close
Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Feb 2;9(2):113.
doi: 10.3390/vaccines9020113.

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

Affiliations
Review

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

Meta Rus et al. Vaccines (Basel). .

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.

Keywords: autonomy; beneficence; bioethics; children; common good; herd immunity; justice; nonmaleficence; principles of biomedical ethics; vaccination.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Relation between parents’ autonomy and benefit:risk ratio of a vaccine (or social justice). The curve can be moved upwards in case of a good society immunisation level, which could allow a higher degree of parents’ autonomy and non-medical exemptions from vaccination.

References

    1. Centers for Disease Control and Prevention Ten Great Public Health Achievements—United States, 1900–1999. MMWR Morb. Mortal. Wkly. Rep. 1999;48:241–243. - PubMed
    1. Dubé E., Vivion M., MacDonald N.E. Vaccine hesitancy, vaccine refusal and the anti-vaccine movement: Influence, impact and implications. Expert Rev. Vaccines. 2015;14:99–117. doi: 10.1586/14760584.2015.964212. - DOI - PubMed
    1. Salmon D.A., Dudley M.Z., Glanz J.M., Omer S.B. Vaccine hesitancy: Causes, consequences, and a call to action. Vaccine. 2015;33(Suppl. 4):D66–D71. doi: 10.1016/j.vaccine.2015.09.035. - DOI - PubMed
    1. Olson O., Berry C., Kumar N. Addressing Parental Vaccine Hesitancy towards Childhood Vaccines in the United States: A Systematic Literature Review of Communication Interventions and Strategies. Vaccines. 2020;8:590. doi: 10.3390/vaccines8040590. - DOI - PMC - PubMed
    1. Giubilini A., Douglas T., Savulescu J. The moral obligation to be vaccinated: Utilitarianism, contractualism, and collective easy rescue. Med. Health Care Philos. 2018;21:547–560. doi: 10.1007/s11019-018-9829-y. - DOI - PMC - PubMed

LinkOut - more resources