The ethics of vaccines

Lesson 7

The ethics in 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 offspring is considered an embryo during the period from approximately the second to the eighth week after fertilization. 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 

Atrial of a new drug in human test subjects. It is mandatory that all drugs undergo such trials to prove they are safe and effective before they can be legally used by doctors to treat patients.

Science understanding

Biological sciences

Describing how the requirements for life (for example oxygen, nutrients, water and removal of waste) are provided through the coordinated function of body systems such as the respiratory, circulatory, digestive, nervous and excretory systems.

Explaining how body systems work together to maintain a functioning body using models, flow diagrams or simulations.

Investigating the response of the body to changes as a result of the presence of micro-organisms.

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 often rely on technological advances and are often linked to scientific discoveries.

People use scientific knowledge to evaluate whether they accept claims, explanations or predictions, and advances in science can affect people’s lives, including generating 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 scientifically.

Analyse patterns and trends in data, including describing relationships between variables and identifying inconsistencies.

What is Ethics?

Ethics are moral principles that govern our behavior as individuals and as a society. 

Ethics is 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 some example of moral dilemmas (i.e. situations 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 core premise of this position is that liberty protects the ability of an individual to act in such a way as to take control of one’s own life, and act towards the realization of one’s goals and live out the values that are important to them.

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 as laws that ensure that individuals act in certain ways (eg. To get vaccinated, ‘no jab, no play’ type policies) interfere with the ability to decide for oneself how to live one’s life.

Promoting Public Health: Utilitarianism

Utilitarianism has a long ethical tradition and 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 the society at large.

The Harm Principle: Protecting the Most Vulnerable

Based on John Stuart Mill’s thinking, this approach argues that it is only possible 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 but seek protection anyway

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 (eg. Cancer), or the elderly, therefore vaccination is justified because it prevents harm to the most vulnerable

Preventing Harm to Individuals

People are able to opt out of public health measures if it is expected to cause harm or illness to themselves

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 not discernable risk to themselves or their children

Example
The immune-compromised are at genuine risk of vaccination as their body will be unable to respond the vaccine effectively to ward off other infections

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 different 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 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 it’s hard to listen when you’re being yelled at. Raise your words, not your voice.

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 trials

A double-blind trial means that neither the patients nor the researchers know 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 drug is truly effective.  This is because sometimes people can feel better just through taking a pill (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 drugs 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 often 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 disease in humans.

 

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 drugs are tested on healthy human volunteers during the clinical trial stage. Consent is required.

 

Reason it is used

Until the first human trials, scientists can not be sure if the drug will be harmful.

 

Ethical issues

In rare cases the drug that is being tested has led 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 high school children against Covid-19?

Children are known to be less likely than adults to be infected; serious illness is rare but does occur.

Children contribute less to community transmission and are less likely to transmit the virus; New variants may challenge this scenario.

Children frequently live with or visit people who are vulnerable (eg. Grandparents).

Children are less likely to be hospitalized and tend to have milder illness
The effects of ‘long Covid’ are as yet unknown on children.

Vaccinating children may help to keep schools open; children have lost learning opportunities through lockdowns, both academic and socialization (eg. Mental health).

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 (eg. Pfizer very infrequently causes myocarditis and pericarditis).

We don’t know how long the current vaccines last; booster shots may be needed. Uncontrolled global spread means more variants. 

As a class discuss:

Should we vaccinate children for their own direct benefit or as a tool to protect the adults in their world (teachers, grandparents etc)

Should we focus on sending doses elsewhere as part of a global form of protection to reduce variants rather than vaccinating children in Australia?

If we don’t know how long the vaccine lasts, should we focus on children or the wider adult population?

If we vaccinate secondary school students, should we focus on inner urban, suburban or regional areas in that order, or all at once?

Should we start with the secondary school children of ‘front line workers’ only (eg. those whose parents are hospital or aged care staff) or all at once?

 

Summary

Students have learned how to:

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.

The have heard about real situations where ethics are tested and have debated the ethics of trialing and testing vaccines.