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Slovenska pediatrija 2021; 28: 78-85

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Review article


Meta Rus
Univerzitetni klinični center Ljubljana, Ljubljana, Slovenija

Urh Grošelj
Klinični oddelek za endokrinologijo, diabetes in presnovne bolezni, Pediatrična klinika, Univerzitetni klinični center Ljubljana, Slovenija, Medicinska fakulteta, Univerza v Ljubljani, Ljubljana, Slovenija, Komisija Republike Slovenije za medicinsko etiko, Ministrstvo za zdravje, Ljubljana, Slovenija


In countries with well-established immunisation programmes, vaccination is the ‘victim of its own success’, because the low incidence of diseases prevented by vaccines has diminished the experience of their historical burdens and hence the obvious benefit of vaccination. The increasing number of parents who reject vaccination of their children already threatens or even effectively disables herd immunity level of the population and results in outbreaks of previously already controlled infectious diseases. We aimed to design a framework for ethical analysis of vaccination in childhood based on the four principles of biomedical ethics (respect for autonomy, non-maleficence, beneficence and justice) to provide a comprehensive and applicable model for addressing the ethical aspects of vaccination at both the individual and societal levels. The principle-based framework can be especially useful to paediatricians in primary care when looking for the best approach to the treatment of children of vaccine-hesitant parents. We suggest finding an ‘ethical equilibrium’, which means that the degree of respect for parents’ autonomy is not constant, but variable; it depends on the level of established herd immunity and it is specific for every society. When the moral obligation of individuals to contribute to herd immunity is not fulfilled, mandatory vaccination policies are ethically justified, because states bear the responsibility to protect herd immunity as a common good.

Key words: vaccination, ethics, children, principles of biomedical ethics, herd immunity, autonomy, common good, justice