Movatterモバイル変換

Cross jurisdictional collaboration efforts and emergency vaccine plans that are consistent with Tribal sovereignty are essential to public health emergency preparedness. The widespread adoption of clearly written federal, state, and local vaccine plans that address fundamental assumptions in vaccine distribution to Tribal nations is imperative for future pandemic response.

Direct download(2 more)   Export citation   Bookmark  

Strategies to increase influenzavaccination rates have typically targeted healthcare professionals and individuals in various high-risk groups such as the elderly. We argue that they should focus on increasingvaccination rates in children. Because children suffer higher influenza incidence rates than any other demographic group, and are major drivers of seasonal influenza epidemics, we argue that influenzavaccination strategies that serve to increase uptake rates in children are likely to be more effective in reducing influenza-related morbidity and (...) mortality than those targeting HCPs or the elderly. This is true even though influenza-related morbidity and mortality amongst children are low, except in the very young. Further, we argue that there are no decisive reasons to suppose that children-focused strategies are less ethically acceptable than elderly or HCP-focused strategies. (shrink)

Direct download(4 more)   Export citation   Bookmark   12 citations  

Preventivevaccination can protect not just vaccinated individuals, but also others, which is often a central point in discussions aboutvaccination. To date, there has been no systematic study of self- and other-directed motives behindvaccination. This article has two major goals: first, to examine and distinguish between self- and other-directed motives behindvaccination, especially with regard to vaccinating for the sake of third parties, and second, to explore some ways in which this approach can help (...) to clarify and guidevaccination debates and policy. I propose conceiving ofvaccination in terms of three basic elements: thevaccination decision-maker, the vaccine recipient and the primary beneficiary. I develop a taxonomy based on the relations between these elements to distinguish four kinds ofvaccination: self-protective, paternalistic, altruistic and indirect. I finally discuss the case of human papillomavirus vaccine regulation for men and women to show how each kind ofvaccination is associated with and raises specific ethical questions. (shrink)

Direct download(4 more)   Export citation   Bookmark   9 citations  

Respect for autonomy is problematic in relation to public health programmes such asvaccination, as the success of such programmes depends on widespread compliance. European countries have different policies for dealing with objectors tovaccination programmes. In some countries compliance is compulsory, while in others objectors are exempted or allowed to enter the programme under specific conditions. In this paper I argue that the objectors should not be treated as a homogenous group as is done in the above-mentioned (...) policies. Objectors have different arguments for not participating invaccination programmes. Considering the value of respect for autonomy, some but not all of these arguments need to be accommodated by authorities. The concept of 'narrative autonomy' provides criteria to distinguish between tenable and untenable claims to the right to refusevaccination. Narrative autonomy understands autonomy as essentially linked to identity, as this provides the moral framework with which we assess our first-order preferences. The above-mentioned concept of autonomy is derived from the concept of narrative identity as described by Marya Schechtman. She suggests that the application of the Articulation Constraint and the Reality Constraint enables us to establish the validity of personal narratives. Additionally, form and content features of identity, as proposed by Anthony Laden, will be used as criteria to establish the compatibility of the defectors' arguments with shared scientific and political values. Such compatibility is essential to accommodate respect for autonomy in the context of public health. (shrink)

Direct download(3 more)   Export citation   Bookmark   5 citations  

Vaccine refusers often seem motivated by disgust, and they invoke ideas of purity, contamination and sanctity. Unfortunately, the emotion of disgust and its companion ideas are not directly responsive to the probabilistic and statistical evidence of research science. It follows that increased efforts to promulgate the results of vaccine science are not likely to contribute to increased rates ofvaccination among persons who refuse vaccines because of the ‘ethics of sanctity’. Furthermore, the fact that disgust-based vaccine refusal is not (...) monolithic – vaccine refusers manifest disgust at different objects and invoke different ideas about purity and contamination – further complicates public health efforts to increasevaccination rates. (shrink)

Direct download(2 more)   Export citation   Bookmark  

There can be little doubt about the ethical imperative to ensure adequatevaccination uptake against certain infectious diseases. In the face of vaccine refusal, health authorities and providers instinctively appeal to coercive approaches or increased education as methods to ensure adequate vaccine uptake. Recently, some have argued that public fear around Ebola should be used as an opportunity for such approaches, should an Ebola vaccine become available. In this article, the author describes the difficulties associated with coercion and education (...) when addressing vaccine opposition. Both coercion and education can cause opposite effects than intended in certain circumstances. The correct area of focus is to address the breakdown in trust within clinical relationships. The author presents suggestions for an approach towards vaccine refusal that may be more promising. (shrink)

Direct download(4 more)   Export citation   Bookmark   10 citations  

Vaccine research, as well as the development, testing, clinical trials, and commercial uses of vaccines involve complex processes with various biological data that include gene and protein expression, analysis of molecular and cellular interactions, study of tissue and whole body responses, and extensive epidemiological modeling. Although many data resources are available to meet different aspects of vaccine needs, it remains a challenge how we are to standardize vaccine annotation, integrate data about varied vaccine types and resources, and support advanced vaccine (...) data analysis and inference. To address these problems, the community-based Vaccine Ontology (VO) has been developed through collaboration with vaccine researchers and many national and international centers and programs, including the National Center for Biomedical Ontology (NCBO), the Infectious Disease Ontology (IDO) Initiative, and the Ontology for Biomedical Investigations (OBI). VO utilizes the Basic Formal Ontology (BFO) as the top ontology and the Relation Ontology (RO) for definition of term relationships. VO is represented in the Web Ontology Language (OWL) and edited using the Protégé-OWL. Currently VO contains more than 2000 terms and relationships. VO emphasizes on classification of vaccines and vaccine components, vaccine quality and phenotypes, and host immune response to vaccines. These reflect different aspects of vaccine composition and biology and can thus be used to model individual vaccines. More than 200 licensed vaccines and many vaccine candidates in research or clinical trials have been modeled in VO. VO is being used for vaccine literature mining through collaboration with the National Center for Integrative Biomedical Informatics (NCIBI). Multiple VO applications will be presented. (shrink)

Direct download   Export citation   Bookmark   2 citations  

No categories

Export citation   Bookmark   1 citation  

Vaccine refusal harms and risks harming innocent bystanders. People are not entitled to harm innocents or to impose deadly risks on others, so in these cases there is nothing to be said for the right to refusevaccination. Compulsoryvaccination is therefore justified because non-vaccination can rightly be prohibited, just as other kinds of harmful and risky conduct are rightly prohibited. I develop an analogy to random gunfire to illustrate this point. Vaccine refusal, I argue, is morally (...) similar to firing a weapon into the air and endangering innocent bystanders. By re-framing vaccine refusal as harmful and reckless conduct my aim is to shift the focus of the vaccine debate from non-vaccinators’ religious and refusal rights to everyone else’s rights against being infected with contagious illnesses. Religious freedom and rights of informed consent do not entitle non-vaccinators to harm innocent bystanders, and so coercivevaccination requirements are permissible for the sake of the potential victims of the anti-vaccine movement. (shrink)

Direct download(5 more)   Export citation   Bookmark   48 citations  

Vaccines are not the only public health tool, but they are critical in routine and emergency settings. Achieving optimalvaccination rates requires timely access to vaccines. However, we have persistently failed to secure, distribute, and administer vaccines in a timely, effective, and equitable manner despite an enduring rhetoric of global health equity.

Direct download(2 more)   Export citation   Bookmark   1 citation  

Many have argued that human enhancement, in particular bioenhancement via genetic engineering, brain-interventions or preimplantation embryo selection, is problematic even if it can be safely implemented. Various arguments have been put forward focusing on issues such as the undermining of autonomy, uneven distribution and unfairness, and the alteration of one’s identity, amongst others. Nevertheless, few, if any, of these thinkers oppose vaccines. -/- In what follows, I argue for the permissibility of a limited set of cognitive enhancements – in particular, (...) the enhancement of evaluative judgment and self-control – by analogy with the permissibility of vaccines. As a result, it follows that if one accepts the permissibility of vaccines one will also, other things being equal, be committed to the permissibility of these enhancements. I then consider and respond to a number of possible objections in order to defend and clarify my position. (shrink)

Direct download(4 more)   Export citation   Bookmark  

COVID-19 vaccine refusal seems like a paradigm case of irrationality. Vaccines are supposed to be the best way to get us out of the COVID-19 pandemic. And yet many people believe that they should not be vaccinated even though they are dissatisfied with the current situation. In this paper, we analyze COVID-19 vaccine refusal with the tools of contemporary philosophical theories of responsibility and rationality. The main outcome of this analysis is that many vaccine-refusers are responsible for the belief that (...) they should not be vaccinated and epistemically rational in holding it. This is an important result because it provides insights into the legitimacy of certain public health policies. In particular, this result shows that a public health policy that would abandon the project of convincing certain vaccine-refusers with reasons – e.g., by simply makingvaccination compulsory – is prima facie illegitimate. (shrink)

Direct download(5 more)   Export citation   Bookmark   5 citations  

This Article examines whether policies—sometimes termed “vaccine mandates” or “vaccine requirements”— that considervaccination status as a condition of employment, receipt of goods and services, or educational or other activity for participation are legally permitted, and whether such policies may even sometimes be legally required. It does so with particular reference to COVID-19 vaccines. -/- Part I explains the legality of private actors, such as employers or private universities, consideringvaccination status, and concludes that such consideration is almost (...) always legally permissible unless foreclosed by specific state legislation. Part II examines the consideration ofvaccination status by state or federal policy. It concludes that such consideration is similarly allowed at the state level unless expressly foreclosed, and is allowed at the federal level if appropriately supported by federal regulatory authority. Part III examines what may be a future front in these debates: whether policies consideringvaccination status may be required rather than merely permitted, just as some courts have found that mask requirements may be federally required in certain circumstances. (shrink)

Direct download   Export citation   Bookmark  

The 2015 Disneyland outbreak of measles in the US unequivocally brought to light what had been brewing below the surface for a while: a slow but steady decline invaccination rates resulting in a rising number of outbreaks. This can be traced back to an increasing public questioning of vaccines by an emerging anti-vaccination movement. This article argues that, in the face of diminishingvaccination rates, childhood vaccinations should not be seen as part of the domain of (...) parental choice but, instead, as a non-negotiable legal obligation. The first part of the article formulates and defends two arguments in favour of unqualified mandatory childhoodvaccination laws. First, government should not permit parents to put their children at avoidable risk of death and suffering; second, government should guard the common good of herd immunity to protect vulnerable persons. The second part rejects legal and pragmatic objections against such mandatoryvaccination laws. (shrink)

Direct download   Export citation   Bookmark   31 citations  

The Covid‐19 pandemic needs to be considered from two perspectives simultaneously. First, there are questions about which policies are most effective and fair in the here and now, as the pandemic unfolds. These polices concern, for example, who should receive priority in being tested, how to implement contact tracing, or how to decide who should get ventilators or vaccines when not all can. Second, it is imperative to anticipate the medium‐ and longer‐term consequences that these policies have. The case of (...) vaccine rationing is particularly instructive. Ethical, epidemiological, and economic reasons demand that rationing approaches give priority to groups who have been structurally and historically disadvantaged, even if this means that overall life years gained may be lower. (shrink)

Direct download(2 more)   Export citation   Bookmark   13 citations  

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. 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 resistvaccination 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. (shrink)

Direct download(2 more)   Export citation   Bookmark   11 citations  

Export citation   Bookmark  

Export citation   Bookmark  

What does vaccine justice require at the domestic and global levels? In this essay, using the COVID-19 pandemic as a backdrop, we argue that deliberative-democratic participation is needed to answer this question. To be effective on the ground, abstract principles of vaccine justice need to be further specified through policy. Anyvaccination strategy needs to find ways to prioritize conflicting moral claims to vaccine allocation, clarify the grounds on which low-risk people are being asked to vaccinate, and reach a (...) balance between special duties toward countrymen and universal duties toward foreigners. Reasonable moral disagreement on these questions is bound to exist in any community. But such disagreement threatens to undermine vaccine justice insofar as the chosenvaccination strategy (and its proposed specification of vaccine justice) lacks public justification. Inclusive democratic deliberation about vaccine justice is a good mechanism for tackling such moral disagreement. By allowing residents and citizens to participate in the specification of abstract principles of vaccine justice, and their translation into policy, democratic deliberation can enhance the legitimacy of anyvaccination strategy and boost compliance with it. (shrink)

Direct download(2 more)   Export citation   Bookmark  

This paper examines the trust relations involved in Israel’s COVID-19vaccination campaign, focusing on vaccine hesitancy and the concept of ‘trust’. The first section offers a conceptual analysis of ‘trust’. Instead of analyzing trust in thevaccination campaign as a whole, a few objects of trust are identified and examined. In section two, the Israelivaccination campaign is presented, and the focus is placed on vaccine hesitancy. In section three, different trust relations are examined: public trust in (...) the Israeli government and health institutions, interpersonal trust in healthcare professionals and experts, trust in the pharmaceutical companies that make the COVID-19 vaccine, the US FDA, and trust in the new vaccine and the new technology. Through this complexity of trust relations, I argue that it is impossible to completely separate the trust that the vaccine is safe and effective from social aspects of mistrust. Additionally, practices of silencing and censoring the concerns of vaccine hesitaters – both experts and among the public, are pointed out. I contend that these cases further minimize vaccine hesitaters' trust in vaccine-related entities. In contrast, in section four, I suggest the ‘trust-based approach’: since vaccine hesitancy is not solely the result of knowledge deficiency but also a lack of trust relations, any campaign that addresses vaccine hesitancy should also focus on trust. The advantages of this approach are spelled out. For governments, a discussion based on trust is, ultimately, the best democratic way to encourage hesitaters to take the plunge and get vaccinated. (shrink)

Direct download(2 more)   Export citation   Bookmark   3 citations  

ABSTRACT Legislation recently adopted by the United States Congress provides producers of pandemic vaccines with near‐total immunity from civil lawsuits without making individuals injured by those vaccines eligible for compensation through the Vaccine Injury Compensation Program. The unusual decision not to provide an alternative mechanism for compensation is indicative of a broader problem of inconsistency in the American approach to vaccine‐injury compensation policy. Compensation policies have tended to reflect political pressures and economic considerations more than any cognizable set of principles. (...) This article identifies a set of ethical principles bearing on the circumstances in which vaccine injuries should be compensated, both inside and outside public health emergencies. A series of possible bases for compensation rules, some grounded in utilitarianism and some nonconsequentialist, are discussed and evaluated. Principles of fairness and reasonableness are found to constitute the strongest bases. An ethically defensible compensation policy grounded in these principles would make a compensation fund available to all individuals with severe injuries and to individuals with less‐severe injuries whenever thevaccination was required by law or professional duty. (shrink)

Direct download(3 more)   Export citation   Bookmark   4 citations  

Vaccine hesitancy is a growing threat to public health. The reasons are complex but linked inextricably to a lack of trust in vaccines, expertise and traditional sources of authority. Efforts to increase immunization uptake in children in many countries that have seen a fall invaccination rates are two-fold: addressing hesitancy by improving healthcare professional-parent exchange and information provision in the clinic; and, secondly, public health strategies that can override parental concerns and values with coercive measures such as mandatory (...) and presumptivevaccination. It is argued that such conflicting, parallel approaches seriously risk undermining trust that is crucial for sustaining herd immunity. Although public health strategies can be ethically justified in limiting freedoms, a parent-centered approach seldom acknowledges how it is impacted by contemporaneous coercive measures. In addition, the clinical encounter is not well suited to helping parents consider the public dimensions ofvaccination, despite these being important for trust formation and informed decision-making. Efforts to address vaccine hesitancy require more consistent engagement of parental and citizen views. Along with evidence-based information, debates need to be informed by ethical support that equips parents and professionals to respond to the private and public dimensions ofvaccination in a more even-handed, transparent manner. Efforts to address vaccine hesitancy need to avoid simple reliance on either parental values or coercive public policies. To do this effectively requires increasing citizen engagement onvaccination to help inform a parent-centered approach and legitimize public policy measures. In addition, cultivating a more ethically consistent strategy means moving beyond the current silos of health ethics - clinical and public health ethics. (shrink)

Direct download(4 more)   Export citation   Bookmark   5 citations  

This paper argues that vice-charging, the practice of charging other persons with epistemic vice, can itself be epistemically vicious. It identifies some potential vices of vice-charging and identifies knowledge of other people as a type of knowledge that is obstructed by epistemically vicious attributions of epistemic vice. The hazards of vice-charging are illustrated by reference to the accusation that parents who hesitate to give their children the MMR triple vaccine are guilty of gullibility and dogmatism. Ethnographic and sociological research is (...) used to make the case that this charge is, in a significant range of cases, epistemically unjust and hinders attempts to make sense of vaccine hesitancy. This epistemic injustice consists in the representation of vaccine hesitant parents as less than full epistemic agents. A case is made for a more tolerant and inclusive approach, not only to vaccine hesitancy but also to other forms of unorthodoxy or non-compliance. The primary objective in these cases should be to achieve Verstehen of seemingly alien outlooks and practices so that policy makers and practitioners in public services can more effectively educate a sceptical public about the risks of vaccine hesitancy. (shrink)

Direct download   Export citation   Bookmark   8 citations  

I argue that a parental prerogative to sometimes prioritize the interests of one’s children over the interests of others is insufficient to make the parental refusal of routine childhood vaccines morally permissible. This is because the moral permissibility of vaccine refusal follows from such a parental prerogative only if the only (weighty) moral reason in favor ofvaccination is thatvaccination is a means for promoting the interests of others. However, there are two additional weighty moral reasons in (...) favor of routinevaccination: fairness and concern for the vulnerable. These moral reasons in favor ofvaccination are not defeated by a parental prerogative to prioritize the interests of one’s children over the interests of others. (shrink)

Direct download   Export citation   Bookmark   9 citations  

Political communities across the world have recently sought to tackle rising rates of vaccine hesitancy and refusal, by implementing coercive immunization programs, or by making existing immunization programs more coercive. Many academics and advocates of public health have applauded these policy developments, and they have invoked ethical reasons for implementing or strengthening vaccine mandates. Others have criticized these policies on ethical grounds, for undermining liberty, and as symptoms of broader government overreach. But such arguments often obscure or abstract away from (...) the diverse values that are relevant to the ethical justifications of particular political communities’ vaccine‐mandate policies. We argue for an expansive conception of the normative issues relevant to deciding whether and how to establish or reform vaccine mandates, and we propose a schema by which to organize our thoughts about the ways in which different kinds of vaccine‐mandate policies implicate various values. (shrink)

Direct download(2 more)   Export citation   Bookmark   7 citations  

This paper offers an explanation for subjects’ lack of confidence in vaccines’ safety, which in turn is widely recognized as one of the main determinants of vaccine hesitancy. I argue that among the psychological roots of this lack of confidence there is a kind of intuitive thinking that can be traced back to a specific superstitious belief: the belief that “it is bad luck to tempt fate”. Under certain conditions, subjects perceive the choice to undergo vaccinations as an action that (...) “tempts fate”, and this leads them to overestimate its risks. When an action is perceived as “tempting fate”, indeed, its possible negative outcomes are anticipated as highly aversive, and as such they capture subjects’ imagination, thereby feeling more subjectively probable. This has important consequences for practical pro-vaccine interventions. Part of what makes an action perceived as “tempting fate” is its being free, arbitrary, and departing from one’s typical behavior: insofar as vaccine hesitancy is driven by beliefs about tempting fate, then, we can predict the success of interventions that make vaccinations nearly mandatory, or buildvaccination opportunities into health care routines as opt-out, rather than opt-in options, making them closer to something that subjects passively accept rather actively seek. (shrink)

Direct download(2 more)   Export citation   Bookmark  

In principle, mandatoryvaccination in employment could be justified in certain circumstances. These include: the availability of safe and effectivevaccination; if alternative, less coercive strategies did not work; and, the costs to the individual were proportionate. However, in COVID-19, the long term safety of vaccines is yet to be established. Vaccines should be made available by employers, and voluntaryvaccination encouraged.

Direct download(2 more)   Export citation   Bookmark  

The Ebola epidemic that broke out inWest Africa West AfricaAfrica towards the end of 2013 had been brought under reasonable control by 2015. The epidemic had severely affected three countries. This case study is about a phase I/II clinical trial Phase I/II clinical trial of a candidate Ebola virus vaccine in 2015 in a sub-Saharan AfricanSub-Saharan Africa country which had not registered any cases of the Ebola virus disease. The study was designed as a randomized double-blinded trialRandomized double blinded trial. (...) It was sponsored and funded by one of the biggest Northern multinational pharmaceutical companiesPharmaceutical companies. The protocol received ethics clearance from the relevantNational Ethics Committee national ethics committeeEthics committee. The study was coordinated and managed at the local branch of a big Northern diagnostic laboratoryDiagnostic laboratory and a laboratory of a local regional hospital. The overall study was a multi-countryMulti-country, multi-siteMulti-site trial aimed at recruiting a total of 3,000 research participantsResearch participants across four or five sub-Saharan African countries. For this country, the recruitmentRecruitment sites were two big cities, each aiming to recruit 200 participants: adults at the first site and childrenChildren at the second. The target sampleSample size was almost achieved at the first site but, before the study commenced at the second site, some members of raised the alarm that the governmentGovernment was carelessly risking the health, safetySafety and lives of citizens in the cause of an unproven vaccine that could precipitate a public health disaster. The trial was immediately suspended. A commentary on this case, and on the importance of trustTrust, is provided by Katharine Browne and Doris Schroeder at the end of this chapter. It highlights differences between this case and a phase I Ebola vaccine trial in CanadaCanada in 2014. (shrink)

Direct download   Export citation   Bookmark   8 citations  

Employment-based vaccine mandates have worse consequences for existing than prospective employees. Prospective employees are not yet dependent on a particular employment arrangement, so they are better positioned to respond to such mandates. Yet despite this asymmetry in consequences, Smith argues that if vaccine mandates are justified for prospective employees, they are similarly justified for existing employees. This paper responds to Smith’s argument. First, Smith holds that bona fide occupational requirements are actions that are necessary for the safe and effective completion (...) of one’s job. As such, they apply to existing and prospective employees alike. However, I argue that the existence of effective alternative interventions precludesvaccination from being considered a bona fide occupational requirement under current circumstances. Second, Smith holds that if a requirement is justified for prospective employees, it is justified for existing employees, despite the asymmetry in consequences. However, I argue that sincevaccination is not a bona fide requirement, the asymmetry in the harms of mandates experienced by prospective versus existing employees entails an asymmetry in the justification required to mandatevaccination for each group. As such,vaccination can be considered a requirement for prospective employees while not being required for existing employees. (shrink)

Direct download(3 more)   Export citation   Bookmark   1 citation  

Lack of vaccine confidence can contribute to drops invaccination coverage and subsequent outbreaks of diseases like measles and polio. Low trust in vaccines is attributed to a combination of factors, including lack of understanding, vaccine scares, flawed policies, social media and mistrust of vaccine manufacturers, scientists and decision-makers. The COVID-19 crisis has laid bare societies’ vulnerability to new pathogens and the critical role of vaccines in containing this and future pandemics. It has also put science at the forefront (...) of the response, with several governments relying on academics to help shape policy and communicate with the public. Against this backdrop, protecting public trust in scientists and scientific output is arguably more important than ever. Yet, conflicts of interest in biomedical research remain ubiquitous and harmful, and measures to curb them have had limited success. There is also evidence of bias in industry-sponsored vaccine studies and academics are voicing concerns about the risks of working in a CoI prevalent research area. Here, we set out to challenge established thinking with regard to vaccine confidence, by shifting the gaze from a deficit in public understanding towards probity in research relationships and suggesting an alternative and perhaps complementary strategy for addressing vaccine mistrust. We argue that a concerted effort needs to be made to revisit the norms that undergird contemporary vaccine research, coupled with a willingness of all stakeholders to reimagine those relationships with an emphasis on demonstrating trustworthiness and probity. (shrink)

Direct download(3 more)   Export citation   Bookmark   1 citation  

It has been proposed that the urgency of having a vaccine as a response to SARS-CoV-2 is so great, given the potential health, economic and social benefits that we should override the established s...

Direct download(2 more)   Export citation   Bookmark   2 citations  

The COVID-19 vaccine is one way to prevent the spread of COVID-19. Indonesia has produced Indovac, a COVID-19 vaccine made by Biofarma which has the opportunity to be distributed to countries in the Indo-Pacific Region. This article aims to explain the opportunities and challenges of Indonesia's vaccine diplomacy during the COVID-19 pandemic to the Indo-Pacific region through Biofarma. By using a vaccine diplomacy approach and qualitative methods with System Dynamic analysis, this article concludes that (i) The opportunity for Indonesia's vaccine (...) diplomacy to the Indo-Pacific is 44% and (ii) The simulation results for all parameters have the opportunity to increase Indonesia's progress in the Indo-Pacific except for the parameters of cooperation with special actors vaccine. The challenges for Indonesia's Covid-19 vaccine diplomacy to the Indo-Pacific come from the United States, India, Japan, Australia and Singapore. (shrink)

No categories

Direct download(2 more)   Export citation   Bookmark   2 citations  

How should liberal-democratic governments deal with emergingvaccination hesitancy when that leads to the resurgence of diseases that for decades were under control? This article argues thatvaccination policies should be justified in terms of a proper weighing of the rights of children to be protected against vaccine-preventable diseases and the rights of parents to raise their children in ways that they see fit. The argument starts from the concept of the ‘best interests of the child involved’. The (...) concept is elaborated for this context into the dual regime structure in which parents have fiduciary authority over what they consider to be best for their child, and the state has fiduciary authority over a child’s basic interests. This argument leads to conditional mandatoryvaccination programs that should be informed by a correct balancing of the two legal principles of proportionality and precaution. This results in contextual childhoodvaccination policies of upscaling interference: a three-tiered approach of increased intrusion, from voluntary program when possible and mandatory or even compulsory programs when necessary to protect the child’s basic interests. (shrink)

Direct download(3 more)   Export citation   Bookmark   4 citations  

Vaccine refusal occurs for a variety of reasons. In this article we examine vaccine refusals that are made on conscientious grounds; that is, for religious, moral, or philosophical reasons. We focus on two questions: first, whether people should be entitled to conscientiously object tovaccination against contagious diseases ; second, if so, to what constraints or requirements should conscientious objection tovaccination be subject. To address these questions, we consider an analogy between CO tovaccination and CO (...) to military service. We argue that conscientious objectors tovaccination should make an appropriate contribution to society in lieu of being vaccinated. The contribution to be made will depend on the severity of the relevant disease, its morbidity, and also the likelihood that vaccine refusal will lead to harm. In particular, the contribution required will depend on whether the rate of CO in a given population threatens herd immunity to the disease in question: for severe or highly contagious diseases, if the population rate of CO becomes high enough to threaten herd immunity, the requirements for CO could become so onerous that CO, though in principle permissible, would be de facto impermissible. (shrink)

Direct download(3 more)   Export citation   Bookmark   14 citations  

Context In response to outbreaks of vaccine‐preventable disease and increasing rates of vaccine refusal, some political communities have recently implemented coercive childhood immunization programs, or they have made existing childhood immunization programs more coercive. Many other political communities possess coercivevaccination policies, and others are considering developing them. Scholars and policymakers generally refer to coercive immunization policies as “vaccine mandates.” However, mandatoryvaccination is not a unitary concept. Rather, coercive childhood immunization policies are complex, context‐specific instruments. Their legally (...) and morally significant features often differ, and they are imposed by political communities in varying circumstances and upon diverse populations. Methods In this paper, we introduce a taxonomy for classifying real‐world and theoretical mandatory childhoodvaccination policies, according to their scope (which vaccines to require), sanctions and severity (which kind of penalty to impose on vaccine refusers, and how much of that penalty to impose), and selectivity (how to enforce or exempt people from vaccine mandates). Findings A full understanding of the operation of a vaccine mandate policy (real or potential) requires attention to the separate components of that policy. However, we can synthesize information about a policy's scope, sanctions, severity, and selectivity to identify a further attribute—salience —which identifies the magnitude of the burdens the state imposes on those who are not vaccinated. Conclusion Our taxonomy provides a framework for forensic examination of current and potential mandatoryvaccination policies, by focusing attention on those features of vaccine mandates that are most relevant for comparative judgments. (shrink)

Export citation   Bookmark   2 citations  

Park and Davies (2024) address the question of whether vaccine status can be an ethically legitimate criterion for the allocation of scarce medical resources, such as access to an ICU bed and venti...

Direct download(2 more)   Export citation   Bookmark   1 citation  

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. Whethervaccination 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 whenvaccination 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 targetvaccination 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? Somevaccination 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. (shrink)

Direct download(8 more)   Export citation   Bookmark   5 citations  

Vaccine apartheid is creating conditions that make for premature death, poverty, and disease in racialized ways. Invoking vaccine apartheid as opposed to euphemisms like vaccine nationalism, is necessary to highlight the racialized distributional consequences of vaccine inequities witnessed with COVID-19. This commentary clarifies the concept of vaccine apartheid against the historical and legal usage of apartheid. It reflects on the connections and important disjunctions between the two. It places the intellectual property regime under heightened scrutiny for reform and transformation. This (...) commentary finds that drawing on the intersections between a human rights and health justice approach can provide creative and novel approaches for anti-subordination. It concludes that acknowledging and naming the structural injustice of vaccine apartheid is only the first step towards providing redress. (shrink)

Direct download(2 more)   Export citation   Bookmark   1 citation  

Coronavirus vaccines have made their debut. Now, allocation practices have stepped into the spotlight. Following Centers for Disease Control and Prevention guidelines, states and healthcare institutions initially prioritised healthcare personnel and elderly residents of congregant facilities; other groups at elevated risk for severe complications are now becoming eligible through locally administered programmes. The question remains, however: whoelseshould be prioritised for immunisation? Here, we call attention to individuals institutionalised with severe mental illnesses and/or developmental or intellectual disabilities—a group highly susceptible to (...) the damages of COVID-19, recent research shows, and critical to consider for priorityvaccination. The language describing both federal-level and state-level intentions for this population remains largely vague, despite the population’s diversity across age, diagnosis, functional status and living arrangement. Such absence of specificity, in turn, leaves room for confusion and even neglect of various subgroups. We review data stressing this group’s vulnerability, as well as select state plans for priorityvaccination, highlighting the importance of clarity when describing intentions to vaccinate, or even generally care for, diverse populations composed of distinct subgroups in need. (shrink)

Direct download(3 more)   Export citation   Bookmark  

The Covid-19 pandemic elevated global attention to the complex problem of allocating and disseminating newly approved vaccines. Following early calls for vaccine equity,1 global health leaders made progress but struggled to fully realize distribution goals.2 With respect tovaccination rates, low and middle income countries have not achieved full parity with high income countries.3 In this issue, Harmon, Kholina, and Graham follow longstanding critiques of market-based vaccine procurement to propose “legal and practical solutions for realizing a new access to (...) vaccines environment”4 that will, they suggest, further the goal of global health justice. (shrink)

Direct download(2 more)   Export citation   Bookmark  

Recent advances have highlighted the outstanding role of the innate immune system for instructing adaptive immunity. Translating this knowledge into successful immunotherapies like vaccines, however, has proven to be a difficult task. This essay is based on the hypothesis that immune responses are tightly scaled to the infectious threat posed by a given microbial stimulus. A meticulous immunological risk‐assessment process is therefore instrumental for eliciting well‐balanced responses and maintaining immune homeostasis. The immune system makes fine distinctions, for example, between live (...) and dead bacteria, or pathogenic and non‐pathogenic microorganisms. Here, I discuss recent evidence for some of the mechanisms underlying these distinctions and speculate on strategies for therapeutically targeting the immunological risk‐assessment machinery. (shrink)

Direct download(2 more)   Export citation   Bookmark  

Vaccine hesitancy has been a major cause for concern throughout the COVID-19 pandemic. The World Health Organization have previously addressed vaccine hesitancy via the ‘3C model’ (Convenience, Complacency, and Confidence). Recent scholarship has added two more ‘Cs’ (Context and Communication) to formulate a ‘5C model’ that is more equipped to adapt to the uncertainties of the pandemic. This paper focuses on the four ‘Cs’ that explicitly concerns trust (Complacency, Confidence, Context, and Communication) and phenomenologically distinguishes confidence from trust. Experts view (...) vaccines in terms of confidence, where the prospect of an undesirable outcome is extremely rare. Hence, not vaccinating and compromising herd immunity is seen to be unreasonable. Hesitant individuals contest the expert perspective and view vaccines in terms of trust, where the prospect of disappointment is likely. From this perspective, to vaccinate is to take a risk, and it is within reason to have the freedom to choose otherwise. This paper focuses on the hesitant perspective to identify the two social indicators of trust in vaccines most prominently shown during the COVID-19 pandemic in the Global North: (i) the expert reaction to hesitant concerns and (ii) the loss of freedom in relation to vaccine requirements. (shrink)

Direct download(2 more)   Export citation   Bookmark   4 citations  

Vaccination is a highly effective public health strategy that provides protection to both individuals and communities from a range of infectious diseases. Governments monitorvaccination rates carefully, as widespread use of a vaccine within a population is required to extend protection to the general population through “herd immunity,” which is important for protecting infants who are not yet fully vaccinated and others who are unable to undergovaccination for medical or other reasons. Australia is unique in employing (...) financial incentives to increasevaccination uptake, mainly in the form of various childcare payments and tax benefits linked to timely, age-appropriatevaccination. Despite relatively high compliance with the childhoodvaccination schedule, however, the Australian government has determined that rates should be higher and has recently introduced policy that includes removing certain tax and childcare benefits for non-vaccinators and formally disallowing conscientious objection tovaccination. In addition, it has raised the possibility of banning unvaccinated children from childcare centres. This article examines the impact of coercive approaches to childhoodvaccination and raises the question of the ethical justification of health policy initiatives based on coercion. We consider the current evidence regarding childhoodvaccination in Australia, the small but real risks associated withvaccination, the ethical requirement for consent for medical procedures, and the potential social harms of targeting non-vaccinators. We conclude that the evidence does not support a move to an increasingly mandatory approach that could only be delivered through paternalistic, coercive clinical practices. (shrink)

Direct download(3 more)   Export citation   Bookmark   9 citations  

SARS-CoV-2 vaccines are indispensable allies in the fight against COVID-19. Behavioral and cognitive scientists have argued for taking advantage of insights from their fields of investigations in shaping anti-COVID policies. B&C scientists extensively discussed the methodological and practical issues that arise in translating B&C research results into policy interventions aimed to boostvaccination, Nevertheless, the same cannot be said for the ethical aspects. In the present work, we discuss the ethics of nudgingvaccination in light of the “alien (...) control” objection, a kind of control whereby an agent has the power to influence the choice of another agent, and the latter cannot control such power. We proceed as follows. We begin by presenting several cases of mandatory policies avaiable to policymakers to boost the vaccine rate. Next, we point out that insights from B&C sciences can inform mandatory policies and open up ways to enhance them. In section 3, we focus on untraditional policy tools, viz. nudges. In the second part of the article, we introduce the debate on the ethics of nudges, focusing on the “alien control” objection and its relevance for the citizens’ freedom and autonomy. We therefore discuss the original point of the paper. We argue that, referring to nudgingvaccination, a somehow neglected ethical issue posed by nudges emerges. Our point is that nudges do not exert exclusively an influence over a targeted behavior. Indeed, nudges impose as well a political influence by which citizens are treated as means to succeed in achieving a peculiar, and potentially controversial, political aim. We argue that, due to what we propose to call the “political multi-justifiability" of nudges, their political influence cannot be detected by citizens. This leads to the threat of alien control. In the last section, we draw some tentative conclusions, suggest a possible solution and its practical advantages. (shrink)

Direct download   Export citation   Bookmark  

This open access book discusses individual, collective, and institutional responsibilities with regard tovaccination 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 thevaccination 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 forvaccination policies. Finally, the fourth chapter presents an ethical argument for unqualified compulsoryvaccination, i.e. for compulsoryvaccination 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 tovaccination. (shrink)

No categories

Direct download(2 more)   Export citation   Bookmark   39 citations  

New vaccines to prevent COVID-19 and malaria underscore the importance of scientific advances to promote public health globally. How is credit for such scientific discoveries attributed, and who benefits? The complex narrative of Amitav Ghosh’s _The Calcutta Chromosome_, both historical and speculative, demonstrates how medicine has come to value particular kinds of advances over others, prompting readers to question who controls access to resources and at what cost to global populations. In Ghosh’s imagined world, scientific discovery is evaluated and rewarded—and (...) ultimately deemed necessary—for its ability to serve communal, public health needs. (shrink)

Direct download(3 more)   Export citation   Bookmark  

Since the outbreak of the Coronavirus disease 2019 (Covid-19), tremendous efforts have been made by scientists, health professionals, business people, politicians, and laypeople around the world. Covid-19 vaccines are one of the most crucial innovations that help fight against the virus. This paper attempts to revisit the Covid-19 vaccines production process by employing the serendipity-mindsponge-3D creativity management theory. Vaccine production can be considered an information process and classified into three main stages. The first stage involved the processes of absorbing information (...) (e.g., digital data and open science) and rejecting unhelpful information (e.g., misinformation and fake news) for effectively acquiring useful insights. Useful insights were later employed by experts, enterprises, governments, and international organizations through interdisciplinary coordinated efforts for developing vaccines within a short period. Finally, the appearance of multiple types of vaccines enabled more strategic options for vaccine distribution and administration. Findings from this vaccine creativity management process could be used as critical lessons for further improvements ofvaccination programs. (shrink)

Direct download(2 more)   Export citation   Bookmark   17 citations  

Vaccines are responsible for many global public health successes, such as the eradication of smallpox and significant reductions in other serious infections like diphtheria, pertussis, tetanus, polio and measles. However, massvaccination has also been the subject of various ethical controversies for decades. Several factors need to be considered before any vaccine is deployed at national programme like the potential burden of disease in the country or region, the duration of the protection conferred, herd immunity in addition to individual (...) protection, vaccine-related risks, financing and the logistical feasibility of the large-scalevaccination. Moreover, several ethical dilemmas revolve around authority and mandates forvaccination, informed consent, benefits vs. risks, and disparities in access tovaccination. This review paper aims to elaborate the ethical issues involved in massvaccination programme and present some additional challenges in the context of a resource-poor settings of public health in Bangladesh. (shrink)

No categories

Direct download(2 more)   Export citation   Bookmark  

Vaccination is an important tool for handling healthcare programs both in developed and developing countries. The current global scenario calls for a more‐efficacious, acceptable, cost‐effective and reliable method of immunization for many fatal diseases. It is hoped that the adoption of oral vaccines will help to provide an effectivevaccination strategy, especially in developing countries. Mucosal immunity generated by oral vaccines can serve as a strong first line of defense against most of the pathogens infecting through the mucosal (...) lining. Advances in elucidating the mechanism of action of oral vaccines will facilitate the design of more effective, new generation vaccines. There are promising developments in the use of different agents to effectively deliver the vaccine candidate. It is hoped that ongoing research may be able to set another cardinal point, after polio vaccine, in eradicating infectious diseases. BioEssays 29:591–604, 2007. © 2007 Wiley Periodicals, Inc. (shrink)

Direct download(2 more)   Export citation   Bookmark  

Contributions to COVID-19vaccination programmes promise valuable collective goods. They can support public and individual health by creating herd immunity and taking the pressure off overwhelmed public health services; support freedom of movement by enabling governments to remove restrictive lockdown policies; and improve economic and social well-being by allowing businesses, schools, and other essential public services to re-open. The vaccinated can contribute to the production of these goods. The unvaccinated, who benefit from, but who do not contribute to these (...) goods can be morally criticised as free-riders. In this paper defends the claim that in the case of COVID-19, the unvaccinated are unfair free-riders. I defend the claim against two objections. First, that they are not unfair free-riders because they lack the subjective attitudes and intentions of free-riders; second, that although the unvaccinated may be free-riders, their free-riding is not unfair. (shrink)

Direct download(3 more)   Export citation   Bookmark   2 citations