Global Ethical Considerations Regarding Mandatory Vaccination in Children
Julian Savulescu1, Alberto Giubilini2, Margie Danchin3
1Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK and Murdoch Children's Research Institute, Victoria, Australia.
Insights
Deciding on childhood vaccinations requires evaluating vaccine safety, efficacy, and benefits for children. Ethical considerations for mandatory vaccination include disease threat, usefulness, and proportionate coercion, with potential for influenza vaccine mandates during pandemics.
Area of Science:
- Pediatric infectious diseases
- Vaccine ethics
- Public health policy
Background:
- Childhood vaccination decisions for diseases like COVID-19 and influenza are complex.
- Key uncertainties exist regarding COVID-19 vaccine safety, efficacy, and impact on transmission in children.
- The role of children in disease transmission and the direct benefit of vaccination to them remain unclear.
Purpose of the Study:
- To outline ethical requirements for mandatory childhood vaccination.
- To analyze the ethical considerations for recommending or mandating novel vaccines for children.
- To assess the balance between individual liberty and public good in vaccination policies.
Main Methods:
- Ethical framework analysis for mandatory vaccination.
- Review of existing literature on vaccine safety, efficacy, and disease burden in children.
- Comparative evaluation of risks, benefits, and alternatives to vaccination.
Main Results:
- Three ethical requirements for mandatory vaccination are proposed: grave threat assessment, positive comparative usefulness, and proportionate coercion.
- The decision-making process necessitates precise data on disease risks and vaccine effectiveness.
- Balancing self-interest with duty to others, and liberty with usefulness is crucial.
Conclusions:
- Mandatory vaccination policies require careful ethical deliberation, especially for diseases posing a lesser threat to children.
- The ethical case for mandatory influenza vaccination in children during the COVID-19 pandemic may be strong.
- Further research is needed to address knowledge gaps concerning pediatric COVID-19 vaccination.
Abstract:
Whether children should be vaccinated against coronavirus disease-2019 (COVID-19) (or other infectious diseases such as influenza) and whether some degree of coercion should be exercised by the state to ensure high uptake depends, among other things, on the safety and efficacy of the vaccine. For COVID-19, these factors are currently unknown for children, with unanswered questions also on children's role in the transmission of the virus, the extent to which the vaccine will decrease transmission, and the expected benefit (if any) to the child. Ultimately, deciding whether to recommend that children receive a novel vaccine for a disease that is not a major threat to them, or to mandate the vaccine, requires precise information on the risks, including disease severity and vaccine safety and effectiveness, a comparative evaluation of the alternatives, and the levels of coercion associated with each. However, the decision also requires balancing self-interest with duty to others, and liberty with usefulness. Separate to ensuring vaccine supply and access, we outline 3 requirements for mandatory vaccination from an ethical perspective: (1) whether the disease is a grave threat to the health of children and to public health, (2) positive comparative expected usefulness of mandatory vaccination, and (3) proportionate coercion. We also suggest that the case for mandatory vaccine in children may be strong in the case of influenza vaccination during the COVID-19 pandemic.
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