Experts are broadly agreed that flu vaccination can reduce the burden of flu for society in general. This could be particularly useful to older people who are at the highest risk of dying from flu but for whom current influenza vaccines offer least protection due to their waning immune system.
There is also strong consensus that serious adverse events associated with flu vaccines are very rare. But the risk of any intervention is never absolutely zero.
So should younger people be given immunisations in part to protect themselves but also to protect others – just as health professionals are offered flu vaccines to protect their vulnerable patients? Or is it simply unethical to use kids to protect others?
Dr Peter Schröder-Bäck, a philosopher at the Maastricht University Department of International Health, attempted to tackle these questions during a pre-conference session at the EUPHA European Public Health Conference in Glasgow.
The answer, it turns out, depends on how you approach the problem. To begin with, Schröder-Bäck said that just because something (in this case, vaccination) is useful or cost-effective does not justify its use: Just because we can doesn’t mean we should.
For doctors, the first port of call on ethical matters is often the Hippocratic Oath, whereby they promise not to harm their patient. Sound straightforward. But this, says Schröder-Bäck, is not an ideal approach because it implies that a doctor should look after the interests of their patient without regard for wider society or for other patients. It is, he said, just too simple to help solve complex problems.
Another way of looking at medical dilemmas is based on utilitarianism. This requires us to do the greatest possible good for the greatest possible number in order to ‘maximise aggregate happiness’. It is useful in that it takes on board all the costs and benefits of action (and inaction) but can be used to support almost anything because ‘The end justifies the means’.
At the opposite end of the philosophical spectrum is libertarianism. Viewing the flu vaccination question through this lens would make it impossible to immunise one group of people (in part) to protect another. For libertarians, it’s all about the individual. The idea that children should be ‘instruments’ of public health protection won’t wash with them. Nor, of course, does the idea of striving for herd immunity against measles in order to protect those too young or too sick to have a vaccine. This perspective is seen as somewhat uncaring.
A ‘social justice’ approach gives greater weight to protecting those who cannot protect themselves, says Schröder-Bäck. If protecting vulnerable groups is challenging, it may be legitimate to do so by recruiting healthy people to the cause.
None of these four theories is sufficient to solve the problem but a blend of approaches can offer some guidance, according to Schröder-Bäck. “There are many good reasons for offering an immunisation programme to children,” he said, provided all patients have genuine choice, efforts are made to retain public trust and engage health professionals, and the evidence supporting the decision is kept under close review.
