Vaccination Policy and Ethical Challenges Posed by Herd Immunity, Suboptimal Uptake and Subgroup Targeting
Vaccination Policy and Ethical Challenges Posed by Herd Immunity, Suboptimal Uptake and Subgroup Targeting
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DOI：
10.1093/phe/phr032
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发表时间：
2011-11-01
影响因子：
2.1
通讯作者：
Beutels, Philippe
中科院分区：
文献类型：
--
作者：
Luyten, Jeroen;Vandevelde, Antoon;Beutels, Philippe
疫苗接种政策是一个在道德上具有挑战性的公共政策领域。这是一个具有集体重要性的问题，涉及公民最私人的领域，并且不可避免地与基于个人的道德准则发生冲突。政策制定者需要走紧绳子，用个人自治权、保护隐私、不歧视和保护最弱势群体来补充功利主义的公共卫生价值观。无论疫苗接种是自愿的还是强制性的、普遍的还是有针对性的，由于人类在传染病问题上的相互依赖，每种选择都面临着复杂的道德障碍。在本文中，我们探讨以下三个政策问题。 (i) 从伦理角度看，当人群中疫苗接种覆盖率不足时，应采取哪些政策措施？信息宣传、法律强制或使用经济激励措施都可以是有效的，但也是有争议的政策选择。 (ii) 针对特定风险群体的疫苗接种计划是否符合道德？如果这些措施是必要的，我们认为政策制定者通常必须决定坚持哪个更重要：不歧视或保护隐私。以及（iii），群体免疫的不利影响的伦理意义是什么？一些疫苗接种计划将改善人口的平均健康状况，但同时也会增加社会最贫困群体的严重发病和死亡风险。
Vaccination policy is an ethically challenging domain of public policy. It is a matter of collective importance that reaches into the most private sphere of citizens and unavoidably conflicts with individual-based ethics. Policy makers need to walk a tight rope in order to complement utilitarian public health values with individual autonomy rights, protection of privacy, non-discrimination and protection of the worst-off. Whether vaccination is voluntary or compulsory, universal or targeted, every option faces complex ethical hurdles because of the interdependence of humans in infectious disease matters. In this article, we explore the following three policy questions. (i) Ethically, which policy measures should be addressed when vaccination coverage is insufficient in a population? Information campaigns, legal compulsion, or the use of financial incentives can all be effective, but also controversial policy options. (ii) Is it ethical to target vaccination programs at certain risk-groups? If such measures are necessary, we argue that policymakers will often have to decide which is more important to uphold: non-discrimination or the protection of privacy. And (iii), what is the ethical significance of adverse herd immunity effects? Some vaccination programs will improve average population health, but will at the same time increase the risk of severe morbidity and mortality for individuals in the worst-off groups of society.