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)

This paper addresses the just distribution of vaccines against the SARS-CoV-2 virus and sets forth an ethical framework that prioritises frontline and essential workers, people at high risk of severe disease or death, and people at high risk of infection. Section I makes the case that vaccine distribution should occur at a global level in order to accelerate development and fair, efficient vaccine allocation. Section II puts forth ethical values to guide vaccine distribution including helping people with the greatest need, (...) reducing health disparity, saving the most lives and promoting narrow social utility. It also responds to objections which claim that earlier years have more value than later years. Section III puts forth a practical ethical framework to aid decision-makers and compares it with alternatives. (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)

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, "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)

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)

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)

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)

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: who else should 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)

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)

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)

In ‘Against vaccine nationalism’, Nicole Hassoun misrepresents our argument, distorts our position and ignores crucial distinctions we present in our article, ‘Love thy neighbor? Allocating vaccines in a world of competing obligations’. She has created a strawman that does not resemble our position. In this reply, we address two features of ‘Against vaccine nationalism’. First, we address a phantom premise. Hassoun misattributes to us a thesis, according to which citizen-directed duties are stronger than noncitizen-directed duties. This thesis is a figment (...) of her imagination, not a fragment of our argument. Second, we address a shape-shifting ism. Ambiguity attaches to ‘vaccine nationalism,’ ambiguity that Hassoun exploits despite our distinguishing various meanings of the phrase. As a result, the type of vaccine nationalism she argues against is not the type we defend. (shrink)

Given the negative consequences of the ongoing COVID-19 pandemic on public health, his study aimed at investigating: the differences between adults with and without chronic illness in buying behavior, vaccination intention, pandemic worry, and the health belief model components; the HBM components as mediators of the relationship between pandemic worry and vaccination intention. The sample consisted of 864 adults, of which 20.5% reported having a chronic illness. Associations between pandemic worry, vaccination intention, and HBM were ascertained using correlation and mediation (...) analyses. Individuals with chronic illness reported a higher level of pandemic worry, higher levels of perceived threat, greater benefits from vaccination, had lower self-efficacy and bought more medicine and sanitary/hygienic products. No significant differences were observed regarding vaccination intention, barriers against vaccination, and changes in food buying behavior. We found that the relationship between pandemic worry and vaccination intention was partially mediated by the perceived threat of disease and the benefits of vaccination. Pandemic worry predicted vaccination intention directly but also through the contribution of the perceived threat of disease and the benefits of vaccination. These findings suggest that presenting evidence of COVID-19 vaccine efficacy and the benefits of having the vaccine will encourage the population to follow vaccination recommendations. (shrink)

The devastating impact of the COVID‐19 (coronavirus disease 2019) pandemic is prompting renewed scrutiny of practices that heighten the risk of infectious disease. One such practice is refusing available vaccines known to be effective at preventing dangerous communicable diseases. For reasons of preventing individual harm, avoiding complicity in collective harm, and fairness, there is a growing consensus among ethicists that individuals have a duty to get vaccinated. I argue that these same grounds establish an analogous duty to avoid buying and (...) eating most meat sold today, based solely on a concern for human welfare. Meat consumption is a leading driver of infectious disease. Wildlife sales at wet markets, bushmeat hunting, and concentrated animal feeding operations (CAFOs) are all exceptionally risky activities that facilitate disease spread and impose immense harms on human populations. If there is a moral duty to vaccinate, we also should recognize a moral duty to avoid most meat. The paper concludes by considering the implications of this duty for policy. (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)

Proponents of vaccine mandates typically claim that everyone who can be vaccinated has a moral or ethical obligation to do so for the sake of those who cannot be vaccinated, or in the interest of public health. I evaluate several previously undertheorised premises implicit to the ‘obligation to vaccinate’ type of arguments and show that the general conclusion is false: there is neither a moral obligation to vaccinate nor a sound ethical basis to mandate vaccination under any circumstances, even for (...) hypothetical vaccines that are medically risk-free. Agent autonomy with respect to self-constitution has absolute normative priority over reduction or elimination of the associated risks to life. In practical terms, mandatory vaccination amounts to discrimination against healthy, innate biological characteristics, which goes against the established ethical norms and is also defeasible a priori. (shrink)

A novel coronavirus in 2019 took the life of ‘patient zero’ and then millions of others alerting nation states to protect and secure the lives of their citizens. The coronavirus known as SARS-CoV-2 caused the ‘COVID-19’ disease which had governments impose restrictions on the freedom of movement or the right to travel in the form of ‘community quarantines.’ The serious adverse effects of these on the world and national economies moved the governments to loosen the quarantines and implement versions of (...) so-called ‘vaccine passport,’ an international digital health certificate proving COVID-19 vaccination status. One of the uses of the vaccine passport is to expedite the safe and orderly passage of people in airports which extends to other travel terminals, essential and commercial establishments, and facilities. There are ethical concerns, however, such as the inequitable distribution of the scarce supply of vaccines, among others. In this article, I briefly describe the vaccine passport idea, its uses, and ethical concerns, and then apply these concerns in a national context through the pending bills that aim to legitimize a Vaccine Passport System in the Philippines. In the end, I recommend that lawmakers (who represent the moral interest of Filipinos) consider such concerns before they cast their votes. (shrink)

Steven Soderbergh’s Contagion positions the vaccine as the end point of the arc of ​pandemic, marking both the containment of an elusive virus and ​the resumption of a life not fundamentally different from ​before the disease outbreak. ​The film reinforces the ​assumption that a pandemic will awaken ​all of us to the urgency of vaccination​, persuading us to put aside our reservations and anxieties ​and the idea that compliance is the inevitable outcome of quarantine. This article explores how pro-vaccination cultural (...) products ​such as Contagion might in fact undermine public health efforts by promoting a false narrative, which simplifies the kind of vaccination campaign necessary for herd immunity to develop. An ethic of sacrifice and selflessness drives the public health messaging of the film but leaves intact certain individualistic tropes and plague narrative scapegoating tendencies, while the framing of the vaccine as “gift” takes it out of the realm of medical science altogether. (shrink)

Preventive vaccination is one of the greatest successes of modern medicine. The SARS-CoV-2 epidemic, during which vaccination is the main method of prevention against death and severe disease, gave rise to a resurgence of anti-vaccine movements. The aim of this study was to analyse the attitudes of students towards vaccination and the COVID-19 pandemic. The statistical analysis was performed with the use of the following data-mining methods: correspondence analysis and basket analysis. The obtained results show that students of medicine are (...) characterized with the highest level of knowledge. Students of other medical faculties, on the other hand, have a significantly less uniform views, as do students of non-medical faculties. (shrink)

We propose 4 equity-advancing operational improvements to eligibility and sign-up processes at mass vaccination sites: (1) preregistration using existing information, (2) eligibility rules that recognize the greater burden of COVID-19 in underserved neighborhoods, (3) appointment assignment that prioritizes those with disadvantage, and (4) socioculturally informed outreach to lottery selectees.

America’s COVID-19 pandemic has both devastated and disparately harmed minority communities. How can the allocation of scarce treatments for COVID-19 and similar public health threats fairly and legally respond to these racial disparities? Some have proposed that members of racial groups who have been especially hard-hit by the pandemic should receive priority for scarce treatments. Others have worried that this prioritization misidentifies racial disparities as reflecting biological differences rather than structural racism, or that it will generate mistrust among groups who (...) have previously been harmed by medical research. Still others complain that such prioritization would be fundamentally unjust. I argue that, to pass muster under current law, policymaking in this area must recognize a crucial distinction: prioritizing minority communities, such as hard-hit neighborhoods, without regard to individual race is typically legal, but prioritizing individuals on the basis of their racial identity faces is likely not. I also explain how prioritization on the basis of Native American status is allowable and legally distinct from prioritization on the basis of individual race. -/- In Part II, I provide a brief overview of current and proposed COVID-19 treatments and identify documented or likely scarcities and disparities in access. In Part III, I argue that randomly allocating scarce medical interventions, as some propose, will not effectively address disparities: it both permits unnecessary deaths and concentrates those deaths among people who are more exposed to infection. In Part IV, I explain why using individual-level racial classifications in allocation is precluded by current Supreme Court precedent. Addressing disparities will require focusing on factors other than race, or potentially considering race at an aggregate rather than individual level. I also argue that policies prioritizing members of Native American tribes can succeed legally even where policies based on race would not. In Part V, I examine two complementary strategies to narrow racial disparities. One would prioritize individuals who live in disadvantaged geographic areas or work in hard-hit occupations, potentially alongside race-sensitive aggregate metrics like neighborhood segregation. These approaches, like the policies school districts adopted after the Supreme Court rejected individualized racial classifications in education, would narrow disparities without classifying individuals by race. The other strategy would address the starkly disparate racial impact of deaths early in life by limiting the use of age-based exclusions from vaccine or treatment access that explicitly deprioritize the prevention of early deaths and so disparately exclude minorities, and by considering policies that prioritize the prevention of early deaths. (shrink)

We argue that the ethical case for instituting vaccine benefit programs is justified by 2 widely recognized values: (1) reducing overall harm from COVID-19 and (2) protecting disadvantaged individuals. We then explain why they do not coerce, exploit, wrongfully distort decision-making, corrupt vaccination's moral significance, wrong those who have already been vaccinated, or destroy willingness to become vaccinated. However, their cost impacts and their effects on public perception of vaccines should be evaluated.

We argue that the universal recommendations against “off-label” pediatric use of approved COVID-19 issued by the FDA, CDC, and AAP are overbroad. Especially for higher-risk children, vaccination can be ethically justified even before FDA authorization or approval – and similar reasoning is relevant for even younger patients. Legal risks can also be managed, although the FDA, CDC, and Department of Health and Human Services (HHS) should move quickly to provide clarity.

Background: Health care practitioners are recognized to have a large influence in shaping uptake of vaccine in new borns, children, adolescents, as well as adults. Parents remain more secure in their decisions when health care practitioners communicate successfully with them about vaccine dangers and benefits, the value as well as necessity for vaccinations, as well as vaccine safety. Thus, immunization remain the foundation of the primary health care system, an indisputable human right as well as a global health and development (...) success story, saving millions of lives yearly. Recently, we have vaccines to prevent more than 20 life threatening diseases, helping people of all ages live longer, healthier lives. Yet despite tremendous progress, far too many people around the world, including nearly 20 million infants yearly have insufficient access to vaccines. In some countries, progress has stalled or even reversed, and there is a real risk that complacency will undermine past achievements. Purpose: The current study aimed to explores vaccine hesitancy, its barriers and impact studies regarding COVID-19 decision impacts. Also, to provides policy and decision makers and operational staff with evidence to inform decisions to promote vaccine uptake across Bayelsa State. Methods: A literature review tried to do a deep dive by using a variety of search engines such as Scopus, Research Gate, Mendeley, Summon, PubMed, Google Scholar, Hinari, Dimension, Academia, CAB Abstract, OARE Abstract, SSRN search strategy to retrieve research publications, “grey literature” and expert working group reports, including author’s field experience. Findings: Absence of uniform methods of organization in the various health care facilities upon which we were obliged to rely. Thus affecting the overall immunization programme and health system. Hence policy must urgently address these challenges with emphasis on policy clarity while continuously improving infrastructure. Conclusions: Bayelsa State is categorized as low/poor performing as the findings suggest that the involvement of community-based leaders can improve community participation and acceptance while enhancing and strengthening integrated disease surveillance and Adverse Events Following Immunization (AEFI) monitoring and reporting systems; and conducting integrated advocacy and communications activities to promote demand for vaccination as part of increasing overall demand and acceptability of all essential Primary Health Centers (PHC) services, thus, breaking barriers of vaccine hesitancy. (shrink)

While public health organizations can detect disease spread, few can monitor and respond to real-time misinformation. Misinformation risks the public’s health, the credibility of institutions, and the safety of experts and front-line workers. Big Data, and specifically publicly available media data, can play a significant role in understanding and responding to misinformation. The Public Good Projects uses supervised machine learning to aggregate and code millions of conversations relating to vaccines and the COVID-19 pandemic broadly, in real-time. Public health researchers supervise (...) this process daily, and provide insights to practitioners across a range of disciplines. Through this work, we have gleaned three lessons to address misinformation. Sources of vaccine misinformation are known; there is a need to operationalize learnings and engage the pro-vaccination majority in debunking vaccine-related misinformation. Existing systems can identify and track threats against health experts and institutions, which have been subject to unprecedented harassment. This supports their safety and helps prevent the further erosion of trust in public institutions. Responses to misinformation should draw from cross-sector crisis management best practices and address coordination gaps. Real-time monitoring and addressing misinformation should be a core function of public health, and public health should be a core use case for data scientists developing monitoring tools. The tools to accomplish these tasks are available; it remains up to us to prioritize them. (shrink)

This paper examines the case of Ebola, ça Suffit trial which was conducted in Guinea during Ebola Virus Disease (EVD) outbreak in 2015. I demonstrate that various non-epistemic considerations may legitimately influence the criteria for evaluating the efficacy and effectiveness of a candidate vaccine. Such non-epistemic considerations, which are social, ethical, and pragmatic, can be better placed and addressed in scientific research by appealing to non-epistemic values. I consider two significant features any newly developed vaccine should possess; (1) the duration (...) of immunity the vaccine provides; and (2) safety with respect to the side effects of the vaccine. Then, I argue that social and ethical values are relevant and desirable in setting the parameters for evaluating these two features of vaccines. The parameters that are employed for setting up the criteria for assessing the features might have far-reaching implications on the well-being of society in general, and the health conditions of several thousand people in particular. The reason is that these features can play a decisive role during the evaluation of the efficacy and effectiveness of the vaccine. I conclude by showing why it is necessary to reject the concept of epistemic priority, at least when scientists engage in policy-oriented research. (shrink)

In a recent article, Ethan Bradley and Mark Navin (2021) argue that vaccine refusal is not akin to free riding. Here, I defend one connection between vaccine refusal and free riding and suggest that, when viewed in conjunction with their other arguments, this might constitute a reason to mandate Covid-19 vaccination.

When considering the persuasive characteristics and prospective influences of Darwin‐skeptic mass media, uncertainties remain about how to reciprocally promote evolutionary theory to skeptical audiences. This study aims to improve evolution advocacy by translating some of the most successful methods of science endorsement to Evolution Wars contexts. In particular, strategies used to address vaccine hesitancies and enhance immunization uptake policies are reinterpreted for those seeking to improve pro‐evolution communications to religious publics. What results are three recommendation categories described as General Guiding (...) Principles, Proximate Interventions, and Auxiliary Interventions. (shrink)

Vaccination complacency occurs when perceived risks of vaccine-preventable diseases are sufficiently low so that vaccination is no longer perceived as a necessary precaution. Disease outbreaks can once again increase perceptions of risk, thereby decrease vaccine complacency, and in turn decrease vaccine hesitancy. It is not well understood, however, how change in perceived risk translates into change in vaccine hesitancy. -/- We advance the concept of vaccine propensity, which relates a change in willingness to vaccinate with a change in perceived risk (...) of infection—holding fixed other considerations such as vaccine confidence and convenience. (shrink)

As we face this unprecedented epidemic, researchers are racing to develop a cure and find ways to prevent more infections in the future. Yet, with so much uncertainty about the future of this virus, the current absence of an effective therapy,[i] and limited research on natural immunity to the disease through direct exposure,[ii] it seems the only certainty is that a vaccine could be a solution. Several laboratories across a multitude of countries have begun to develop a vaccine[iii] for SARS-CoV-2 (...) with anticipated public arrival as early as late 2020. However, a vaccine is not effective at the population level if only a few decide to receive it. Herd immunity is the phenomenon that occurs when a sufficient proportion of a population is immune to a virus. This decreases the amount and/or duration of pathogen shedding, thereby reducing the spread of a pathogen to susceptible individuals.[iv] Herd immunity is obtained most easily and safely through widespread vaccination, and it is essential to protecting the most vulnerable. This includes individuals of lower socioeconomic status who are more likely to have high-risk comorbidities, the immunocompromised, the elderly, and those with disabilities. The question then arises: should we consider mandating compulsory vaccinations for SARS-CoV-2? Is this the only way to ensure the virus does not return? The prospect of compulsory vaccinations has an arduous history in the United States dating back to the 1905 court case Jacobson v. Massachusetts when, in the face of the smallpox epidemic, Henning Jacobson refused vaccination, arguing that the law requiring all adults vaccinate or pay a fine was an infringement on his autonomy and “an assault on his person”[v].[vi] In the modern era, the conversation has largely shifted its focus toward childhood vaccinations. A combination of poorly conducted research,[vii] sensational media coverage, safety concerns, desire for additional education, and philosophical opinions about “natural” immunity have all been cited as reasons that people refuse to vaccinate.[viii] As a result, many parents have claimed exemptions to vaccinations, and consequently, outbreaks of preventable diseases such as measles have struck several communities across the country.[ix] Now, this is not to say that these fears are entirely unwarranted. Although most adverse reactions to vaccinations are quite mild, there are some known, extremely rare potential side effects to some common childhood vaccinations.[x] These, however, are frequently mitigated through proper medical screening and exemption. Furthermore, rigorous research on the efficacy and safety of the SARS-CoV-2 vaccine prior to FDA approval will help to prevent our most vulnerable populations from experiencing adverse effects. Government control over vaccine research and use of the National Vaccine Injury Compensation Program [xi] can ensure potential adverse outcomes are limited and properly addressed. Furthermore, educational resources and proper use of the media can help establish trust in concerned populations. The greater philosophical discussion of the value of personal autonomy in the U.S., however, is much more complicated. The case for autonomy may be summarized as the right to choose for oneself. Culturally and constitutionally, it is considered to be a fundamental right in the U.S., and Supreme Court Cases have ruled in favor of autonomy and the right to bodily integrity time and time again, as demonstrated in Roe v. Wade [xii] and Griswold v. Connecticut.[xiii] There is a basic philosophy of autonomy: any person with capacity and competence has the right to choose what they deem to be in their own best interests, and a right to protect their body from unwanted intrusion or harm. A competent patient cannot be forced to undergo surgery, nor can they be held against their will in the emergency room, nor forced to receive a blood transfusion if they are a Jehovah’s Witness. There is, however, a second part to this philosophy: an autonomous decision may not pose significant risk or harm to another person. Consequently, the case for personal autonomy and bodily integrity in the context of highly infectious diseases is weak. Unlike many other personal medical decisions, refusing to vaccinate is not a decision that affects the patient independently. Instead, it poses a threat to any community member who is unable to vaccinate for legitimate medical purposes. Moreover, I argue that a mandatory vaccination program does not significantly inhibit the autonomy of any normally healthy person, but rather it acts to protect those who are not already in good health. A compulsory vaccination program would serve as a viable public health effort to protect the most vulnerable groups. In the case of COVID-19, this includes those who are immunocompromised, diabetic, elderly, obese, or with chronic heart or lung disease.[xiv] Vaccination should therefore be considered a moral responsibility of the healthy. In essence, the argument for autonomy simply does not carry enough significance when weighed against community-level beneficence. This novel coronavirus also raises an entirely new dilemma not often faced with other infectious diseases – scarcity of resources. For those who become extremely ill, treating this disease requires invasive, expensive, and scarce medical resources. Many of the patients admitted to the hospital are placed on ventilators and their healthcare providers require copious amounts of personal protective equipment. As many states reach their projected peak of new cases, many hospitals continue to teeter on the edge of maximum capacity. Hospital ethics committees face the real possibility of deciding to withdraw or withhold care to preserve resources for those with a higher chance of survival.[xv] This has raised alarms for disability rights groups,[xvi] as should a purely utilitarian approach be applied to resource allocation, people with many cognitive and physical disabilities may be denied treatment despite the fact that it violates the American with Disabilities Act.[xvii] As we look toward the future of this pandemic, it is unclear if hospitals will face another spike of cases come autumn that will, once again, stretch resources and place many lives at risk. I argue that we have a moral duty to do what we can to prevent this ethical quandary from occurring as part of an effort to protect those with high-risk comorbidities and disabilities. These individuals deserve equal moral value under the utilitarian practices that guide triage decisions. This is most easily realized through a compulsory vaccination program for SARS-CoV-2. There is a caveat, however. Should a mandatory vaccination program be implemented, cost should not represent a limitation. This virus already disproportionately affects those of lower socioeconomic status.[xviii] Populations already at increased risk of contracting the virus should not be denied access to the vaccine due to cost. If vaccination becomes mandatory, these populations should not incur the burden of cost. For such a system to be considered just, the U.S. government must be willing to cover the cost of SARS-CoV-2 vaccination for everyone. We cannot be certain what the next several months will look like. This novel coronavirus may fade over the summer, or it may return in the fall, and we may experience another spike in cases. Nevertheless, in the absence of effective therapeutic measures, and assuming a vaccine becomes available, the risk of repeating our current situation is too high and we must consider mandatory vaccination as a real possibility. Personal liberty does not give one the right to endanger another person, and people have an individual right to be protected from others who may place them in danger. Even a culture that prides itself on individual choice and personal liberty should be willing to see the crucial need for such measures. It is thought that younger generations are unwilling to trust vaccines because they have not experienced outbreaks such as smallpox or polio, and therefore do not believe vaccines are an effective or necessary tool in preventing disease. Perhaps this pandemic will be the experience that motivates them to reconsider and reappreciate the role of vaccination in our lives. With that in mind, we can begin to ask again, is the ongoing pandemic the catalyst we needed for compulsory vaccinations to enter the forefront of health policy discourse? [i] “Therapeutic Options for COVID-19 Patients.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, March 21, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/therapeutic-options.html. [ii] Apoorva Mandavilli. “Can You Become Immune to the Coronavirus?” The New York Times, March 25, 2020. https://www.nytimes.com/2020/03/25/health/coronavirus-immunity-antibodies.html?auth=link-dismiss-goo gle1tap. [iii] Jeff Craven. “COVID-19 Vaccine Tracker.” Regulatory Affairs Professionals Society. Regulatory Focus, April 10, 2020. https://www.raps.org/news-and-articles/news-articles/2020/3/covid-19-vaccine-tracker. [iv] FE Andre, R Booy, HL Bock, J Clemens, SK Datta, TJ John, BW Lee, et al. “Vaccination greatly reduces disease, disability, death, and inequity worldwide.” Bulletin of the World Health Organization 86, no. 2 : 81-160. [v] DA Salmon, SP Teret, CR MacIntyre, D Salisbury, MA Burgess, and NA Halsey. “Compulsory vaccination and conscientious or philosophical exemptions: past, present, and future.” Lancet 367, no. 9508 : 436-42. [vi] Wendy K Mariner, George J Annas, and Leonard H Glantz. “Jacobson v Massachusetts: It's Not Your Great-Great-Grandfather's Public Health Law.” American Journal of Public Health 95, no. 4 : 581–90. https://doi.org/10.2105/AJPH.2004.055160. [vii] AJ Wakefield, SH Murch, A Anthony, J Linnell, DM Casson, M Malik, M Berelowitz, et al. “RETRACTED: Ileal-Lymphoid-Nodular Hyperplasia, Non-Specific Colitis, and Pervasive Developmental Disorder in Children.” The Lancet 351, no. 9103 : 637–41. https://doi.org/10.1016/s0140-673611096-0. [viii] Chephra McKee and Kristin Bohannon. “Exploring the Reasons Behind Parental Refusal of Vaccines” The Journal of Pediatric Pharmacology and Therapeutics 21, no. 2, : 104-109 [ix] “Measles Cases and Outbreaks.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, April 6, 2020. https://www.cdc.gov/measles/cases-outbreaks.html. [x] “Vaccines: Vac-Gen/Side Effects.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, April 2, 2020. https://www.cdc.gov/vaccines/vac-gen/side-effects.htm. [xi] “National Vaccine Injury Compensation Program.” Official web site of the U.S. Health Resources & Services Administration, January 7, 2020. https://www.hrsa.gov/vaccine-compensation/index.html. [xii] Roe v. Wade, 410 U.S. 113 [xiii] Griswold v. Connecticut, 381 U.S. 479 [xiv] Shikha Garg, Lindsay Kim, Michael Whitaker, Alissa O’Halloran, Charisse Cummings, Rachel Holstein, Mila Prill, et al. “Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019 – COVID-NET, 14 States, March 1-30, 2020” MMWR Morb Mortal Wkly Rep 69,. https://dx.doi.org/10.15585/mmwr.mm6915e3 [xv] Mike Baker, and Sheri Fink. “At the Top of the Covid-19 Curve, How Do Hospitals Decide Who Gets Treatment?” The New York Times, March 31, 2020. https://www.nytimes.com/2020/03/31/us/coronavirus-covid-triage-rationing-ventilators.html. [xvi] “Protect Rights of People with Disabilities During COVID-19.” Human Rights Watch, March 26, 2020. https://www.hrw.org/news/2020/03/26/protect-rights-people-disabilities-during-covid-19. [xvii] Amy Osteen. “Preventing Discrimination in the Treatment of COVID-19 Patients: The Illegality of Medical Rationing on the Basis of Disability.” Disability Rights Education & Defense Fund, April 2, 2020. https://dredf.org/the-illegality-of-medical-rationing-on-the-basis-of-disability/. [xviii] Max Fisher, and Emma Bubola. “As Coronavirus Deepens Inequality, Inequality Worsens Its Spread.” The New York Times, March 15, 2020. (shrink)

In this article, we propose the Fair Priority Model for COVID-19 vaccine distribution, and emphasize three fundamental values we believe should be considered when distributing a COVID-19 vaccine among countries: Benefiting people and limiting harm, prioritizing the disadvantaged, and equal moral concern for all individuals. The Priority Model addresses these values by focusing on mitigating three types of harms caused by COVID-19: death and permanent organ damage, indirect health consequences, such as health care system strain and stress, as well as (...) economic destruction. It proposes proceeding in three phases: the first addresses premature death, the second long-term health issues and economic harms, and the third aims to contain viral transmission fully and restore pre-pandemic activity. -/- To those who may deem an ethical framework irrelevant because of the belief that many countries will pursue "vaccine nationalism," we argue such a framework still has broad relevance. Reasonable national partiality would permit countries to focus on vaccine distribution within their borders up until the rate of transmission is below 1, at which point there would not be sufficient vaccine-preventable harm to justify retaining a vaccine. When a government reaches the limit of national partiality, it should release vaccines for other countries. -/- We also argue against two other recent proposals. Distributing a vaccine proportional to a country's population mistakenly assumes that equality requires treating differently situated countries identically. Prioritizing countries according to the number of front-line health care workers, the proportion of the population over 65, and the number of people with comorbidities within each country may exacerbate disadvantage and end up giving the vaccine in large part to wealthy nations. (shrink)

Some societies tolerate or encourage high levels of chickenpox infection among children to reduce rates of shingles among older adults. This tradeoff is unethical. The varicella zoster virus (VZV) causes both chickenpox and shingles. After people recover from chickenpox, VZV remains in their nerve cells. If their immune systems become unable to suppress the virus, they develop shingles. According to the Exogenous Boosting Hypothesis (EBH), a person’s ability to keep VZV suppressed can be ‘boosted’ through exposure to active chickenpox infections. (...) We argue that even if this hypothesis were true, immunization policies that discourage routine childhood varicella vaccination in order to prevent shingles for other people are unethical. Such policies harm children and treat them as mere means for the benefit of others, and are inconsistent with how parents should treat their children and physicians should treat their patients. These policies also seem incompatible with institutional transparency. (shrink)