摘要：Childhood immunization involves a balance between parents’ autonomy in deciding whether to immunize their children and the benefits to public health from mandating vaccines. Ethical concerns about pediatric vaccination span several public health domains, including those of policymakers, clinicians, and other professionals. In light of ongoing developments and debates, we discuss several key ethical issues concerning childhood immunization in the United States and describe how they affect policy development and clinical practice. We focus on ethical considerations pertaining to herd immunity as a community good, vaccine communication, dismissal of vaccine-refusing families from practice, and vaccine mandates. Clinicians and policymakers need to consider the nature and timing of vaccine-related discussions and invoke deliberative approaches to policymaking. Following the December 2014 measles outbreak at a popular amusement park in California, 1,2 which spread to other states, Canada, and Mexico, there has been increased attention to US childhood immunization practices. A recent study attributed the outbreak to underimmunization, 3 and several policymakers have called for an end to religious and philosophical (i.e., personal-belief) exemptions altogether, with the state of California passing legislation removing the option of personal-belief exemptions. 4,5 Political candidates have expressed various viewpoints on vaccination. 6 In light of these developments, we discuss several key ethical issues concerning childhood immunization in the United States and describe how they affect policy development and clinical practice. There are a myriad of ethical issues regarding such topics as vaccination development, administration, communication, and safety monitoring. We focus on a few key ethical issues concerning childhood immunization in the United States—what we refer to as a “vaccine ethics” approach—and describe how such an approach affects policy development and clinical immunization practice.
