http://id.medscape.com/37494.rhtml?srcmp=id-051101
Ethics And Immunization Policy Choices Require Public Dialogue
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WESTPORT, CT (Reuters Health) May 07 - A thorough consideration of the
epidemiological, economic, and ethical dimensions of immunization policy options requires a broad public
dialogue, suggest essayists in the May issue of Pediatrics.
Eroding support for existing immunization practices, engendered by a lack of
widespread acquaintance with the morbidity and mortality of vaccine-preventable
disease and fostered by campaigns that overstate the dangers of vaccines, calls
for a systematic approach to evaluate immunization policy options, according to
Dr. Chris Feudtner and Dr. Edgar K. Marcuse from the University of Washington
in Seattle.
The authors propose a framework designed to promote a clearer understanding of
the underlying issues and inherent tradeoffs between policies mandating,
recommending, or merely offering particular vaccines. Choosing between the
policy alternatives - mandated, recommended, or elective - demands, they say,
an assignment of values to the possible outcomes and a close examination of the
tradeoffs.
To this end, they suggest that any immunization policy should include the
following objectives: minimize the deleterious consequences of the disease and the vaccine; optimize
personal liberty to choose or refuse vaccination; maximize the just
distribution of benefits and burdens across society; promote the duty of
families to protect their child and the long-term duty of society to protect
all children; and use limited health care resources wisely.
Unfortunately, the authors suggest, predicting outcomes and assigning values to
these outcomes is complicated, because surprisingly few data exist to build
evidence-based answers to many of the outcome questions.
Even with incomplete information, write the authors, "breaking down broad
tradeoffs between different categories of concerns into a comprehensible series
of smaller judgments clarifies our values and facilitates the dialogue about
how to think about and make these complex tradeoffs." It also promotes
"a discussion that is itself a fundamental task for a transparent
policy-making process."
"Without a broad public understanding [that] grows out of public debate,
our health policies will not have the sort of support needed to weather the
inevitable storms," Dr. Marcuse told Reuters Health. "A continuing
national discussion is necessary to sustain the consensus required to support
immunization policy and take full advantage of new vaccines' potential to
prevent disease and disability."
"A new, broader perspective is needed everywhere these issues are
considered," Dr. Marcuse concluded. "Public health policy is as
important to our nation as is national defense or foreign policy, but too often
left to experts."
Pediatrics 2001;107:1158-1164.
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