Healthcare Assignment: Ethical Dilemmas Regarding Vaccination

Question

Task: For this healthcare assignment, you are required to prepare an essay on the topic “Healthcare professionals have an ethical responsibility to always advocate for the introduction of new treatments and technologies into healthcare”.

Answer

Introduction
The present healthcare assignmentshedslight on the role of vaccination has been immensely important in public health for eradicating several deadly infectious diseases like polio, smallpox, rubella, tetanus, and many more since the past century. According to Orenstein & Ahmed (2017), mass vaccination against these infectious diseases has not only toned down the spread of the diseases in the 21st century compared to the 20th, but it has also reduced substantial treatment costs. As per the authors, investments of $34 billion for 10 vaccines used in 94 developing nations have enabled them to save $586 billion related to treatment costs and $1.53 trillion when considering the broader perspective. However, vaccination or immunisation programs raise different moral and ethical issues that often become a source of debate when it comes to public health. In this context, this essay has used ethical arguments to contradict the assertion that restricting sovereignty, freedoms, and social processes based on a national vaccination program is ethically and morally unacceptable. For this purpose, this essay will briefly discuss the ethical issues regarding vaccination and use bioethical principles to justify the stance.

Ethical issues regarding vaccination
While vaccination has helped to improve public health across the world, there still are ethical issues involved with the process which are- making vaccinations mandatory, the safety of vaccines, informed consent from acceptors, and equal distribution of vaccines (Infectiousdiseases.edc.org, 2021). In this context, the World Health Organisation (2021) mentions that various countries have made vaccination against infectious pathogens compulsory, although not directly threatening by legal action but implying bans on activities like work, travel, and so on if a person denies getting vaccinated. Here, the WHO states that vaccination should not be made mandatory unless absolutely necessary and also, enough vaccines are available for easy access to individuals maintaining equity in distribution.

Further, there should be scientific data regarding the safety of the developed vaccines and these data should be publicised so that the citizens are informed adequately to make up their minds about undergoing vaccination.

Moreover, the vaccine's effectiveness should be evident and tested before administering to people and governments should assure the public with compensation schemes for any unfortunate outcomes related to vaccination. In addition, the WHO recommends public health organisations in countries consider the effect of mandatory immunisation on public trust and confidence. According to the WHO (2021), if vaccination policy threatens people's confidence and trust, it may negatively impact their adherence to the immunisation programs, thereby the main goal of ensuring public health safety will not be achieved. Therefore, as mentioned before, authorities should enable vaccinations mandatory only after ensuring the public about the availability, safety, and efficacy of the vaccines with published scientific evidence.

Bioethical principles and ethical theories applicable to vaccination programs
Due to the aforementioned ethical dilemmas regarding vaccination programs, it is necessary to adhere to an ethical framework to maintain ethics in the process. Campbell (2017) mentions that since the 1970s the idea of autonomy gained popularity in bioethics as a part of gathering informed consent. While Kant's proposed theories on autonomy shaped modern medical law, Beauchamp and Childress' created a strong ethical foundation in medical science. In this context, Beauchamp & Childress (2019) state that they proposed the framework of ethical principles consisting of 4 broad ethical rules to dissolve moral conundrums in medical science. These four rules are- autonomy, beneficence, non-maleficence, and justice.

The principle of autonomy emphasises respecting the decisions taken by a competent adult regarding his healthcare including vaccination. This concept gained ground due to severe unrest in the Western countries when people protested against racism and women claimed reproductive rights. Against this backdrop, the rights of patients in healthcare got attention from the public as well as medical authorities (Campbell, 2017). The importance of respecting autonomy or an individual's decision got further boost when researchers got accused of conducting human trials without obtaining informed consent from the participants.

The second principle of beneficence emphasises that the authorities or medical professionals act by maintaining the well-being of the patients or in the case of vaccination, the general public (Colgrove, 2019). Therefore, it can be defined as a moral responsibility of a clinician or medical authority to ensure that the patient's interest is maintained throughout the process of healthcare including vaccination, and he or she is not put at any undue risk.

In the context of avoiding undue risk, the third principle of non-maleficence was developed which has been of immense importance in medical science since the time of Hippocrates as he mentioned- "Primum non nocere" of "First do no harm" (Rus&Groselj, 2021, p.113). Therefore, according to this principle, it is important to weigh the benefits and adversities of the proposed intervention or vaccination and only vaccination is justified when the benefits outweigh the risks involved.

The final principle is that of justice which underscores that everyone is treated equally and fairly when administering treatments or vaccines (Rus&Groselj, 2021). Therefore, in public health justice ensures that resources like vaccines are allocated without any bias, and authorities, as well as clinicians, avoid any conflict of interest like suggesting an expensive vaccine instead of an equally effective lower-cost one when they have financial benefits in recommending the expensive vaccine.

The other mentionable ethical principles in this context are deontology and utilitarian theories. The deontological principle proposed by Kant emphasises respecting the patient's autonomy while the utilitarian principle considers the greater interest of the public and justifies the harms in the process if the outcome benefits the receiver (H Barrett et al. 2016).

Does the national vaccination program unethically and morally restrict the sovereignty, freedoms, and social process?
As mentioned earlier, countries develop national vaccination programs to safeguard public health against infectious diseases.

The National Immunisation Program (NIP) in Australia was developed in 1997 by the Commonwealth, state, and territorial governments in Australia to decrease the spread of diseases that are preventable by vaccination in the country (Department of Health, 2021). As per the NIP, free vaccines are provided to infants, children, teenagers, and older citizens along with people of all ages who are at heightened risk to be infected with certain diseases due to pre-existing medical conditions. When it comes to analysing if NIP violates sovereignty, it can be stated that as the NIP is developed in collaboration with individual territories and state governments, it does not hinder the sovereignty of the states. However, due to the sovereign power of the states, they can decide who are eligible for vaccines and at what point in time creating a contradiction with the justice principle of ethics as equal distribution is not always done (Ahmed, 2021). Nevertheless, the NIP promotes vaccination across Australia but does not interfere with individual's decisions about getting vaccinated. Therefore, the program respects the autonomy of the citizens as it is not made legally mandatory in Australia (Department of Health, 2021). On the other hand, the Australian Government is accused of promoting policies like 'No Jab, No Play' and 'No Jab, No Pay' to indirectly deprive unvaccinated citizens of socio-economic and healthcare benefits since 2015 despite the country having a high vaccination rate (Australian Human Rights Commission, 2019). However, these indirect policies to increase vaccination rate is done to guard all individuals against deadly diseases thereby following the rules of beneficence and non-maleficence as vaccines are given after proof is available regarding their safety and efficiency (Department of Health, 2021).

Further, the benefits of NIP can be seen as coverage of vaccination has been increasing since its introduction in the country. By 2018, 94.6% of children below the age of 5 were vaccinated against 17 diseases like polio, rubella, influenza, tetanus, pertussis, and others while the rate of vaccinated indigenous children was 95% (Department of Health, 2018). Also, the positive impact of vaccination can be reflected as the WHO declared Australia to be free from rubella due to their vaccination drives (World Health Organisation, 2018). Therefore, drawing the argument it can be said NIP secured public health in Australia without violating ethical principles, and the contradictions raised by 'No Jab, No Play' can be justified by the utilitarian principles as the program saved millions of Australians from deadly diseases. Rather, it can be said refusing to get vaccinated is unethical as it not only compromises individual health but also increases the chance of spreading infectious diseases in the community. According to Hussain et al. (2018) the rise in refusal of parents to vaccinate their children against the MMR (mumps, measles, and rubella) vaccine has caused outbreaks of measles in Western nations recently where the diseases were thought to be eliminated. The authors further claim that a 96% to 99% vaccination rate in a country is necessary to prevent diseases like measles as they are highly contagious. Moreover, D'ancona et al. (2019) mention that Italy made it necessary for children to be vaccinated to attain educational institutions after eruption of measles in 2017. While this law removed the hesitation against vaccination, it also prevented such outbreaks as the rate of vaccination increased. Therefore it can be said that developing national vaccination programs are absolutely justified for the benefit of society.

Conclusion
This essay has elaborated the bioethical principles of autonomy, beneficence, non-maleficence, and justice to analyse the ethical challenges faced during vaccination programs along with the deontological and utilitarian principles. Further, it has been found that vaccination is unethical if not distributed equally, administered without conducting research about safety and efficacy and taking informed consent. In this context, it has been found that the NIP in Australia does not violate the sovereignty, freedoms, and social processes of citizens. Rather the vaccination efforts have enabled the country to eliminate rubella. Similarly, it is seen refusal to vaccinate has a detrimental effect on public health. Therefore, these ethical arguments demonstrate that restricting sovereignty, freedoms, and social processes based on a national vaccination program is ethically and morally acceptable to achieve a greater good for society.

References
Ahmed, A.K. (2021). The Human Right to Vaccines: Preventing Discrimination Against the Unvaccinated. [online] retrieved 4 September 2021 from: https://www.hhrjournal.org/2021/02/the-human-right-to-vaccines-preventing-discrimination-against-the-unvaccinated/

Australian Human Rights Commission (2019).Vaccine Mandates: an unjustified assault on our human rights and freedoms. [online] retrieved 4 September 2021 from: https://humanrights.gov.au/sites/default/files/2020-09/sub_148_-_australian_vaccination-risks_network_inc.pdf

Barrett, D. H., Ortmann, L. W., Dawson, A., Saenz, C., Reis, A., & Bolan, G. (2016). Public Health Ethics: Cases Spanning the Globe. Springer International Publishing. [Retrieved from: https://www.researchgate.net/profile/Karin-Johansson-Blight/publication/322791713_Can_Asylum_Seeking_Be_'Managed'_Ethically'_in_ Public_Health_Ethics_Cases_Spanning_the_Globe_Editors_Drue_H_Barrett_CDCUS_ Gail_Bolan_CDCUS_Angus_Dawson_University_of_Sydney_Australia_Leonard_Ortmann_CD/links/5a705abea6fdcc33daa8b468/Can-Asylum-Seeking-Be-Managed-Ethically-in-Public-Health-Ethics-Cases-Spanning-the-Globe-Editors-Drue-H-Barrett-CDC-US-Gail-Bolan-CDC-US-Angus-Dawson-University-of-Sydney-Australia-Leonard-Ortmann.pdf]

Beauchamp, T., & Childress, J. (2019). Principles of biomedical ethics: marking its fortieth anniversary. The American Journal of Bioethics, 19(11), 9-12. https://doi.org/10.1080/15265161.2019.1665402

Campbell, L. (2017). Kant, autonomy and bioethics. Ethics, Medicine and Public Health, 3(3), 381-392. http://dx.doi.org/10.1016/j.jemep.2017.05.008

Colgrove, J. (2019). Immunization and ethics: Beneficence, coercion, public health, and the State.Healthcare assignmentThe Oxford Handbook of Public Health Ethics, 435. [Retrieved from: https://www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780190245191.001.0001/oxfordhb-9780190245191-e-38]

D’Ancona, F., D’Amario, C., Maraglino, F., Rezza, G., &Iannazzo, S. (2019). The law on compulsory vaccination in Italy: an update 2 years after the introduction. Eurosurveillance, 24(26), 1900371.https://doi.org/10.2807/1560-7917.ES.2019.24.26.1900371

Department of Health (2018).National Immunisation Strategy for Australia 2019–2024. [online] retrieved 4 September 2021 from: https://www.health.gov.au/sites/default/files/national-immunisation-strategy-for-australia-2019-2024_0.docx#:~:text=The%20Immunise%20Australia%20Program%20outlined,fully%20vaccinated%20(Figure%201).

Hussain, A., Ali, S., Ahmed, M., &Hussain, S. (2018). The Anti-vaccination Movement: A Regression in Modern Medicine. Cureus, 10(7), e2919.https://doi.org/10.7759/cureus.2919

Infectiousdiseases.edc.org (2021).Key Ethical Issues Related to Vaccinations. [online] retrieved 4 September 2021 from: http://infectiousdiseases.edc.org/sites/infectiousdiseases.edc.org/files/documents/ethical_issues_vaccinations.pdf

Orenstein, W. A., & Ahmed, R. (2017). Simply put: Vaccination saves lives. PNAS, 114(16), 4031-4033. https://doi.org/10.1073/pnas.1704507114

Rus, M., &Groselj, U. (2021). Ethics of Vaccination in Childhood—A Framework Based on the Four Principles of Biomedical Ethics. Vaccines, 9(2), 113.https://doi.org/10.3390/vaccines9020113

World Health Organisation (2018).Singapore wipes out measles; Australia, Brunei Darussalam and Macao SAR (China) eliminate rubella. [online] retrieved 4 september 2021 from: https://www.who.int/news/item/31-10-2018-singapore-wipes-out-measles-australia-brunei-darussalam-and-macao-sar-(china)-eliminate-rubella

World Health Organisation (2021).COVID-19 and mandatory vaccination: Ethical considerations and caveats. [online] retrieved 4 September 2021 from: https://apps.who.int/iris/rest/bitstreams/1342697/retrieve