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:

  1. Autonomy & liberty
  2. Promoting public health (utilitarianism)
  3. The harm principle: protecting the most vulnerable
  4. 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 will 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 are at genuine risk of vaccination as their body may be unable to respond to vaccines effectively to ward off infection

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 may be obtained from human embryos left over from IVF treatment – or sometimes especially created in the laboratory for clinical trials. Consent is required

 

Reason it is used

Drugs can be tested on human cells to investigate how they will behave in the human body

This would be better than using animal cells as eventually the drug could potentially be used to cure human 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