Ethics of Vaccination in Childhood—A Framework Based on the Four Principles of Biomedical Ethics

Abstract

Although vaccination is recognised as the top public health achievement of the twentieth century, unequivocal consensus about its beneficence does not exist among the general population. In countries with well-established immunisation programmes, vaccines are “victims of their own success”, because low incidences of diseases now prevented with vaccines diminished the experience of their historical burdens. Increasing number of vaccine-hesitant people in recent years threatens, or even effectively disables, herd immunity levels of the population and results in outbreaks of previously already controlled diseases. We aimed to apply a framework for ethical analysis of vaccination in childhood based on the four principles of biomedical ethics (respect for autonomy, nonmaleficence, beneficence and justice) to provide a comprehensive and applicable model on how to address the ethical aspects of vaccination at both individual and societal levels. We suggest finding an “ethical equilibrium”, which means that the degree of respect for parents’ autonomy is not constant, but variable; it shall depend on the level of established herd immunity and it is specific for every society. When the moral obligation of individuals to contribute to herd immunity is not fulfilled, mandatory vaccination policies are ethically justified, because states bear responsibility to protect herd immunity as a common good.

Using a Harm Reduction Model to Reduce Barriers to Vaccine Administration

“…These vaccine mandate policy changes and the persistence of those who opt out of vaccination highlights the tension between safeguarding public health and respecting the rights of the individual 19 . Many people cherish their personal autonomy and strive for self‐determination in health care choices 22 for themselves and their children 22‐24 . Vaccine mandates can become a point of contention among individuals who believe that personal responsibility should supersede government action or interference in individual health care decisions 22 .…”

“…Vaccine mandates can become a point of contention among individuals who believe that personal responsibility should supersede government action or interference in individual health care decisions 22 . Navigating the line between vaccine mandates and informed choice for vaccination can be uncomfortable for both the individual and the health care professional 22‐24 . However, disease outbreaks associated with suboptimal vaccination rates can affect any person who is inadequately immunized, including individuals with medically necessary exemptions who are unvaccinated, 12,24 and result in resurgence of vaccine‐preventable infectious diseases 1 …”

“…The clinician following best practice recommendations to avoid missed opportunities for vaccination 3 must also take into consideration the principles of informed consent that recognizes and respects individual autonomy. When client concerns about vaccine safety are dismissed or ignored, rather than increasing the rate of vaccination, 5,20 this can result in continued resistance to vaccine acceptance 22‐24 . Some pediatric settings have a policy of client dismissal from the practice when recommended childhood vaccinations are declined 24,25 .…”

“…When client concerns about vaccine safety are dismissed or ignored, rather than increasing the rate of vaccination, 5,20 this can result in continued resistance to vaccine acceptance 22‐24 . Some pediatric settings have a policy of client dismissal from the practice when recommended childhood vaccinations are declined 24,25 . Such dismissal policies are viewed by some as a form of coercion 25 that can fracture the therapeutic relationship and significantly limit access to health care, especially in rural or underserved areas 26 .…”

Mass Immunization and Vaccine Hesitancy in Children and Their Families: A Long and Winding Road Ahead to Address without a Second Thought

“…The first issue to be considered is ethical, as discussed by Meta Rus and Urh Groselj [ 10 ]. Indeed, it is important to find a so-called “ethical equilibrium” between parental autonomy and the levels of herd immunity achieved in a specific social and geographic context, since, in case of insufficient coverage rates, an institutional intervention with mandatory vaccination policies could be required.…”