First appeared in 1798, vaccines have played important roles in many global public health successes. From the eradication of smallpox to HPV vaccine, vaccination is recognized as the most effective method in preventing infectious diseases. Yet, vaccination has been subject to many controversies, with ethical debates revolving their development and regulation.
In the United States, the first school vaccination requirements were enacted in the 1850s to prevent smallpox. Since then, many controversies have risen on the restrictiveness of vaccination mandates, with ethical debates and objections from religious or philosophical individuals and communities. The rights and freedoms at stake are the right to make decisions about one’s own health and the health of one’s children, and the right to bodily integrity. Resulting in the rise of opposition to mandating vaccination, and to seek balance for interested in taking the vaccines. Currently, all 50 states allow vaccination exemptions for medical contraindications with 48 states allowing religious exemptions, and 20 states allowing exemptions for philosophical reasons. Yet, the struggle is clear, for the balance on collective interest to safeguard public health and personal beliefs are still at question.
Vaccine Research and Testing
The research and testing that goes into vaccines are under discussion, from their development, study design, population, and trail location. A licensed vaccine requires years of research, yet who is involved, the stakeholders from scientific expects to the pharmaceutical companies, play key roles in who vaccine trials are performed. During the HIV/AIDS vaccine trial, researchers have struggled over whether or not it is safe and ethical to give control participants these vaccines, as ethical concerns were raised on the psychological risk of vaccine trial participants from AIDS stigma. While during the malaria vaccine trial in Mali, a developing country, participants found difficulty in understanding the procedures and lack supervision in reaching the participants’ consent to take part in the trial. The effects of vaccines, how participants joined the trials, involvement of different stakeholders are all ethical debates due to the insecurity caused by how vaccine trials are performed, putting everyone at risk. The complexity of these issues places ethics analyses at the forefront of vaccine research.
Herd immunity is the situation where enough people in a community are immune from a certain infectious disease and therefore those who are not vaccinated are indirectly protected because the high immunization rate stops the virus transmission. From an ethical point of view, herd immunity is a public good. With vaccines being the most effective way to reach herd immunity, the contribution of who and how many people take vaccines raised questions on responsibility of the public. The COVID-19 outbreak puts forward the idea that herd immunity is the most important public good. Yet, is this a moral and legal obligation we should bear? The problem with herd immunity is the demand for high public participation, however, should this be part of the public responsibility, and if so, is this a choice or a must? The nature of public good of herd immunity gives rise to some distinctive ethical issues both with regard to individual behaviour and vaccination policies.
Many vaccine-related ethical debates centers on the access and distribution of vaccines in the context of socioeconomic and racial ethnic minority status. Currently, for COVID-19 vaccines, rich nations vaccinate one person every second while the majority of the poorest nations are yet to give a single dose. Global health disparities are even more extreme and highlight additional ethical dilemmas. Developing countries face threats from deadly infections, yet they struggle to get hold of access to the needed vaccines as developed countries take hold of the majority of vaccine supply. The matter is complicated as places affected by poverty also lack necessary infrastructure to support wide-scale vaccination which creates an endless cycle of social and health disparity. To control the virus, enough doses of vaccines need to be produced in different geographies. However, this places a question on the fairness of vaccine access for the economic disparity to worsen the social disparity among countries.
The ethics of vaccination exemplifies very well the interdependence of individual responsibilities, collective responsibilities and institutional responsibilities. It is vital to understand and address these ethical debates to facilitate vaccination decisions and policies for the future of public health is at stake with lack of attention towards the problems in the existing healthcare system.
Feature Image: Maria Fabrizio/NPR