Ethical Considerations In the Use of Evidence-Based Decision Making for Vaccine Policy

Background: Few medical interventions have proven as cost-effective as vaccination, however, it is not cost-free, especially when many newer vaccines are involved.  To weigh these costs in public health programs, officials often turn to evidence-based decision making, frequently in the form of quantitative cost-effectiveness analysis.  While this technique has been used widely to inform policy decisions regarding therapeutic interventions, it raises distinct ethical considerations when applied to preventive efforts like vaccination.  Prevention programs commonly operate on a population-wide basis, while therapies are administered to individuals.  From an ethical perspective, prevention thereby relies on the principle of rule-utilitarianism, which holds that actions should be directed toward achieving the optimal balance of benefit over harm, while therapies emphasize the principle of beneficence in directing aid to those known to be in need.  Predominant reliance on rule-utilitarianism risks offending societal norms that may place other values above it.  Such values include justice in allocating vaccine supplies, autonomy in permitting individuals to decline vaccination, and beneficence in directing resources to vulnerable groups such as children or the elderly.

Setting: Public health policy making agencies at both the federal and state levels.

Population: N/A

Project Description: Ethical implications and conflicts were analyzed in the use of evidence-based decision making techniques in vaccine policy planning and implementation.

Results/Lessons Learned: To successfully guide policymakers in planning and implementing vaccination efforts for specific populations, an approach is needed that considers unquantifiable ethical values in addition to quantifiable assessments of cost and effectiveness.  Such an approach should be systematic, transparent, and inclusive.  A template for conducting such analyses could include a graphical representation of competing ethical considerations in place of numerical indicators.