'empêche pas pour autant d'être porteur sain (et donc de pouvoir contaminer autrui). La contamination n'est pas une agression, sauf si elle résulte d'une action volontaire.
Le problème est complexe, car de nombreux facteurs entrent en jeu et sont souvent très contrastés selon les maladies et les vaccins :
- Les modalités de transmission : le sida est très peu contagieux relativement à la grippe.
- Les risques des maladies : la rage est une maladie 100 % mortelle et la variole (aujourd'hui éradiquée) avec un taux de létalité proche de 30 % ne sont pas comparables avec la varicelle dont le taux de létalité est de 30 sur 100 000 pour les adultes (il est notoirement plus faible pour les enfants où le taux est de 1 à 1,5 pour 100 000).
- Les risques du vaccin : les premiers vaccins anti-varioliques pouvaient avoir des taux de létalité de 1 à 2 %
- L'efficacité du vaccin : elle peut être très variable entre une efficacité quasi absolue dans le cas de la poliomyélite, statistique dans le cas des vaccins anti-grippes (plusieurs souches sont choisies en fonction des années), partielle dans le cas du vaccin contre la tuberculose (qui ne protège que partiellement contre une forme particulière de la maladie).
Étude de cas : la vaccination obligatoire en Angleterre (XIXᵉ siècle)
- . Double stratégie argumentative des anti-vaccinationnistes. Face aux Vaccination Acts (1853, 1867)[2], les opposants déploient deux lignes complémentaires[3]. D’un côté, un registre scientifique et médical : ils contestent l’efficacité et la sûreté des pratiques de l’époque, en s’appuyant sur des recueils de cas, des statistiques et des monographies polémiques (par ex. William White, The Story of a Great Delusion, 1885[4] ; plus tard Joseph P. Swan, "The Vaccination Problem", 1936). De l’autre, un registre de principe : l’obligation légale viole la liberté des parents et inaugure une « tyrannie médicale », si bien qu’une politique juste devrait convaincre sans contraindre. Cette articulation s’inscrit dans un contexte historique clair : l’Acte de 1853 rend la vaccination infantile obligatoire et sanctionne les parents défaillants, l’Acte de 1867 étend et durcit l’obligation, suscitant ligues et pétitions d’ampleur[5].
- . La logique binaire appliquée à la coercition sanitaire. Les porte-parole anti-obligation formulent une règle simple, reprise par Carl Watner pour illustrer la « logique de l’anarchie »[6] : si la vaccination est bonne, son adoption volontaire suffit, l’obligation est superflue ; si elle est mauvaise, contraindre est illégitime[7], en distinguant l’évaluation empirique d’un procédé et le jugement moral sur la contrainte. Watner généralise le raisonnement : la coercition n’est jamais un argument probant et son usage trahit une faiblesse de la thèse défendue.
- . Enseignement méthodologique du cas. De cette controverse victorienne ressort une leçon transposable : la validité d’une politique publique ne se prouve pas par la force. Plus une mesure est robuste empiriquement et comprise par le public, moins l’obligation est nécessaire ; inversement, recourir d’emblée à la compulsion affaiblit la confiance et renforce la contestation. Les débats de 1853–1907 en Angleterre (période de pics de mobilisation, exemptions et réformes) illustrent ce principe, que Watner rattache à un biais épistémologique contre la violence : la charge de la preuve incombe à qui veut restreindre la liberté, non à qui souhaite s’en tenir au consentement.
Informations complémentaires
Bibliographie
- 2004, Nadja Durbach, "Bodily Matters: The Anti-Vaccination Movement in England, 1853–1907", Duke university Press
- 2013, A. M. Buttenheim, D. A. Asch, "Making vaccine refusal less of a free-ride. Human Vaccines & Immunotherapeutics", Vol 9, n°12, pp2674–2675
- 2015,
- Randal John Meyer, "Mandatory vaccinations can be compatible with liberty", The Freeman, Vol 65, n°2, Summer, pp2-3
- Robert P. Murphy, ""Mandatory vaccinations are incompatible with liberty. Social conflict can be resolved through the fuller application of private property rights", The Freeman, Vol 65, n°2, Summer, pp4-5
- 2016, K. Browne, "The measles and free-riders: California’s mandatory vaccination law", Cambridge Quarterly of Healthcare Ethics, Vol 25, n°3, pp472–478
- 2019, C. N. McKillop, et al., "Do traditional economic theories of free-riding behavior explain spatial clustering of HPV vaccine uptake?", SSM - Population Health, Vol 8, n°100421
- 2020, A. Giubilini, "An argument for compulsory vaccination: The taxation analogy", Journal of Applied Philosophy, Vol 37, n°3, pp446–466
- 2021, E. Bradley, M. Navin, "Vaccine refusal is not free-riding", Erasmus Journal for Philosophy and Economics, Vol 14, n°1, pp167–181
Notes et références
- Repris en 1983, "The Logic of Anarchy", The Voluntaryist
Citations
- « Parlé, avec la sage-femme, de la vaccination, qui est, paraît-il, exigée par la loi, car toute liberté décampe. J’exprime fortement, quoique inutilement, mon horreur pour cette ordure, dont l’humanité s’est si bien passée, jusqu’au dernier siècle, et dont l’Angleterre nous gratifia. Le courant moderne est, d’ailleurs, aux inoculations de tout genre. On finira par putréfier les petits enfants de quarante sortes de vaccins. » (Léon Bloy, Le Mendiant ingrat, 1892-1895)
- « En partie à cause des carences de l’État, l’hostilité à l’égard de la vaccination n’a cessé de grandir. (...) Paradoxalement la France, pays des Lumières, est l’une des rares contrées où l’on maintient des vaccinations obligatoires au point même de menacer d’envoyer en prison les réfractaires, y compris quand il s’agit de vaccins inutiles, comme cela s’est produit avec le fameux DT Polio, chez les enfants de trois mois. » (Didier Raoult, La vérité sur les vaccins, Michel Lafon, 2018)
Liens externes
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