a Issues Vaccination ethics Introduction ver since it began as an intervention designed to protec against smalpo, vaccination has been controversial. However, the passion that people bring to debates about vaccination i not aways supported by fair review of the evidence and luc. In thi chapter Tvl outline and discus few of the key arguments abou this important area of pubic heath begin with some darificatons about the limits ofthis chapter. Fist vaccination atts ‘broadest canbe taken to involve some form of ata stimulation ofthe immune system 2 a response to actual o potential bacteria or viroloial infection. Vaceination might be citer preventive (given prior to potential infection) or therapeutic (given in reponse to infection). This chapter is delierately termed ‘vacation etic’ aT vil rit my discsson to priming ofthe immune sytem before contact with any diese. Ths means ‘we can excude from this chapter discussion of other forms of immunization such as the ‘ving of immunoglobulin after possible exposure to, o fer infection with deat, This {snot because such technique are unimportant, but because both the we ofimsmanogcba- lin and therapeutic vaccination might be thought of as primarily clinica interventions rather than public heath actives. This chapter wil concentrate on preventive vxsnation 28 this is the core controversial issue. Second, the asc image of vaccination const ofan injection (nto the muscle or under the skin) However, in some cates the relevant material Js oven orl (and absorbed through the digestive tractor though a nasal spray, om he future it might be delivered in some other way (such as through the consumption of fortified foods. Lastly, most preventive vaccination is erred out in childhood. This i because ti the ime when the immune system canbe primed tothe greatest afvantags, but also itis tine of greatest theat to the individual from many dieses. However it should not be forgoten that many othe vaccinations are arid out with adolescents and adults Such vaccination might be fora numberof reasons boosters for dildhood vczin- ations, because older individuals might be at threat of cscate due to travel or beeuse they ae held to beat increased rik for some medical reaon (fr example, medial endtions rested to immune suppression or general ol age) or some expected ifsyle change (or czample human pepiloma virus vaccination prior to sexual activity). 1 wil focus on produce en argument not just to say why we have such a right, but explain why that particular right is supposed to take precedence in our moral deliberations. While such an ‘argument can, no doubt, be produced, it can surely be contested. Once again, while such a ‘ght might, at most, have some claim in relation to arguments about best interests itis not dear how it might defect any harm-to-others argument. “While all ofthese objections may be important, as the risk of harm-to-ohers from the relevant disease grows, it becomes more and more dificult to hold that any such rights take ‘precedence. Even in relation to best interests, we might doubt whether these arguments are Gecisive. This Is because any deliberations about best interests mean that no parent has an | absolute right todo as they want with a child. Parents havea great deal of eeway about how they choose to bring up their children, but there are serious constraints upon what will count as being legitimately in the best interests of any child. | K te Condusion “These diferent arguments will work In diferent ways depending on the nature of the putcular disease, vaccine and potential recipient). Determining the most relevant | and efectve vaccination poly isnot easy. However, It wl cersinly involve a consier- ftion of the risks of harm and benefits from vaccination and non-vacinstion, as well SS more theoretical anpiments about harm-to-others and best intrest. Considering, | the ethical issues related to vaccination requires new thinking because the focs of tad itional bioethics as been on the individual. This is unhelpful as it misses the fact chat ‘acination snot ust about individuals and wei choles but population health as wel Acknowledgement “This chapter i @ revised version ofa chapter, used with permission, that first appeared as: ‘Dawson, A. (2007) Vaccination ethics. In Principles of Health Care Ethic, 2nd edn, ed. | Ashcrofi, A. Dawson, H. Draper and J. MeMillan. Chichester: Wiley. 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