Exploring Bioethics - NIH Office of Science Education - National ...

adopting vaccination policies that allow large numbers of citizens to opt outof vaccination, reinforce what’s at stake in resolving questions related to vaccinationpolicies. As a final assessment, students make recommendations fortheir state’s school vaccination policy, justifying their positions with scientificinformation and ethical considerations.1Learning ObjectivesStudents will• recognize the inherent tension between respecting an individual’s choicenot to be vaccinated and the need for widespread vaccination to ensurethe health of the entire community;• apply the ethical consideration of fairness to circumstances in whichindividuals who do not bear any potential burdens of vaccination stillbenefit from community immunity; and• describe under what circumstances, if any, students believe vaccinationshould be mandatory and what justifiable exceptions there might be.Major Concepts• Vaccines have greatly reduced the incidence of infectious diseases(including childhood transmissible diseases).• Everyone in the community is protected from outbreaks if a largepercentage of members of the community are vaccinated(community immunity).• This means that a small number of people can remain unvaccinatedwithout risking the community’s health overall. Even though they havenot themselves been vaccinated, they will directly benefit because ofcommunity immunity.• Once the number of people vaccinated falls below a certain threshold,the disease regains a foothold and all unvaccinated individuals in thecommunity are at higher risk of contracting the disease.• Public health policies must strive to balance the rights of individuals tomake their own choices with the needs of the larger community.• U.S. states permit different types of exemptions—medical, religious, andphilosophical (personal belief)—to their mandatory vaccination policies.However, they vary in how they enforce their policies and in how easy it isfor people to opt out.• Because of recent outbreaks of vaccine-preventable illnesses such asmeasles, people all over the country are debating how to handle citizens’requests to opt out in a way that respects the right of individuals to maketheir own choices, is fair, and protects the health of community members.NotePeople have many reasons for notbeing vaccinated—some betterthan others. Bioethicists sometimesrefer to people who choose not tobear any of the potential burdensof vaccination but who still benefitfrom community immunity as “freeriders.” Although this module doesnot use that term, it does raisefairness questions about gainingthe benefits of vaccination withoutbeing vaccinated.2345Assessment OutcomeStudents will apply key bioethical concepts to developing and justifying arecommendation for a state vaccination policy.Module 2 2-36