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The Role of Public Health Ethics in Vaccine Decision Making: Insights from the Centers for Disease Control and Prevention

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Vaccinophobia and Vaccine Controversies of the 21st Century

Abstract

Despite the documented public health benefits of immunization, developed countries continue to face threats to public confidence in vaccines. Both vaccine refusal and the more common phenomenon of vaccine hesitancy need to be comprehensively addressed using the tools of science and risk communication. There has also been recognition of the need for greater transparency and acknowledgment of the role of values in vaccine decision making; the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) recently adopted a formal scientific evidence framework in which transparency and values of stakeholders play a central role. Going beyond the use of data, we here discuss the role of public health ethics in supporting vaccine decision making and in broader public discussion of vaccination. The population perspective of the public health ethics approach is contrasted with bioethics which traditionally champions the rights of the individual. The tools of public health ethics, including formal consultations and public engagement processes, can be incorporated into public policy deliberations around vaccines. CDC ethical expertise has added value to ACIP deliberations, most notably in setting policy weighing the risks and benefits of measles, mumps, rubella, and varicella vaccine. Ethicists from the CDC have also been engaged in high-profile public health emergency responses involving vaccination issues, including the 2009 H1N1 influenza pandemic. Just as economic analyses have strengthened discussions centered on scientific evidence in setting policy for vaccines, systematically considering ethics and values can add rigor to the process by which societal input about vaccines occurs. Greater transparency in clarifying the trade-offs made in vaccine decision making can expedite the process of achieving a social consensus on vaccine policy.

The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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Acknowledgments

We acknowledge Robert T. Chen of the CDC National Center for HIV/AIDS, Viral Hepatitis, STD and Tuberculosis Prevention and Walter Orenstein of the Emory University School of Medicine for their perspectives and expertise; Christy Cechman of the CDC Public Health Library and Information Center and Lindsay Kramer of the CDC Public Health Ethics Unit for bibliographic support; and Jane Gidudu of the CDC Office of Scientific Quality and Captain Drue Barrett of the CDC Public Health Ethics Unit for reviews of an earlier draft of this chapter.

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Authors and Affiliations

  1. Office of Scientific Integrity, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, D-74, Atlanta, GA, 30333, USA

    Leonard Ortmann Ph.D.

  2. Office of the Associate Director for Science, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, D-50, Atlanta, GA, 30333, USA

    John Iskander M.D., M.P.H.

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  1. Leonard Ortmann Ph.D.
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Correspondence to Leonard Ortmann Ph.D. .

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  1. , School of Medicine, Creighton University, North 30th Street,Suite 6814 601, Omaha, 68131, Nebraska, USA

    Archana Chatterjee

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Ortmann, L., Iskander, J. (2013). The Role of Public Health Ethics in Vaccine Decision Making: Insights from the Centers for Disease Control and Prevention. In: Chatterjee, A. (eds) Vaccinophobia and Vaccine Controversies of the 21st Century. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7438-8_15

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  • DOI: https://doi.org/10.1007/978-1-4614-7438-8_15

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