Skip to main content
Download PDF

Ethical Issues Concerning Vaccination Requirements

Public Health Reviews volume 34, Article number: 14 (2012) Cite this article

Abstract

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.

References

  1. 1.

    Centers for Disease Control and Prevention (CDC). Ten great public health achievements–United States, 1900–1999. MMWR Morb Mort Wkly Rep. 1999;48:241–3.

    Google Scholar 

  2. 2.

    Salmon DA, Teret SP, MacIntyre CR, Salisbury D, Burgess A, Halsey NA. Compulsory vaccination and conscientious or philosophical exemptions: past, present, and future. Lancet. 2006;367:436–42.

    Article  PubMed  Google Scholar 

  3. 3.

    Bayer R, Fairchild AL. The genesis of public health ethics. Bioethics. 2004; 18:473–92.

    Article  PubMed  Google Scholar 

  4. 4.

    Childress JF, Faden RR, Garre RD, Gostin LO, Kahn J, Bonnie RJ, et al. Public health ethics: mapping the terrain. J Law Med Ethics. 2002;30:170–8.

    Article  PubMed  Google Scholar 

  5. 5.

    Diekema DS, Marcuse EK. Ethical issues in the vaccination of children. In: Bayer R, Gostin LO, Jennings B, Steinbock B, (editors). Public Health Ethics: Theory, Policy and Practice. New York, NY: Oxford University Press; 2007. p.279–88.

    Google Scholar 

  6. 6.

    Gostin LO, Bayer R, Fairchild AL. Ethical and legal challenges posed by severe acute respiratory syndrome: implications for the control of severe infectious disease threats. JAMA. 2003;290:3229–37.

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Dudgeon JA. Development of smallpox vaccine in England in the eighteenth and nineteenth centuries. Br Med J. 1963;1(5342):1367–72.

    Article  Google Scholar 

  8. 8.

    Durbach N. Bodily Matters: The Anti-Vaccination Movement in England, 1853–1907. Durham: Duke University Press; 2005. p.23.

    Google Scholar 

  9. 9.

    Fraser SM. Leicester and smallpox: the Leicester method. Med Hist. 1980; 24:315–32.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Stewart AJ, Devlin PM. The history of the smallpox vaccine. J Infect. 2006; 52:329–34.

    Article  PubMed  Google Scholar 

  11. 11.

    Colgrove J. State of Immunity: The Politics of Vaccination in Twentieth-Century America. Berkeley, CA: University of California Press; 2006.

    Google Scholar 

  12. 12.

    Mariner WK, Annas GJ, Glantz LH. Jacobson v Massachusetts: it’s not your great-great-grandfather’s public health law. Am J Public Health. 2005;95:581–90.

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Jacobson v. commonwealth of Massachusetts, 197 U.S. 11 (1905).

  14. 14.

    Zucht v. King, 260 U.S. 174 (1922).

  15. 15.

    Gostin LO, (editor). Public Health Law and Ethics: A Reader. Rev. & Updated 2nd ed. Berkeley, CA: University of California Press; 2010.

    Google Scholar 

  16. 16.

    Buchanan DR. Autonomy, paternalism, and justice: ethical priorities in public health. Am J Public Health. 2008;98:15–21.

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Author’s personal experience with Los Angeles County Department of Children and Family Services and local courts.

  18. 18.

    Balog JE. The moral justification for a compulsory human papillomavirus vaccination program. Am J Public Health. 2009;99:616–22.

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Centers for Disease Control and Prevention (CDC). Recommendations on the use of quadrivalent human papillomavirus vaccine in males–Advisory Committee on Immunization Practices (ACIP), 2011. MMWR Morb Mortal Wkly Rep. 2011;60:1705–8.

    Google Scholar 

  20. 20.

    Charo RA. Politics, parents, and prophylaxis-mandating HPV vaccination in the United States. N Engl J Med. 2007;356:1905–8.

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Opel DJ, Diekema DS, Marcuse EK. A critique of criteria for evaluating vaccines for inclusion in mandatory school immunization programs. Pediatrics. 2008; 122:e504–10.

    Article  Google Scholar 

  22. 22.

    Human Papillomavirus vaccination and reporting Act of 2007. D.C. Act 17–39, D.C. Law. No. 17–10. District of Columbia Register 2007;54:5146–8.

    Google Scholar 

  23. 23.

    An act relating to immunization against Human Papillomavirus, HB 1098, 80thR. Sess. (TX 2007).

  24. 24.

    An act to amend section 6926 of the Family Code, relating to minors, AB no. 499. 2011–2012 Sess. (Ca 2011).

  25. 25.

    Williamson S. One hundred years ago: anti-vaccination leagues. Arch Dis Child. 1984; 59:1195–6.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Retraction—Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet 2010; 375:445. Retraction of: Wakefield AJ, Murch SH, Anthony A, Linnell J, Casson DM, Malik M, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 1998;351:637–41.

    Article  Google Scholar 

  27. 27.

    Isaacs D, Kilham H, Leask J, Tobin B. Ethical issues in immunisation. Vaccine. 2009;27:615–8.

    Article  PubMed  Google Scholar 

  28. 28.

    Gerber JS, Offit PA. Vaccines and autism: a tale of shifting hypotheses. Clin Infect Dis. 2009;48:456–61.

    Article  PubMed  PubMed Central  Google Scholar 

  29. 29.

    Edwards KM, Decker MD. Pertussis vaccines. In: Plotkin S, Orenstein W, (editors). Vaccines. 5th ed. Philadelphia, PA: Saunders; 2008. p.467–518.

    Google Scholar 

  30. 30.

    Immunization levels in child care and schools. Available from URL: http://www.cdph.ca.gov/programs/immunize/Pages/ImmunizationLevels.aspx (Accessed 20 November 2012).

  31. 31.

    Centers for Disease Control and Prevention (CDC). National, state, and local area vaccination coverage among children aged 19–35 months-United States, 2011. MMWR Morb Mortal Wkly Rep. 2012;6135:689–96.

    Google Scholar 

  32. 32.

    Washington State Department of Health. News release: May 17, 2012. Available from URL: http://www.doh.wa.gov/Newsroom/2012NewsReleases/12061VaccineExemptionDecrease.aspx (Accessed 20 November 2012).

  33. 33.

    California Assembly Bill No. 2109. An act to amend Section 120365 of the Health and Safety Code, relating to a communicable disease. Available from URL: http://www.leginfo.ca.gov/pub/11–12/bill/asm/ab_2101–2150/ab_2109_bill_20120930_chaptered.pdf (Accessed 20 November 2012).

    Google Scholar 

  34. 34.

    The future of legislation on vaccination. Br Med J. 1896;2:1397–8.

    Article  Google Scholar 

  35. 35.

    Guide to Community Preventive Services. Vaccinations to prevent diseases: universally recommended vaccinations. Available from URL: www.thecommunityguide.org/vaccines/universally/index.html (Accessed 20 November 2012).

  36. 36.

    Offit PA, Davis RL, Gust D. Vaccine safety. In: Plotkin S, Orenstein W, (editors). Vaccines. 5th ed. Philadelphia, PA: Saunders; 2008. p.1629–50.

    Google Scholar 

  37. 37.

    Evans G, Levine EM, Saindon EH. Legal issues. In: Plotkin S, Orenstein W, (editors). Vaccines, 5th ed. Philadelphia, PA: Saunders; 2008. p.1651–176.

    Google Scholar 

  38. 38.

    Serpell L, Green J. Parental decision-making in childhood vaccination. Vaccine. 2006;24:4041–6.

    Article  PubMed  Google Scholar 

  39. 39.

    Larson HJ, Cooper LZ, Eskola J, Katz SL, Ratzan S. Addressing the vaccine confidence gap. Lancet. 2011;378:526–35.

    Article  PubMed  Google Scholar 

  40. 40.

    Diekema DS. Improving childhood vaccination rates. N Engl J Med. 2012; 366:391–3.

    CAS  Article  PubMed  Google Scholar 

  41. 41.

    Gust DA, Darling N, Kennedy A, Schwartz B. Parents with doubts about vaccines: which vaccines and reasons why. Pediatrics. 2008;122:718–25.

    Article  PubMed  Google Scholar 

  42. 42.

    Parikh RK. Fighting for the reputation of vaccines: lessons from American politics. Pediatrics. 2008;121:621–2.

    Article  PubMed  Google Scholar 

  43. 43.

    Dawson A. Vaccination and the prevention problem. Bioethics. 2004;18:515–30.

    Article  PubMed  Google Scholar 

  44. 44.

    Omer SB, Enger KS, Moulton LH, Halsey NA, Stokley S, Salmon DA. Geographic clustering of nonmedical exemptions to school immunization requirements and associations with geographic clustering of pertussis. Am J Epidemiol. 2008;168:1389–96.

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

  1. Los Angeles County Dept of Public Health, 3530 Wilshire Blvd. Suite 700, Las Angeles, CA, 90010, USA

    Alvin Nelson El Amin MD, MPH, Michelle T. Parra PhD, Robert Kim-Farley MD, MPH & Jonathan E. Fielding MD, MPH

Authors
  1. Alvin Nelson El Amin MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michelle T. Parra PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert Kim-Farley MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jonathan E. Fielding MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alvin Nelson El Amin MD, MPH.

Rights and permissions

Open Access  This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/.

The Creative Commons Public Domain Dedication waiver (https://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

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

Download citation

Key Words

  • Immunization
  • vaccination
  • vaccine mandates
  • personal belief exemption

Public Health Reviews

ISSN: 2107-6952

Contact us