The ethics of vaccination
Lesson 7
The ethics of developing and testing vaccines for use in public health
Learning outcomes & key terms
Students will:
Think critically about moral and ethical implications of vaccination, particularly allowing and refusal
Consider the relationship between individual rights and responsibilities and the common good of the community at large through the promotion of public health
Placebo
A substance that has no therapeutic effect used as a control in testing new drugs
Embryo
An unborn offspring in the process of development. A human baby is considered an embryo during the period from about the second to the eighth week after fertilisation – after that, it is considered a foetus
IVF
In vitro fertilisation, where fertilisation of a human egg by sperm occurs outside of the body
Human Clinical Trial
A trial of a new treatment in human test subjects – it is mandatory that all drugs and vaccines undergo such trials to prove they are safe and effective before they can be legally used by doctors to treat patients
Understanding science
Biological science
Describing how the requirements for life (for example oxygen, nutrients and water) are provided through the coordinated function of body systems – such as the respiratory, circulatory, digestive and nervous systems
Explaining how body systems work together to maintain a functioning body using models, analogies and flow diagrams
Investigating the response of the body to changes as a result of the presence of germs
Science as a human endeavour
Scientific understanding, including models and theories, is contestable and is refined over time through a process of review by the scientific community
Advances in scientific understanding may rely on technological advances and are often linked to scientific discoveries
People use scientific knowledge to evaluate whether they accept claims, explanations or predictions. Advances in science affect people’s lives and generate new career opportunities
Values and needs of contemporary society can influence the focus of scientific research
Science enquiry skills
Formulate questions or hypotheses that can be investigated or tested
Analysing patterns in data can explain relationships between variables and also identify inconsistencies
What are Ethics?
Ethics are moral principles that govern our behaviour as individuals and as a society
Ethics are concerned with what’s good and bad (our values), and right and wrong (our morals)
Read the definitions of values, morals and ethics here
Brief reflection and class discussion:
What values do you hold most dear?
Can you think of an example of a moral dilemma (i.e. where morals conflict with each other)?
Gain of function
The ethics of mutating a virus in a lab
Different ethical positions
There are a range of ethical positions that can be held for and against the use of vaccines – four common positions are:
- Autonomy & liberty
- Promoting public health (utilitarianism)
- The harm principle: protecting the most vulnerable
- Preventing harm to individuals
A brief explanation of each are on the following sections
It is important to note that these are not exhaustive explanations of these positions, just a brief introduction that will assist the teacher in the classroom
Autonomy & Liberty
The theory is that liberty protects the ability of an individual to take control of one’s own life, realise one’s own goals and live out their important values
Autonomy is the ability to make choices that consistent with those values and goals; to live our lives as we see fit
Example
Some see mandatory vaccination as an infringement upon their liberty and autonomy by laws that demand that individuals act in certain ways (e.g. to get vaccinated, ‘no jab, no play’ type policies) can interfere with the ability to decide for oneself how to live one’s life
Promoting Public Health: Utilitarianism
Utilitarianism is based on the assumption that an action is right when it produces the greatest good for the greatest number
There are two types of utilitarianism: act and rule
Act utilitarianism considers individual actions and determines which one of all the available options will have the best outcome to an individual
Rule utilitarianism asks which rule will have the best outcome for society if followed by everyone
Example
Public health interventions, like vaccination campaigns, are often justified by utilitarianism, especially rule utilitarianism, as these type of public health initiatives produce the greatest benefit to the greatest number of people in society
The Harm Principle: Protecting the Most Vulnerable
Based on John Stuart Mill’s thinking, this argues that it is only right to interfere with the liberty of an individual, against their will, if it is to prevent harm to others
We have a special obligation as a community to protect the most vulnerable and those who are unable to protect themselves from disease
Example
Herd immunity through vaccination can protect not just the vaccinated but those who cannot be vaccinated such as newborns, those who are immunocompromised by disease (e.g. cancer) or age; so vaccination is justified because it prevents harm to the vulnerable
Preventing Harm to Individuals
People are able to opt out of public health measures if these are expected to cause harm or illness
This principle is only relevant to the vaccination debate when the risk of harm is a genuine risk
Some use this position to avoid vaccination even if there is no discernable risk to themselves or their children
Example
The immune-compromised may be at risk from live, attenuated vaccines as their immune system may be unable to respond effectively, even though the live vaccine is attenuated
Class activity
Choose an ethical issue to present to the class (there are several)
The class will then discuss the values, morals/principles and purpose associated with the issue and how these might be different for various people
Repeat for the other ethical issues
Debate guidelines
Debating ethical issues can be a delicate matter and can evoke strong emotions
Here are some tips for the debate:
There are no right or wrong answers
There is no judgement – we all need to be respectful of each other’s opinions even if we don’t agree with them
It’s easy to get emotional about things that you feel strongly about, but getting emotional in a debate often will mean you’re not heard, because people won’t listen when they’re being yelled at
Remember, others don’t view the world through the same lens as you do – they see things differently. It doesn’t make their view any less valid than yours, just different and that’s OK.
Placebo controlled trial
A double-blind trial means that neither the patient nor the researcher knows who is getting placebo and who is getting the trial treatment
Reason it is used
A double blind placebo controlled trial is often the best way of telling whether the treatment is truly effective – this is because sometimes people can feel better just through taking a pill or injection (of any kind)
This is called the placebo effect
By giving some volunteers the placebo and some the real drug without anyone knowing what they are receiving, the effects can be measured without the psychology of the placebo effect involved
Ethical issue
The people taking part in the trial don’t know if they are taking the real medicine or the placebo. There are some who object to tricking people like this
As a class, discuss:
What is the purpose of the trial?
What values are important (i.e. what’s good or bad)?
What morals or principles are important (i.e. what’s right or wrong, based on those values)?
Animal testing
Drugs are tested on animals such as rabbits, dogs and mice before it reaches clinical trials. This is required by law in most countries
Reason it is used
Drugs are tested on animals before they care tested on humans in order to investigate the drug’s side-effects which could be potentially harmful to humans
Ethical issues
Many people think that animal testing is unethical as it infringes on the animals rights. It may lead to injury, harm and even death of the animal
As a class, discuss:
What is the purpose of the trial?
What values are important (i.e. what’s good or bad)?
What morals or principles are important (i.e. what’s right or wrong based on those values)?
Testing on human cells
Cells for pre-clinical trials are mostly obtained from cell cultures and some in the past were obtained from aborted human embryos – they usually are created in the laboratory for clinical trials
Reason it is used
Drugs can be tested on human cells to investigate how they will behave in the human body; also human cells may be effective in growing viruses
This is better than using animal cells as eventually the drug could potentially be used to cure human disease, or the vaccine developed could be used to prevent disease
Ethical issue
Using human embryos that would have potentially developed into a human being
Read this article
As a class, discuss:
What is the purpose of the trial?
What values are important (i.e. what’s good or bad)?
What morals or principles are important (i.e. what’s right or wrong, based on those values)?
Human trials
New treatments are tested on healthy, human volunteers during the clinical trial stage. Consent is required
Reason it is used
Until the first human trials, scientists cannot be sure if the drug will be harmful
Ethical issues
In rare cases the drug that is being tested may lead to healthy volunteers becoming seriously ill
As a class, discuss:
What is the purpose of human trials?
What values are important (i.e. what’s good or bad)?
What morals or principles are important (i.e. what’s right or wrong, based on those values)?
Re-visit Jenner’s work, and James Phipps’ role. Was what Jenner did ethical?
Should we vaccinate children against Covid-19?
Children are known to be less likely than adults to be infected; serious illness is rare but does occur
Children may contribute less to community transmission and are less likely to transmit the virus; new variants may challenge this scenario e.g. Omicron
Children frequently live with or visit people who are vulnerable (e.g. grandparents)
Children are less likely to be hospitalised and tend to have milder illness, unless they have a major medical problem, like Down syndrome or cerebral palsy. Rarely (1 in several 1,000) an inflammatory complication occurs. The effects of ‘long Covid’ are less on children
Vaccinating children may help to keep schools open; children have lost learning opportunities, socialisation and exercise through lockdowns
Sociologists have found that a quality education has a positive impact on other social indicators (health, wealth, longevity)
Protecting children also protects adults (teachers)
Known side-effects of Covid vaccines are rare but have occurred, mainly in boys and young men (e.g. mRNA vaccines infrequently causes heart inflammation, called myocarditis, and pericarditis) – but heart inflammation is much more likely after Covid disease
We don’t know how long the current vaccines last & booster shots may be needed. Ongoing global spread means more variants
As a class discuss:
Should we vaccinate children for their own direct benefit and as a tool to protect the adults in their world (teachers, grandparents)? Should we also focus on giving Covid vaccines to other countries to help them as part of a global approach to protection to reduce variants?
If we vaccinate school students, should we focus on higher risk children e.g. with chronic medical conditions?
Should we prioritise the school children of immunosuppressed parents and ‘front-line workers’ (e.g. those whose parents are hospital workers or aged-care staff) or all at once?
Summary
Students have learned how to:
Think critically about moral and ethical implications of vaccination
Consider the relationship between individual rights and responsibilities and the common good of the community through the promotion of public health
Deal with real situations where ethics are tested and have debated the ethics of trialing, testing and implementing vaccines
Quiz
1) Which of the following statements is the most correct?
a) Ethics are moral principles that govern our behaviour as individuals and as a society
b) Values teach us right from wrong
c) Values are moral principles that govern our behaviour as individuals and as a society
d) Ethics teach us right from wrong
2) Values are:
a) How much something is worth
b) The fundamental beliefs that form the foundation of someone’s ability to judge right from wrong
c) Morals
d) Not considered part of the decision to vaccinate
3) The assumption that an action is right when it produces the greatest good for the greatest number is called
a) Autonomy and liberty
b) Utilitarianism
c) The harm principle
d) Preventing harm to individuals
4) There is debate about the ethics of gain of function research because
a) The research involves animals
b) By artificially introducing functions to a virus to make it more virulent, it might become a danger to people and cause unintended harm
c) By artificially introducing functions to a virus to make it more virulent, it might help find a cure
d) All of the above