Vaccines

وفقًا لأحدث التقارير، هناك أكثر من مائة وأربعين تركيبة كيميائية تخضع الآن للتجارب على مستويات مختلفة، كما استثمرت الحكومات والمؤسسات الكبرى مثل مؤسسة «بيل وميليندا جيتس» مليارات الدولارات لتمويل البحث عن «الرصاصة الفضية» Silver Bullet السحرية التي من شأنها القضاء على الفيروس العنيف والمُراوغ. وما زالت كثرة من البروتوكولات المتعلقة بتطوير اللقاح المُنتظر – ونتائج تجاربها على البشر – مُحاطة بالسرية في ظل التنافس المحموم على أخذ زمام المبادرة.

COVID-19 vaccination of children has begun in various high-income countries with regulatory approval and general public support, but largely without careful ethical consideration. This trend is expected to extend to other COVID-19 vaccines and lower ages as clinical trials progress. This paper provides an ethical analysis of COVID-19 vaccination of healthy children. Specifically, we argue that it is currently unclear whether routine COVID-19 vaccination of healthy children is ethically justified in most contexts, given the minimal direct benefit that COVID-19 vaccination (...) provides to children, the potential for rare risks to outweigh these benefits and undermine vaccine confidence, and substantial evidence that COVID-19 vaccination confers adequate protection to risk groups, such as older adults, without the need to vaccinate healthy children. We conclude that child COVID-19 vaccination in wealthy communities before adults in poor communities worldwide is ethically unacceptable and consider how policy deliberations might evolve in light of future developments. (shrink)

Introduction/objectives Vaccination is a process that involves individual, social, and ethical aspects, beyond public governance of vaccines or vaccination as a public health concern. The aim of this study is to describe the sociocultural and moral narratives that influence the decision to vaccinate in general and to vaccinate against COVID-19 specifically, among patients at the rheumatology units of two hospitals. Methods Qualitative study involving individual semi-structured interviews following an interview guide. We conducted a thematic analysis using the ATLAS.ti software, with (...) further triangulation to verify concordance and aid in the interpretation of the data from a medical anthropology framework and using a narrative ethics approach to gain insight into the participants’ underlying moral values. Results We interviewed 37 patients in total, along with 3 rheumatologists. Five core themes emerged from the analysis to understand the decision to vaccinate: (1) information about vaccines and disease, (2) perceived risk–benefit of vaccination, (3) the physician–patient relationship, (4) governance of vaccination programs, (5) attitudes towards vaccines. Individual and family experiences with vaccination are diverse depending on the type of vaccine. The COVID-19 vaccine, as a new medical technology, is met with more controversy leading to hesitancy. Conclusions The decision to vaccinate among Mexican rheumatic disease patients can sometimes involve doubt and distrust, especially for those with a lupus diagnosis, but ultimately there is acceptance in most cases. Though patients make and value autonomous decisions, there is a collective process involving sociocultural and ethical aspects. (shrink)

The prospect of vaccinating children and young people (CYP) against COVID raises questions that apply more widely to vaccination in children. When can CYP consent, on their own, for vaccination? What should happen if children and their parents disagree about the desirability of a vaccine? When, if ever, should vaccination proceed despite a child’s dissent or apparent refusal? A range of ethical dilemmas may arise. (Box 1) In this article, we will address general ethical issues relating to consent for vaccination, (...) highlighting their relevance to COVID. We will not address the wider ethical questions of whether or when children should be vaccinated against COVID. (shrink)

Recent philosophical investigations on the topic of vaccination research and policy have highlighted the importance of public trust for the success of vaccination programs. This paper will look at the problem of expert disagreement and trustworthiness in the case of vaccine research. Giubilini, Gur-Arie and Jamrozik (2025) have argued for a notion of trustworthiness involving virtues of experts, such as epistemic humility and transparency in order to deal with situations of uncertainty, when there is a minority of scientists disagreeing with (...) the majority consensus. Using this account as a starting point, I will investigate the conditions necessary for the trustworthiness of institutions involved in vaccine research under uncertainty. I will highlight that, in addition to the virtues of individual researchers, certain structural features of the research community are required. More specifically, I will make the case for conditions that enable a fair resolution of disagreement: involving all relevant members of the scientific community and seeking solutions that adequately respond to the public’s needs and interests. (shrink)

Individuals unvaccinated against COVID-19 (C19) experienced prejudice and blame for the pandemic. Because people vastly overestimate C19 risks, we examined whether these negative judgements could be partially understood as a form of scapegoating (ie, blaming a group unfairly for an undesirable outcome) and whether political ideology (previously shown to shape risk perceptions in the USA) moderates scapegoating of the unvaccinated. We grounded our analyses in scapegoating literature and risk perception during C19. We obtained support for our speculations through two vignette-based (...) studies conducted in the USA in early 2022. We varied the risk profiles (age, prior infection, comorbidities) and vaccination statuses of vignette characters (eg, vaccinated, vaccinated without recent boosters, unvaccinated, unvaccinated-recovered), while keeping all other information constant. We observed that people hold the unvaccinated (vs vaccinated) more responsible for negative pandemic outcomes and that political ideology moderated these effects: liberals (vs conservatives) were more likely to scapegoat the unvaccinated (vs vaccinated), even when presented with information challenging the culpability of the unvaccinated known at the time of data collection (eg, natural immunity, availability of vaccines, time since last vaccination). These findings support a scapegoating explanation for a specific group-based prejudice that emerged during the C19 pandemic. We encourage medical ethicists to examine the negative consequences of significant C19 risk overestimation among the public. The public needs accurate information about health issues. That may involve combating misinformation that overestimates and underestimates disease risk with similar vigilance to error. (shrink)

This commentary examines the role of sustainability in the latest draft of the WHO pandemic accord, highlighting its notable absence from the official list of guiding principles despite being mentioned frequently throughout the text. It argues that sustainability should be explicitly acknowledged as a core principle and given a clear definition tailored to pandemic preparedness, and proposes defining sustainability as ensuring that immediate emergency responses don't compromise future pandemic preparedness and response capabilities. Including sustainability as a guiding principle would serve (...) two key purposes: validating the relevance of ethical principles in the accord's provisions and emphasizing the importance of long-term planning in pandemic preparedness. The commentary notes that while humans naturally discount future consequences, sustainable pandemic planning requires considering impacts beyond the next pandemic. It recommends coupling any reforms, such as intellectual property changes, with alternative innovation incentives to maintain a balanced approach to pandemic preparedness and response. (shrink)

Vaccination against various diseases has been widely practised for more than a century and on a more limited scale its use in a variety of forms stretches back far longer. During earlier eras disease spread more slowly along shipping lanes on water and traditional transport routes on land. Today, in an era of air transport, contagion spreads far more rapidly. Travelling far more rapidly (indeed instantaneously) is the spread of misinformation that hinders vaccination which can, in the instance of Covid-19, (...) reduce disease impacts, including rates of severe illness and death. This paper explores the ethical issue of informed consent in the context of the contest between personal choice and the greater public welfare. It also makes reference to a number of low, middle and high income countries where vaccine hesitance, and to a lesser extent refusal, has been fed by misinformation on a scale not previously observed but made possible by the proliferation of modern technology. This campaign of ignorance has further undermined trust in governmental health bodies and their attempts to implement quarantine and other measures such as vaccination that had already been damaged by early variations and vacillation in governmental approaches around the globe due in part to a reluctance by some governments to take actions that would have economic repercussions but also by the necessary evolution of their approaches as more became known about the disease and its variants. The paper examines the historical background and the current situation and finds that more must be done to restore or increase trust levels between citizens and governmental authorities, including the dissemination of high quality accurate information in a form relevant to readers/viewers. While potential side-effects of vaccines must be disclosed to ensure informed consent, their incidence should also be clearly communicated (e.g., in vaccine information statements) so that clients/patients are aware that a risk is 1 in 100 or 1in 1000 or 1 in 2 million etc. Governments are urged to learn from their experience and better prepare for inevitable future pandemics to minimise vaccine hesitancy and refusal and maximise its acceptance where evidence is overwhelming as to the benefit to the community. Informed consent is part of the context of efforts to use vaccination to contain or eradicate any disease. Nevertheless, while better information for clients/patients/consumers may reduce vaccine hesitancy/refusal, it is unlikely that it would but eliminate the need for mandating vaccination in some circumstances for the benefit of the broader community, although strict quarantine of those reluctant to accept it is an alternative but one not generally accepted by those reluctant to be vaccinated. The information war is one that needs to be won to increase the voluntary uptake of vaccination in the context of voluntary informed consent. (shrink)

The public health benefits of herd immunity are often used as the justification for coercive vaccine policies. Yet, ‘herd immunity’ as a term has multiple referents, which can result in ambiguity, including regarding its role in ethical arguments. The term ‘herd immunity’ can refer to (1) the herd immunity threshold, at which models predict the decline of an epidemic; (2) the percentage of a population with immunity, whether it exceeds a given threshold or not; and/or (3) the indirect benefit afforded (...) by collective immunity to those who are less immune. Moreover, the accumulation of immune individuals in a population can lead to two different outcomes: elimination (for measles, smallpox, etc) or endemic equilibrium (for COVID-19, influenza, etc). We argue that the strength of a moral obligation for individuals to contribute to herd immunity through vaccination, and by extension the acceptability of coercion, will depend on how ‘herd immunity’ is interpreted as well as facts about a given disease or vaccine. Among other things, not all uses of ‘herd immunity’ are equally valid for all pathogens. The optimal conditions for herd immunity threshold effects, as illustrated by measles, notably do not apply to the many pathogens for which reinfections are ubiquitous (due to waning immunity and/or antigenic variation). For such pathogens, including SARS-CoV-2, mass vaccination can only be expected to delay rather than prevent new infections, in which case the obligation to contribute to herd immunity is much weaker, and coercive policies less justifiable. (shrink)

This article argues that non-consensual vaccination is morally impermissible, for the same reasons for which sexual assault is not permissible. Likewise, mandatory vaccination is morally akin to sexual harassment, and therefore is not to be allowed.

In a recent article, ―The Lacuna of Hermeneutics: Notes on the Freedom of Thought, Marcia Sá Cavalcante Schuback raises an important question regarding the limitations of philosophical hermeneutics to be critical and attentive to the reality of current, concrete socio-political issues. In response, I claim that Gadamerian hermeneutics is well positioned to address current and controversial instances of epistemic injustice. In this article, I focus on the contemporary and controversial example of testimony of those who have been injured by the (...) COVID-19 vaccines. In turning to selections from Gadamer‘s Truth and Method, as well his lectures and essays on health and medicine, I argue that Gadamer‘s emphasis on hermeneutic openness and readiness, as well as an attunement to the linguistic and embodied experience of pain, allow us to consider a responsible approach to testimonies of the vaccine injured. Instead of providing a set of criteria or a particular method for distinguishing true from false testimony, Gadamerian hermeneutics calls for an examination and transformation of one‘s prejudices, especially prejudices which may impede one‘s ability to interpret and understand the subject matter in the first place. (shrink)

Equal access to vaccines has been one of the key ethical challenges during the COVID-19 pandemic. Most scholars consider the massive purchase and hoarding of vaccines by high-income countries, especially at the beginning of the pandemic, to be unjust towards the vulnerable living in low-income countries. A recent proposal by Andreas Albertsen of a vaccine tax has been put forward to remedy this problem. Under such a scheme, high-income countries would pay a contribution, conceptualised as a vaccine tax, dedicated to (...) buying vaccines and distributing them to low and middle-income countries. Proceeding from this proposal, we critically assess the feasibility of a vaccine tax and suggest how to conceptualise and implement a vaccine tax in practice. We present our ‘VaxTax model’ and explore its comparative advantages and disadvantages while considering other possible measures to address the global vaccine access problem, also in view of future pandemics and disease outbreaks. (shrink)

The COVID-19 pandemic, which spread around the world in 2020, changed the lives of millions of people and affected the life and functioning of all countries and people without exception. With the emergence of the opportunity to be vaccinated against COVID-19, the problem of making a decision about vaccination also appeared. But it has become increasingly clear that the coronavirus is moving into the group of annual viral epidemic diseases that occur every year in different countries during the seasonal wave (...) of acute respiratory viral infections. The ongoing COVID-19 pandemic against the background of the adoption of serious quarantine measures indicates the need for large-scale vaccination of the population as the most effective way to protect against COVID-19. In this article, we pay special attention to vaccination, as the main factor in ensuring health, reducing the morbidity and severity of the course of the COVID-19 disease, and an important task of the state and modern public administration. (shrink)

This dissertation explores the idea and ethics of vaccination for the sake of others. It conceptually distinguishes four different kinds of vaccination—self-protective, paternalistic, altruistic, and indirect—based on who receives the primary benefits of vaccination and who ultimately makes the vaccination decision. It describes the results of focus group studies that were conducted to investigate what people who might get vaccinated altruistically think of this idea. It also applies the different kinds of vaccination to ethical issues surrounding COVID-19, such as lockdown (...) measures, routine or mandatory vaccination of healthy children, and the ethical justification of restrictive measures for unvaccinated people. A more general philosophical account of vaccination ethics is ultimately developed, which is based not on moral duties, but on the moral reasons that people may have to get vaccinated for the sake of others. It is argued that such reasons may be stronger or weaker, depending on various factors related to the vaccines in question and the specific epidemiological circumstances. (shrink)

Recently, several states in the US have made it more difficult to receive nonmedical exemptions to school vaccine mandates in the hope of better orienting parents towards vaccination. However, little is known about how public-facing school staff implement and enforce mandate policies, including why or how often they steer parents towards nonmedical exemptions. This study focused on Michigan, which has recently added an additional burden for families seeking nonmedical exemptions. We used an anonymous online survey to assess Michigan public-school employees (...) (n = 157) about their knowledge, attitudes, and behaviors regarding Michigan's school enrollment vaccine mandate policy. Our main conclusions are that frontline school staff are generally knowledgeable about vaccines and immunization policy, but are at best ambivalent about their role in immunization governance, believing that other agents should be responsible for ensuring that children are vaccinated. Furthermore, some respondents indicated low vaccine confidence, which was associated with increased ambivalence about, or opposition to, their role in immunization governance. As more jurisdictions within and beyond the US consider introducing or tightening childhood vaccine mandates, it is increasingly important to understand how these policies can be improved by attending to the attitudes and roles of relevant frontline actors. (shrink)

With the world grappling with continued spread of monkeypox internationally, vaccines play a crucial role in mitigating the harms from infection and preventing spread. However, countries with the greatest need - particularly historically endemic countries with the highest monkeypox case-fatality rates - are not able to acquire scarce vaccines. This is unjust, and requires rectification through equitable allocation of vaccines globally. We propose applying the Fair Priority Model for such allocation, which emphasizes three key principles: 1) preventing harm; 2) prioritizing (...) the disadvantaged; and 3) treating people with equal moral concern. Post-exposure prophylaxis (PEPV) has the most potential to mitigate harm, and so ensuring countries have sufficient supply for PEPV should be the first priority. And historically endemic countries, which face disadvantages that compound potential harms from monkeypox, should be the first recipients of such vaccines. Once sufficient supply is allocated for countries to apply PEPV, global allocation could move on to pre-exposure prophylaxis (PrEP), again prioritizing historically endemic countries first before distribution to the rest of the global community, based on projected number of cases and vulnerability to harm. (shrink)

As we journey into the fourth year of the COVID-19 pandemic, a majority of Americans express relief at a “return to normal,” experience pandemic fatigue, or embrace the idea of living with COVID-19 in much the same way we live with the seasonal flu. But transition to a new phase of life with SARS-CoV-2 does not diminish the importance of vaccination. The US Centers for Disease Control and the Food and Drug Administration recently recommended another round of booster dose for (...) persons age 5 and up, or an initial series for those not previously vaccinated, with an updated bivalent formula that protects against both the original virus strain and Omicron subvariants that are now the dominant source of infection. By most accounts most of the population has been or will become infected with SARS-CoV-2. Suboptimal uptake of the COVID-19 vaccines among the approximately 25 million adolescents in the United States is a significant obstacle to population coverage, public health, and the health and well-being of adolescents. A major cause of low adolescent uptake is parental vaccine hesitancy. This article discusses parental vaccine hesitancy and argues that permitting independent adolescent consent to COVID-19 vaccination should be an ethical and policy priority as we continue to confront the threat of Omicron and other variants of the coronavirus. We discuss the central role of the pediatric healthcare team in caring for adolescent patients who disagree with their parents about vaccination. (shrink)

In a recent article, "Can One Both Contribute to and Benefit from Herd Immunity?", Lucie White argues that vaccine refusal is more like free riding than we have claimed that it is. Here, we critically reply to White’s arguments.

We propose a framework for the description of the effects of vaccinations on the spreading of an epidemic disease. Different vaccines can be dosed, each providing different immunization times and immunization levels. Differences due to individuals’ ages are accounted for through the introduction of either a continuous age structure or a discrete set of age classes. Extensions to gender differences or to distinguish fragile individuals can also be considered. Within this setting, vaccination strategies can be simulated, tested and compared, as (...) is explicitly described through numerical integrations. (shrink)

It is widely accepted that a liberal state has a general duty to protect its people from undue health risks. However, the unprecedented emergent measures against the COVID-19 pandemic taken by governments worldwide give rise to questions regarding the extent to which this duty may be used to justify suspending a vaccine rollout on marginal safety grounds. -/- In this chapter, I use the case of vaccination to argue that while a liberal state has a general duty to protect its (...) people’s health, there is a limit to the measures this duty can be used to justify. First, I argue that since every available option involves different risks and benefits, the incommensurability of the involved risks and benefits forbids the prioritisation of a particular vaccine. Second, I argue that given epistemic limitations and uncertainty, policies that favour certain vaccines are not only epistemically ill-founded but also morally unacceptable. I conclude that in a highly uncertain situation such as the unfolding pandemic, the duty a liberal state ought to uphold is to properly communicate the knowns and unknowns to the general public and help people decide which option to choose for themselves. I call this duty the duty to facilitate risk-taking. (shrink)

It is widely accepted that a liberal state has a general duty to protect its people from undue health risks. However, the unprecedented emergent measures against the COVID-19 pandemic taken by governments worldwide give rise to questions regarding the extent to which this duty may be used to justify suspending a vaccine rollout on marginal safety grounds. -/- In this chapter, I use the case of vaccination to argue that while a liberal state has a general duty to protect its (...) people’s health, there is a limit to the measures this duty can be used to justify. First, I argue that since every available option involves different risks and benefits, the incommensurability of the involved risks and benefits forbids the prioritisation of a particular vaccine. Second, I argue that given epistemic limitations and uncertainty, policies that favour certain vaccines are not only epistemically ill-founded but also morally unacceptable. I conclude that in a highly uncertain situation such as the unfolding pandemic, the duty a liberal state ought to uphold is to properly communicate the knowns and unknowns to the general public and help people decide which option to choose for themselves. I call this duty the duty to facilitate risk-taking. (shrink)

For the past three years, Coronavirus-19 (Covid-19) has become one of the major global health problems. Unlike any previous virus in the past decades, Covid-19 has shown its unprecedented spreading speed, infection rate, fatality rate, etc. Under this urgent disease outbursting event, scientists around the globe, through the myriad of research and experiments, successfully developed effective vaccines. However, like many other medical innovations, Covid-19 vaccines are categorized as intellectual properties and a scarce resource. As a consequence, the citizens of developed (...) and developing countries face an imbalanced distribution of affordable vaccines. The formation of this issue is not only due to manufacturing, transportation, and other infrastructures, but also strongly correlated with aspects in the legal field, such as intellectual property rights (IPRs). With a humane common sense of vaccination many people, through comparative research method, this article aims to discuss the conflicts between the global crisis of Force Majeure and the interests of certain countries or corporations, possible solutions to resolve this conflict, and future coping strategies that ought to be published. (shrink)

BackgroundVaccination has been considered one of the most effective public health interventions. In the context of the global epidemic of coronavirus disease 2019, it remains unclear what role general vaccination attitudes and perceptions have on the acceptance of COVID-19 vaccine.ObjectiveThis study aims to explore the impact of general attitudes and perceptions toward vaccination on the acceptance of a newly developed vaccine, taking COVID-19 vaccines as an example.MethodA cross-sectional survey was conducted among 2,013 Chinese adult participants. Generalized order logistic regression and (...) path analysis models were used to analyze impacts of general attitudes and perceptions toward vaccination on the acceptance of the COVID-19 vaccine.ResultsThe prevalence of hesitancy to vaccination in general is 49.9% among the Chinese adult population. General perceptions of vaccination were associated with corresponding perceptions of the COVID-19 vaccine. A “no hesitancy” attitude toward vaccination is a significant determinant of future COVID-19 vaccination compared to vaccine refusers, and perceptions of COVID-19 vaccine remain a significant determinant for the acceptance of the COVID-19 vaccine. Path analysis indicates that perceptions of the importance and safety of vaccination have a positive overall effect on the acceptance of the COVID-19 vaccine, and that general perceptions of vaccination as a whole on each measure indirectly influence the acceptance of the COVID-19 vaccine.ConclusionGeneral attitudes and perceptions toward vaccination were associated with those of the COVID-19 vaccine and future vaccination intention. To prepare for possible emergence of diseases in the future, routine health campaigns should be launched by relevant government departments and vaccination authorities to enhance the overall awareness and knowledge of vaccination among the public and to ensure optimal vaccination experience. In addition, targeted knowledge dissemination and mass mobilizations should be urged for newly developed vaccines when some specific infectious diseases emerge, such as COVID-19 at present. (shrink)

In bioethics vaccine refusal is often discussed as an instance of free riding on the herd immunity of an infectious disease. However, the social science of vaccine refusal suggests that the reasoning behind refusal to vaccinate more often stems from previous negative experiences in healthcare practice as well as deeply felt distrust of healthcare institutions. Moreover, vaccine refusal often acts like an exit mechanism. Whilst free riding is often met with sanctions, exit, according to Albert Hirschman’s theory of exit and (...) voice is most efficiently met by addressing concerns and increasing the quality and number of feedback channels. If the legitimate grievances responsible for vaccine refusal are not heard or addressed by healthcare policy, further polarization of attitudes to vaccines is likely to ensue. Thus, there is a need in the bioethics of vaccine refusal to understand the diverse ethical questions of this inflammable issue in addition to those of individual responsibility to vaccinate. (shrink)

Introduction: YouTube is a very important source of information. The videos in YouTube provide a message with information. The purpose of this article was to assess the main message of available materials about coronavirus disease 2019 vaccines on YouTube. Methods: In this study, the four search terms "COVID-19 vaccine", "COVID-19 vaccination", "Coronavirus vaccine", "Coronavirus vaccination" were scanned on the YouTube media platform on 9 February 2021. We examined video parameters i.e., durations, view counts, likes, dislikes, comments, messages and sources of (...) the 83 videos about COVID-19 vaccine. Results: The messages were defined as 52 positive, 12 negative, and 17 ambiguous about getting vaccinated. Significant differences were determined between the message category groups in respect of the like ratio. Positive group videos were less liked. Conclusion: More negative messages about the COVID-19 vaccine were found in media-sourced videos. Negative and ambiguous videos were more attractive to YouTube users. Scientists, policymakers, and community leaders should play a role in disseminating information about COVID-19 vaccine and vaccination. (shrink)

Healthcare workers in Pakistan are still fighting at the frontline to control the spread of severe acute respiratory syndrome coronavirus-2 and have been identified as the earliest beneficiaries for COVID-19 vaccination by the health authorities of the country. Besides, the high vaccination rates of frontline healthcare workers are essential to overcome the ongoing pandemic and reduce the vaccines hesitancy among the general population. The current research employed the theory of planned behavior to investigate the COVID-19 vaccination behavior among FHWs in (...) Pakistan as well as the predictors of such behavior. Following the epidemic control and prevention policies, a sample of 680 FHWs were accessed to fill in the questionnaire evaluating the components of the TPB. Moreover, the potential role of anticipated regret and perceived susceptibility on COVID-19 vaccination behavior was also assessed. The partial least square structural equation modeling results revealed that the TPB components, as well as the AR, have positive associations with the COVID-19 vaccination behavior. The results further confirmed that PS positively affects the anticipated regret, attitude, and subjective norm to vaccinate against SARS-CoV-2. The perceived susceptibility also has a positive association with COVID-19 vaccination behavior through the mediation of anticipated regret, ATT, and SN. Our findings highlighted the importance of COVID-19 vaccination among healthcare workers, which can be applied to reduce vaccine hesitancy among the general public. (shrink)

One solution to prevent the spread of coronavirus disease 2019 (COVID-19) is getting vaccinated. The promotion of vaccines through religion helps to control the pandemic. One of the causes of doubts about vaccination in society is religious understanding. Vaccination has an important correlation with Islamic law or Islamic jurisprudence. This research aims to analyse the effect of understanding Islamic law on doubts about vaccination. This research used quantitative pre-experimental designs. The research sample consisted of 160 people who were not vaccinated. (...) The sampling technique involved a non-random sampling method. The data analysis is descriptive and inferential. The results of this research showed the following: (1) the understanding of Islamic law related to the status of halal and haram has a positive influence on the Muslim community's willingness to vaccinate, (2) the understanding of the emergency concept can increase confidence in vaccines and (3) the education related to understanding Islamic law can effectively reduce doubts about vaccination. CONTRIBUTION: This research provides knowledge about the COVID-19 vaccine from the perspective of Islamic law. This research provides a new strategy to reduce public doubts about vaccination. (shrink)

The potential for vaccines to prevent the spread of infectious diseases is crucial for vaccination policy and ethics. In this paper, I discuss recent evidence that the current COVID-19 vaccines have only a modest and short-lived effect on reducing SARS-CoV-2 transmission and argue that this has at least four important ethical implications. First, getting vaccinated against COVID-19 should be seen primarily as a self-protective choice for individuals. Second, moral condemnation of unvaccinated people for causing direct harm to others is unjustified. (...) Third, the case for a harm-based moral obligation to get vaccinated against COVID-19 is weak. Finally, and perhaps most significantly, coercive COVID-19 vaccination policies (e.g., measures that exclude unvaccinated people from society) cannot be directly justified by the harm principle. (shrink)

Bioethics, Volume 36, Issue 6, Page 687-698, July 2022.

Vaccination can protect vaccinated individuals and often also prevent them from spreading disease to other people. This opens up the possibility of getting vaccinated for the sake of others. In fact, altruistic vaccination has recently been conceptualized as a kind of vaccination that is undertaken primary for the benefit of others. In order to better understand the potential role of altruistic motives in people’s vaccination decisions, we conducted two focus group studies with a total of 37 participants. Study 1 included (...) three focus groups on the subject of HPV vaccination for boys. Study 2 included three focus groups on the subject of pertussis and measles vaccination for childcare workers. We found substantial evidence of other-regarding motives across all focus groups, which suggests that altruistic motives could be an important factor when it comes to people’s vaccination decisions. We address the significance of these findings for vaccination policy surrounding HPV vaccination for boys and vaccination for childcare workers. We also extend the findings to normative work on vaccination for the sake of others more generally. (shrink)

While most of the mortality associated with severe acute respiratory syndrome coronavirus 2 has been in elderly populations and adults with significant medical comorbidities, there has been death and morbidity in paediatric populations. As vaccine trial data is released to the public, many people look to the future with hope ; with good vaccine uptake there is the opportunity to reduce the spread of infectious pandemics. Initial vaccine trials were completed with adults and were expanded to include paediatric populations delaying (...) paediatric COVID-19 vaccine initiatives. The exclusion of children from initial vaccine trials during a pandemic is not morally justifiable and fosters distrust with the pharmaceutical and medical industries and inevitably postpones vaccinating children when there is a surplus of available vaccines. The delayed vaccination of children under twelve may have significant public health and economic consequences as there may be ongoing viral transmission in the context of reopening strategies. The safety and efficacy of these candidate vaccines in children should be assessed expeditiously so that distribution to vulnerable paediatric populations is not impacted. Vaccine uptake compliance in the general population is important in establishing herd immunity and ensuring that there is thorough scientific evidence to support vaccination for children is important in establishing community trust. (shrink)

To understand how different types of cues in vaccine education messages affect attitude toward campaign messages and vaccination intention, this study examined the impact of the presence of social norm appeals and the presence of fear appeals in coronavirus disease 2019 vaccine campaign posters on perceived communication quality and vaccination intention. A 2 × 2 × 3 within-subject factorial design experiment was conducted in China. Findings demonstrated that the presence of fear appeals in COVID-19 vaccine campaign posters elicited lower levels (...) of perceived communication quality and vaccination intention than those without fear appeals. The interactive effect of fear appeals and social norm appeals was also found to be significant. Specifically, positive-framed messages with group cues and fear appeal messages with individual cues elicited higher perceived information quality and stronger vaccination intention than other types of messages. Understanding how these cues function jointly in COVID-19 vaccine campaign messages will help public health practitioners create more effective intervention strategies. (shrink)

Modern public-health initiatives in industrialized countries revolve around immunization against contagious diseases. The practice of engendering immunity against disease through disease first emerged in Western European social and medical landscapes in the eighteenth century as inoculation, based on the imported Middle Eastern practice of ‘engrafting’. By the nineteenth century, this practice had evolved into the procedure of vaccination, in the first instance directed against smallpox. Popular and academic narratives thus often categorize inoculation as a procedure from the Middle East which (...) was transformed into the truly scientific procedure of vaccination by English and French knowledge. This characterization has obscured the complex traditions of intellectual exchange between English and French networks and Middle Eastern societies in the eighteenth and nineteenth centuries. This article examines these networks in order to show how knowledge was transformed as it circulated between communities during this period. Both Western Europeans and Egyptians across different social hierarchies translated foreign or new medical practices according to the needs of their knowledge and goals, creating cycles of adoption and adaptation. This exploration of inoculation and vaccination furthers our understanding of the bilateral translation processes ingrained in the global circulation of knowledge. (shrink)

Here, an epidemiological model considering pro and anti-vaccination groups is proposed and analyzed. In this model, susceptible individuals can migrate between these two groups due to the influence of false and true news about safety and efficacy of vaccines. From this model, written as a set of three ordinary differential equations, analytical expressions for the disease-free steady state, the endemic steady state, and the basic reproduction number are derived. It is analytically shown that low vaccination rate and no influx to (...) the pro-vaccination group have similar impacts on the long-term amount of infected individuals. Numerical simulations are performed with parameter values of the COVID-19 pandemic to illustrate the analytical results. The possible relevance of this work is discussed from a public health perspective. (shrink)

There have been calls for mandatory vaccination legislation to be introduced into the UK in order to tackle the national and international rise of vaccine-preventable disease. While some countries have had some success associated with mandatory vaccination programmes, the Royal College of Paediatrics and Child Health insist this is not a suitable option for the UK, a country which has seen historical opposition to vaccine mandates. There is a lack of comprehensive data to demonstrate a direct link between mandatory vaccination (...) legislation and increased uptake. While there are examples whereby there has been an improvement, some studies suggest that comparable results can be obtained by strongly recommending vaccinations instead. The RCPCH insist that healthcare workers are ideally placed to engage and inform parents to make every interaction a ‘vaccine opportunity’. This paper calls for a principled, rational approach to interpretations of autonomy which underpin parental informed consent. MacLean’s concept of mutual persuasion could be a vehicle to ensuring parents are suitably informed of both the material risks associated with vaccine choices and to consider the rationality of their decisions, while ultimately upholding parental autonomy. It is argued that this, alongside infrastructural improvement, could create a more sustainable, long-term improvement in childhood vaccination rates in the UK than mandatory vaccination. (shrink)

Reserve systems are a tool to allocate scarce resources when stakeholders do not have a single objective. This paper introduces some basic concepts about reserve systems for pandemic medical resource allocation. At the onset of the Covid-19 pandemic, we proposed that reserve systems can help practitioners arrive at compromises between competing stakeholders. More than a dozen states and local jurisdictions adopted reserve systems in initial phases of vaccine distribution. We highlight several design issues arising in some of these implementations. We (...) also offer suggestions about ways practitioners can take advantage of the flexibility offered by reserve systems. (shrink)

This Article examines whether policies—sometimes termed “vaccine mandates” or “vaccine requirements”— that consider vaccination 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, considering vaccination status, and concludes that such consideration is almost always legally (...) permissible unless foreclosed by specific state legislation. Part II examines the consideration of vaccination 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 considering vaccination 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)

The allocation of scarce medical treatments, such as antivirals and antibody therapies for COVID-19 patients, has important legal dimensions. This Essay examines a currently debated issue: how will courts view the consideration of characteristics shielded by equal protection law, such as race, sex, age, health, and even vaccination status, in allocation? Part II explains the application of strict scrutiny to allocation criteria that consider individual race, which have been recently debated, and concludes that such criteria are unlikely to succeed under (...) present Supreme Court precedent. Part III analyzes the use of sex-based therapy allocation criteria, which are also in current use, and argues that they also face substantial legal obstacles, despite only being subject to intermediate scrutiny. Parts IV and V examine the use of age and health status in allocation. Part VI discusses how the nascent law on “vaccination status” discrimination might apply to therapy allocation. (shrink)

When hospitals face surges of patients with COVID-19, fair allocation of scarce medical resources remains a challenge. Scarcity has at times encompassed not only hospital and intensive care unit beds—often reflecting staffing shortages—but also therapies and intensive treatments. Safe, highly effective COVID-19 vaccines have been free and widely available since mid-2021, yet many Americans remain unvaccinated by choice. Should their decision to forgo vaccination be considered when allocating scarce resources? Some have suggested it should, while others disagree. We offer a (...) framework for evaluating when it is ethical and briefly discuss its legality in American law. (shrink)

By 20 October 2021, the U.S. Food and Drug Administration (FDA) had amended its Emergency Use Authorizations for immunocompetent adults who previously received the Pfizer-BioNTech, Moderna, or Johnson & Johnson COVID-19 vaccines. For the 2-dose Pfizer-BioNTech and Moderna vaccines, the FDA permitted a single booster dose for adults aged 65 years or older and adults aged 18 to 64 years at high-risk for severe COVID-19 or at high risk for occupational or institutional COVID-19 exposure. For the single-dose Johnson & Johnson (...) vaccine, the FDA permitted a single booster dose for all adults aged 18 or older. These eligibility schemes were endorsed by the Centers for Disease Control and Prevention shortly after FDA approval. (shrink)

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 priority vaccination. 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 priority vaccination, highlighting the importance of clarity when describing intentions to vaccinate, or even generally care for, diverse populations composed of distinct subgroups in need. (shrink)

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)

In the years around 1900 one of the most significant practical consequences of new styles of bacteriological thought and practice was the development of preventive vaccines and therapeutic sera. Historical scholarship has highlighted how approaches rooted in the laboratory methods of Robert Koch, Louis Pasteur and their collaborators were transformed in local contexts and applied in diverse ways to enable more effective disease identification, prevention and treatment. Amongst these, the anti-anthrax serum developed by the Italian physician Achille Sclavo (1861–1930) has (...) received little to no attention from historians. This article positions Sclavo's serum as a neglected but significant presence in British microbiology, which achieved widespread uptake amidst a wave of optimism, despite prolonged uncertainty about its mechanism of action and dosage. After being introduced to Britain in 1904 by the enterprising first medical inspector of factories Thomas Morison Legge, within a matter of months the serum became regarded by medical practitioners as an effective treatment of cutaneous anthrax, though access to ‘fresh’ serum and the necessary speedy diagnosis remained problematic. Like the disease anthrax itself, discussion of ‘Sclavo's serum’ was out of all proportion to the relatively low number of cases, reflecting a deep-seated fascination with the wider possibilities afforded by effective serum therapy. (shrink)

Objective: A deep understanding of the relationship between a scarce drug's dose and clinical response is necessary to appropriately distribute a supply-constrained drug along these lines. Summary of key data: The vast majority of drug development and repurposing during the COVID-19 pandemic – an event that has made clear the ever-present scarcity in healthcare systems –has been ignorant of scarcity and dose optimisation's ability to help address it. Conclusions: Future pandemic clinical trials systems should obtain dose optimisation data, as these (...) appear necessary to enable appropriate scarce resource allocation according to societal values. (shrink)

The way communicable diseases do spread from one person to another, depending upon the specific disease or causative infectious agent. Out of these diseases, some are incurable and the health care workers during their practice or otherwise acquire such infections and transmit them further to innocent patients who are unaware of about the health status of health care workers. The rights of an infected health care worker and patients are protected by many laws but in case of conflict of interests (...) between the individual right of the health care worker and life of a patient, then obviously by the principle of natural justice, saving the life of a person from such incurable infection gets the privilege. Therefore, there is a lot of ethical and professional dilemma, arising out, in such a type of scenario, irrespective of concealed or disclosed health status and the question mark is raised on whether clinical practice may be allowed in such cases. Some of the studies show the actual but very little risk of transmission from infected health care workers to patients. Therefore, in the current scenario, many western countries such as USA and UK are following different guidelines in this regard but the same is lacking in India. So, this article critically analyses the various issues arising out of it and thereby justifies the need to have a uniform infection control policy in this regard apart from legal and ethical binding on infected health care workers. (shrink)

With the limited initial availability of COVID-19 vaccines in the first months of 2021, decision-makers had to determine the order in which different groups were prioritized. Our aim was to find out what normative approaches to the allocation of scarce preventive resources were embedded in the national COVID-19 vaccination schedules. We systematically reviewed and compared prioritization regulations in 27 members of the European Union, the United Kingdom, and Israel. We differentiated between two types of priority categories: groups that have increased (...) infection fatality rate (IFR) compared to the average for the general population and groups chosen because their members experience increased risk of being infected (ROI). Our findings show a clear trend: all researched schedules prioritized criteria referring to IFR (being over 65 years old and coexisting health conditions) over the ROI criteria (eg occupation and housing conditions). This is surprising since, in the context of treatment, it is common and justifiable to adopt different allocation principles (eg introducing a saving more life-year approach or prioritizing younger patients). We discuss how utilitarian, prioritarian, and egalitarian principles can be applied to interpret normative differences between the allocation of curative and preventive interventions. (shrink)

Vaccine refusal is not a free rider problem. The claim that vaccine refusers are free riders is inconsistent with the beliefs and motivations of most vaccine refusers. This claim also inaccurately depicts the relationship between an individual’s immunization choice, their ability to enjoy the benefits of community protection, and the costs and benefits that individuals experience from immunization and community protection. Modeling vaccine refusers as free riders also likely distorts the ethical analysis of vaccine refusal and may lead to unsuccessful (...) policy interventions. (shrink)

Although a safe, effective, and licensed coronavirus vaccine does not yet exist, there is already controversy over how it ought to be allocated. Justice is clearly at stake, but it is unclear what justice requires in the international distribution of a scarce vaccine during a pandemic. Many are condemning ‘vaccine nationalism’ as an obstacle to equitable global distribution. We argue that limited national partiality in allocating vaccines will be a component of justice rather than an obstacle to it. For there (...) are role-based and community-embedded responsibilities to take care of one’s own, which constitute legitimate moral reasons for some identity-related prioritisation. Furthermore, a good form of vaccine nationalism prioritises one’s own without denying or ignoring duties derived from a principle of equal worth, according to which all persons, regardless of citizenship or identity, equally deserve vaccine-induced protection from COVID-19. Rather than dismissing nationalism as a tragic obstacle, it is necessary to acknowledge that a limited form of it is valuable and expresses moral commitments. Only then can one understand our world of competing obligations, a world where cosmopolitan duties of benevolence sometimes conflict with special obligations of community membership. Once these competing obligations are recognised as such, we can begin the work of designing sound ethical frameworks for achieving justice in the global distribution of a coronavirus vaccine and developing practical strategies for avoiding, mitigating or resolving conflicts of duty. (shrink)