So many conflicting thoughts as I read this. I'll start with this one:

Alfie’s lived experience would be equivalent to that of living with a neuro-degenerate disease such as dementia

This goes to the heart of shared values. The problem here is with how the medical community decides on the value of a life--most of us have a personal idea about what a life worth living looks like. The medical community made the decision that a person with dementia does not have a life worth living. This is a value judgment. It is conceivable that many people will disagree with this judgment.

And then there's another aspect of value judgment--healthcare professionals make judgments based on overall social good. When it comes to vaccines, there's herd protection. It is acknowledged that a certain number of individuals may suffer an adverse event with vaccination, but overall, society is protected. An awareness of this value that the medical establishment places on the public good, rather than the private good, does affect trust.

Finally (no, it's not actually the last point I think of but it is the last one I will inflict on you), we are all aware of the financial aspect of healthcare. Resources are limited. Choices are made not always based on ideal outcome but often with an eye to what that outcome will cost. An awareness of this dynamic does affect public trust in the healthcare establishment.

This is a great post. You are in such a responsible position. Often choices, decisions, will come your way that have no comfortable path forward. I respect you for choosing to be in such in important role. I do trust you to act in the best interest of others, as you understand it :)