The Ethics Of Vaccination

This open access book discusses individual, collective, and institutional responsibilities with regard to vaccination from the perspective of philosophy and public health ethics. It addresses the issue of what it means for a collective to be morally responsible for the realisation of herd immunity and what the implications of collective responsibility are for individual and institutional responsibilities. The first chapter introduces some key concepts in the vaccination debate, such as ‘herd immunity’, ‘public goods’, and ‘vaccine refusal’; and explains why failure to vaccinate raises certain ethical issues. The second chapter analyses, from a philosophical perspective, the relationship between individual, collective, and institutional responsibilities with regard to the realisation of herd immunity. The third chapter is about the principle of least restrictive alternative in public health ethics and its implications for vaccination policies. Finally, the fourth chapter presents an ethical argument for unqualified compulsory vaccination, i.e. for compulsory vaccination that does not allow for any conscientious objection. The book will appeal to philosophers interested in public health ethics and the general public interested in the philosophical underpinning of different arguments about our moral obligations with regard to vaccination.

A comprehensive overview of important and contested issues in vaccination ethics and policy by experts from history, science, policy, law, and ethics. Vaccination has long been a familiar, highly effective form of medicine and a triumph of public health. Because vaccination is both an individual medical intervention and a central component of public health efforts, it raises a distinct set of legal and ethical issues—from debates over their risks and benefits to the use of government vaccination requirements—and makes vaccine policymaking uniquely challenging. This volume examines the full range of ethical and policy issues related to the development and use of vaccines in the United States and around the world. Forty essays, articles, and reports by experts in the field look at all aspects of the vaccine life cycle. After an overview of vaccine history, they consider research and development, regulation and safety, vaccination promotion and requirements, pandemics and bioterrorism, and the frontier of vaccination. The texts cover such topics as vaccine safety controversies; the ethics of vaccine trials; vaccine injury compensation; vaccine refusal and the risks of vaccine-preventable diseases; equitable access to vaccines in emergencies; lessons from the eradication of smallpox; and possible future vaccines against cancer, malaria, and Ebola. The volume intentionally includes texts that take opposing viewpoints, offering readers a range of arguments. The book will be an essential reference for professionals, scholars, and students. Contributors Jeffrey P. Baker, Seth Berkley, Luciana Borio, Arthur L. Caplan, R. Alta Charo, Dave A. Chokshi, James Colgrove, Katherine M. Cook, Louis Z. Cooper, Edward Cox, Douglas S. Diekema, Ezekiel J. Emanuel, Claudia I. Emerson, Geoffrey Evans, Ruth R. Faden, Chris Feudtner, David P. Fidler, Fiona Godlee, D. A. Henderson, Alan R. Hinman, Peter Hotez, Robert M. Jacobson, Aaron S. Kesselheim, Heidi J. Larson, Robert J. Levine, Donald W. Light, Adel Mahmoud, Edgar K. Marcuse, Howard Markel, Michelle M. Mello, Paul A. Offit, Saad B. Omer, Walter A. Orenstein, Gregory A. Poland, Lance E. Rodewald, Daniel A. Salmon, Anne Schuchat, Jason L. Schwartz, Peter A. Singer, Michael Specter, Alexandra Minna Stern, Jeremy Sugarman, Thomas R. Talbot, Robert Temple, Stephen P. Teret, Alan Wertheimer, Tadataka Yamada

Parents in the US and other societies are increasingly refusing to vaccinate their children, even though popular anti-vaccine myths – e.g. ‘vaccines cause autism’ – have been debunked. This book explains the epistemic and moral failures that lead some parents to refuse to vaccinate their children. First, some parents have good reasons not to defer to the expertise of physicians, and to rely instead upon their own judgments about how to care for their children. Unfortunately, epistemic self-reliance systematically distorts beliefs in areas of inquiry in which expertise is required (like vaccine immunology). Second, vaccine refusers and mainstream medical authorities are often committed to different values surrounding health and safety. For example, while vaccine advocates stress that vaccines have low rates of serious complications, vaccine refusers often resist vaccination because it is ‘unnatural’ and because they view vaccine-preventable diseases as a ‘natural’ part of childhood. Finally, parents who refuse vaccines rightly resist the utilitarian moral arguments – ‘for the greater good’ – that vaccine advocates sometimes make. Unfortunately, vaccine refusers also sometimes embrace a pernicious hyper-individualism that sanctions free-riding on herd immunity and that cultivates indifference to the interpersonal and social harms that unvaccinated persons may cause.

This open access book discusses individual, collective, and institutional responsibilities with regard to vaccination from the perspective of philosophy and public health ethics. It addresses the issue of what it means for a collective to be morally responsible for the realisation of herd immunity and what the implications of collective responsibility are for individual and institutional responsibilities. The first chapter introduces some key concepts in the vaccination debate, such as 'herd immunity', 'public goods', and 'vaccine refusal'; and explains why failure to vaccinate raises certain ethical issues. The second chapter analyses, from a philosophical perspective, the relationship between individual, collective, and institutional responsibilities with regard to the realisation of herd immunity. The third chapter is about the principle of least restrictive alternative in public health ethics and its implications for vaccination policies. Finally, the fourth chapter presents an ethical argument for unqualified compulsory vaccination, i.e. for compulsory vaccination that does not allow for any conscientious objection. The book would appeal both philosophers interested in public health ethics and the general public interested in the philosophical underpinning of different arguments about our moral obligations with regard to vaccination. This work was published by Saint Philip Street Press pursuant to a Creative Commons license permitting commercial use. All rights not granted by the work's license are retained by the author or authors.

"The book is a balanced and comprehensive treatment of an important social issue. It is accessible to the general reader and belongs in public as well as academic libraries." -- Religious Studies Review "Painstaking analysis of the knotty ethical problems involved in human-subjects research, and a well-thought-out proposal for a community approach to conducting field trials for an HIV vaccine.... Highly recommended for medical ethicists and anyone concerned about the AIDS epidemic and how HIV research is conducted."Â -- Kirkus Reviews "... a carefully reasoned account of how research for and trial of a preventive vaccine differ from the methods used to discover a therapy."Â -- Booklist "I highly recommend reading this book which I would attest to be a thrilling, ethically challenging, and informative descent into the allopathic solution." -- Ryan Hosken, Bastyr University Library Newsletter "As the scientific effort to produce an efficacious vaccine continues, [Grady's] work provides an ethical compass that will guide us well, regardless of where phase III HIV vaccine trials ultimately occur." -- Journal of the American Medical Association "Highly recommended... " -- AIDS Book Review Journal "A remarkable treatment of a most difficult and complex subject... Grady's book is of special merit because it is simple, readable, and understandable, while conveying in-depth perceptions that are critical to the reader. A useful and essential reference work for those who would engage in the initiative to bring about a resolution of a mighty human health problem." -- Maurice R. Hilleman, Ph.D., D.Sc., Director, Merck Institute for Therapeutic Research "Dr. Grady's important study captures the complexity of the search for an AIDS vaccine with startling clarity. Her insights into the full range of forces that shape our national response to AIDS vaccine development should read like signposts to vaccinologists, AIDS community activists, and most importantly, the Public Health Service. An impressive contribution." -- Derek Hodel, Gay Men's Health Crisis "This book is recommended to medical ethicists, those involved in non-HIV vaccine trials, and all persons involved in HIV vaccine trials, including investigators, sponsors, study subjects and communities at risk." -- Journal of Health Politics, Policy and Law The creation of a vaccine now seems the best hope for controlling AIDS. Yet developing and testing an HIV vaccine raises a host of difficult ethical issues. These concerns are the focus of this timely and important book. Essential reading for everyone interested in ethics and the conduct of HIV vaccine research.

Public health ethics is a discipline concerned with the health of the public or a population as a whole, rather than focusing on the individual. This book introduces a number of this new field's central concepts and explores the key and controversial issues arising. Topics covered include the nature of public health ethics, the concepts of disease and prevention, risk and precaution, health inequalities and justice, screening, vaccination and disease control, smoking and issues relating to the environment and public health. With insightful contributions from leading experts, Public Health Ethics presents thought-provoking reviews of these topics, at the same time as encouraging and identifying areas for future discussion in this emerging discipline. This is a valuable addition to the library of anyone working in the fields of public health, health policy, ethics, philosophy and social science.

This book assists health care providers to understand the specific interplay of the roles and relationships currently forming the debates in pediatric clinical ethics. It builds on the fact that, unlike adult medical ethics, pediatric ethics begins within an acutely and powerfully experienced dynamic of patient-family-state-physician relationship. The book provides a unique perspective as it interacts with established approaches as well as recent developments in pediatric ethics theory, and then explores these developments further through cases. The book first focuses on setting the stage by introducing a theoretical framework and elaborating how pediatric ethics differ from non-pediatric ethics. It approaches different theoretical frameworks in a critical manner drawing on their strengths and weaknesses. It helps the reader in developing an ability to engage in ethical reasoning and moral deliberation in order to focus on the wellbeing of the child as the main participant in the ethical deliberation, as well as to be able to identify the child’s moral claims. The second section of the book focuses on the practical application of these theoretical frameworks and discusses specific areas pertaining to decision-making. These are: the critically ill child, new and enduring ethical controversies, and social justice at large, the latter of which includes looking at the child’s place in society, access to healthcare, social determinants of health, and vaccinations. With the dynamic changes and challenges pediatric care faces across the globe, as well as the changing face of new technologies, no professional working in the field of pediatrics can afford not to take due note of this resource.