What is the responsibility of national government with respect to vaccination?☆
Introduction
All industrialised countries and more and more developing nations have well-working and effective national immunisation programmes [1]. Building such programmes where they are not yet in place and sustaining them is essential for promoting global health and protecting populations against dangerous infections. At the same time, vaccine development is an on-going process and more and more vaccinations are becoming available, which raises questions to what extent new vaccinations should be included in existing national programmes – especially given that, in many countries, state budgets are under pressure. Given the obvious ethical dimensions of immunisation [2], and threats to public trust in vaccination [3] clear criteria for adoption are necessary. The Health Council of the Netherlands developed such a framework of criteria in 2007 [4], [5], and has been using this as basis for advising the government of the Netherlands about vaccinations against cervical cancer, hepatitis B, influenza H1N1 (2009), and Q-fever [6], [7], [8], [9]. However, general criteria alone offer insufficient ground and direction for thinking about what the state ought to do. In this paper we outline two more basic ethical principles for national immunisation programmes that offer explanation why certain vaccinations are the state's moral-political responsibility, and that may further help guiding decision-making about the content and character of immunisation programmes.
Section snippets
Criteria for including vaccinations in the Netherlands’ national immunisation plan
The Netherlands have had a National Immunisation Programme since 1957. The programme is voluntary but, in general, participation rates are very high: 95% and more of all children complete their vaccination schedules [10]. In some protestant Christian communities it is more common to forego vaccination because people considered it as acting against divine providence and these regions have seen various outbreaks of vaccine preventable diseases, including measles (2008, 2013), rubella (2004–2005,
Responsibility for government: protecting public health and societal life
The first consideration is closely linked to one of the most basic tasks for government: to create conditions for societal life, which includes protecting people against threats within societal life (harmful behaviour) as well as protecting them against external threats. Such forms of protection are basic public goods that still fit with liberal political views that emphasise only a modest role for the state [15]. The spread of infectious diseases can have severe effects on communal life and
Responsibility for government: health justice and access to basic care
The second consideration guiding government's responsibility for public health is justice. In our previous work, we discussed this primarily as a principle for fair distribution, e.g. among subgroups, of the benefits of vaccination, and not so much as a principle that would guide choices as to why the state should offer certain vaccinations. However, in public health ethics – and notably the ethical literature on universal health insurance – justice is seen as argument par excellence for the
The inevitability of evaluations of severity of disease
Acknowledging these two principles for the state's responsibility to offer vaccination does not make assessments of the seriousness of infection and of related disease burden irrelevant. To the contrary, applying the principle of equal access to basic health care requires evaluative judgments about what vaccinations are indeed basic for maintaining health – and this involves evaluating the burden of disease or risk for individuals and populations. As we explained, finding reasonable consensus
Implications
We have argued that collective vaccination is not just a matter of protecting the public and societal life against threats of infection, but also of providing equal access to basic vaccinations. For vaccinations that aim to protect the population at large, it is undesirable that individual persons decide about vaccination solely on the basis of their individual risk and benefits, as this would overlook the population-level benefits at stake. Pro-active policies are necessary to attain
Conflicts of interests
None.
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Cited by (0)
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Submitted for the Vaccination Ethics Special Section in Vaccine (guest edited by A.M. Viens and Angus Dawson).