Bioethics goes beyond the ethical problems that arise in clinical practice concerning vaccination. It is conditioned both by teleological (aristotelian) ethics that has a good purpose orientation and by the ethical ethics (kantian) in which moral goodness is determined by the awareness of duty as a human being. According to the principle of opportunity we study what are the possibilities available that are more suitable to reach a purpose since the values and principles of Bioethics should be a useful tool for public health and, being that vaccinations are a part of it, in the decision-making.

problems in vaccinations

If ethics are social we cannot forget that their application is individual (the moral) and in this area there may well be more bioethical questions regarding vaccinations than possibly suspected, when considering two of their aspects already mentioned: clinical and health-based. Some of them may be the following (specifying the most relevant bioethical criterion or criteria but do not excluding the others and paying particular attention to health-based bioethics):

Is vaccine research preferentially made for diseases occurring in the developed world? Most relevant criteria: justice and opportunity. Is clinical safety guaranteed? Accepting there can never be zero risk. Most relevant criterion: Non maleficence. Is it viable to vaccinate only a small part of the population against meningococcal B? Most relevant criterion: Justice. Should young adults be vaccinated against the papiloma virus  to prevent one disease – cervical cancer – which they do not have but which they may transmit? Most relevant criterion: Beneficence. Should differences in vaccination coverage due to socioeconomic differences and different vaccine accessibility exist? Most relevant criteria. Justice and autonomy. Does being foreign have an impact on being less vaccinated against the human papilloma virus, as suggested by some studies? Most relevant criteria. Justice and beneficence. Is the market conditioned by the introduction of vaccines? Most relevant criteria: Justice and opportunity Is uncertainty appropriately managed? Most relevant criterion: Non maleficence. Is it ethical to incentivise vaccines chrematistically? Most relevant criteria: Justice and opportunity. Is a ministerial decision to block vaccine in pharmacies just? Most relevant criteria: Justice and opportunity. Is it ethical to intentionally not vaccinate a control group of children? (Some studies have tried to resolve this problem with a random assignation to the groups and offering the standard locally available treatment although we doubt that the procedure totally rules out the ethical dilemma). Most relevant criteria: Justice, opportunity and beneficence. Is it ethical to oblige children to be vaccinated when their parents reject it? Is it an ethical measure to make vaccination obligatory in order to be admitted to a school? Most relevant criterion: Autonomy. Are patients informed about the immune status of the professional caring for them? (particularly regarding vaccination against influenza. Have they been vaccinated against it or not?) Most relevant criteria: Autonomy and non maleficence. Should any effective vaccine (regardless of its efficacy and/or efficiency) be made universal to the susceptible population? Most relevant criterion: Opportunity. Is it better to vaccinate a few people rather than no one? Most relevant criteria: Opportunity and Justice. Gender expression, is it ethically acceptable to be able to receive a vaccination? Most relevant criteria: Justice and autonomy. Should healthcare professionals operate independently from pharmaceutical companies and consequently impact their opportunities to research and train? Most relevant criterion: Opportunity. This is by no mean an exhaustive list of all the bioethical questions and conflicts because, among other issues, we could also direct our attention to the bioethics of anti-vaccination: children who do not receive vaccinations are 35 times more likely to contract measles than those children whose parents did not reject the vaccines. Furthermore, the request that anti-vaccination parents be recorded in the medical record proposed by some paediatricians is also a bioethical conflict which affects not only the criteria already referred to but others such as confidentiality and privacy. Spinoza's criteria and guide to reason would have to be applied here, where someone would choose the better of 2 good things and the lesser of two evils.

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