Ethics and Childhood Vaccination Policy in the United States

Abstract

Childhood immunization involves a balance between parents' autonomy in deciding whether to immunize their children and the benefits to public health from mandating vaccines. Ethical concerns about pediatric vaccination span several public health domains, including those of policymakers, clinicians, and other professionals.In light of ongoing developments and debates, we discuss several key ethical issues concerning childhood immunization in the United States and describe how they affect policy development and clinical practice. We focus on ethical considerations pertaining to herd immunity as a community good, vaccine communication, dismissal of vaccine-refusing families from practice, and vaccine mandates.Clinicians and policymakers need to consider the nature and timing of vaccine-related discussions and invoke deliberative approaches to policymaking. (Am J Public Health.

Parents' Support for School-Entry Requirements for Human Papillomavirus Vaccination: A National Study

“…These stakeholders have been key actors advocating about health policies in the U.S (47). Because school-entry requirements are legislated on a state-by-state basis in the U.S., challenges arise with regard to the capacity of states to provide school-required vaccines, monitor compliance, and enforce such policies (48). Our study provides key information about the perspectives of parents towards HPV vaccine school-entry requirements, which can inform state policy discussions about this important topic.…”

The Ethics of Parental Refusal to Vaccinate: Costs, Community Safety, and Individual Rights

“…All ten articles presented that vaccinations have proven to be effective in eradicating numerous disease outbreaks, largely due to maintenance of herd immunity. Two of the ten studies (Diekema 2014;Hendrix, Sturm, Zimet, & Meslin, 2016) expressed that though there are some schools of thought believing that a few non-vaccinated children are not enough risk for the likelihood of an outbreak, these risks are ultimately dependent on some other underlying factors that include the infectiousness of the disease, effectiveness of the vaccine and degree of contact between individuals in the community. Several of the articles addressed the issue of herd immunity providing coverage for those not vaccinated but also pointed to the fact that herd immunity thresholds vary by disease and coverage can be precarious.…”

“…One study made reference to what is known as Hardin's iconic 1968 "Tragedy of the Commons" and uses it as an analogy that it is a common good to the society if its population are appropriately vaccinated against highly infectious diseases and maintaining this common good requires that all vaccine-eligible individuals be vaccinated (Hendrix, Sturm, Zimet, & Meslin, 2016). In considering community safety some physicians exclude patients from their practices for not adhering to the recommended vaccines (Hendrix, Sturm, Zimet, & Meslin, 2016;Silverman & Wiley, 2017). In 2013, approximately 1 in 8 excluded such patients which was a twofold increase from 2007 (Silverman & Wiley, 2017).…”

Vaccines: why and how do we need to improve vaccine coverage?

“…Nevertheless, certificates of vaccination are required to enter schools in some of the states and the vaccination policies are different in each state 52 …”