Elsevier

The Journal of Pediatrics

Volume 231, April 2021, Pages 10-16
The Journal of Pediatrics

Reflections on Ethics and Advocacy in Child Health
Global Ethical Considerations Regarding Mandatory Vaccination in Children

https://doi.org/10.1016/j.jpeds.2021.01.021Get rights and content
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Whether children should be vaccinated against coronavirus disease-2019 (COVID-19) (or other infectious diseases such as influenza) and whether some degree of coercion should be exercised by the state to ensure high uptake depends, among other things, on the safety and efficacy of the vaccine. For COVID-19, these factors are currently unknown for children, with unanswered questions also on children's role in the transmission of the virus, the extent to which the vaccine will decrease transmission, and the expected benefit (if any) to the child. Ultimately, deciding whether to recommend that children receive a novel vaccine for a disease that is not a major threat to them, or to mandate the vaccine, requires precise information on the risks, including disease severity and vaccine safety and effectiveness, a comparative evaluation of the alternatives, and the levels of coercion associated with each. However, the decision also requires balancing self-interest with duty to others, and liberty with usefulness. Separate to ensuring vaccine supply and access, we outline 3 requirements for mandatory vaccination from an ethical perspective: (1) whether the disease is a grave threat to the health of children and to public health, (2) positive comparative expected usefulness of mandatory vaccination, and (3) proportionate coercion. We also suggest that the case for mandatory vaccine in children may be strong in the case of influenza vaccination during the COVID-19 pandemic.

Abbreviations

COVID-19
Coronavirus disease-2019

Cited by (0)

J.S. is a Partner Investigator on an Australian Research Council Linkage award (LP190100841, Oct 2020-2023), which involves industry partnership from Illumina and does not personally receive any funds from Illumina. J.S.'s work was funded by the Wellcome Trust (WT104848 and WT203132), and UKRI/ AHRC Ethics Accelerator (AH/V013947/1). Through his involvement with the Murdoch Children’s Research Institute, J.S. also received funding from the Victorian State Government through the Operational Infrastructure Support (OIS) Program. A.G.'s work was funded by UKRI/AHRC (AH/V006819/1). M.D. was funded by a David Bickart Clinician Scientist fellowship at the University of Melbourne.