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Ethical Issues Concerning Vaccination Requirements

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Vaccinations are one of public health’s greatest achievements. However, an ethical dilemma lies in the balance of personal autonomy and choice versus protection of the entire at risk population. Vaccines have become readily available in most parts of the world, yet debates continue as to the appropriateness of requirements for vaccinations, including legal mandates of vaccinations during public health emergencies and more routinely for school entry. This paper addresses ethical issues concerning vaccination requirements in the context of historical as well as current immunization program activities. Five important programmatic focus areas for immunization programs are identified for minimizing conflicts among the relevant ethical principles when developing and implementing vaccination requirements; namely: 1) reviewing and evaluating current vaccination mandates in the relevant health jurisdiction; 2) increasing the use of non-compulsory vaccination strategies; 3) addressing parent/guardian vaccine safety concerns; 4) enhancing public awareness of vaccine-preventable disease risks; and 5) promoting a better public understanding of herd immunity. We suggest that strengthening these programmatic focus areas can lead to a greater public acceptance of vaccination requirements.


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Correspondence to Alvin Nelson El Amin MD, MPH.

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Amin, A.N.E., Parra, M.T., Kim-Farley, R. et al. Ethical Issues Concerning Vaccination Requirements. Public Health Rev 34, 14 (2012) doi:10.1007/BF03391666

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Key Words

  • Immunization
  • vaccination
  • vaccine mandates
  • personal belief exemption