A blog from the Centre for Research Ethics & Bioethics (CRB)

Tag: vaccination

Proceed carefully with vaccine against covid-19

Pharmaceutical companies want to quickly manufacture a vaccine against covid-19, with human testing and launch in the market as soon as possible. In a debate article, Jessica Nihlén Fahlquist at CRB warns of the risk of losing the larger risk perspective: “Tests on people and a potential premature mass vaccination entail risks. It is easy to forget about similar situations in the past,” she writes.

It may take time for side effects to appear. Unfortunately, it therefore also takes time to develop new safe vaccines. We need to develop a vaccine, but even with new vaccines, caution is needed.

The article is in Swedish. If you want to Google translate: Proceed carefully with vaccine against covid-19

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

We have a clinical perspective

Risks are not just about numbers

Jessica Nihlén FahlquistOn a daily basis, we are informed about risks. The media tell us that obesity increases the risk of cardiovascular diseases and that we can reduce the risk of Alzheimers by eating the right kind of food. We are confronted with the potential danger of nanoparticles and mobile phone radiation. Not to mention the never ending discussion about nuclear power. Some news are more serious than others, but we cannot avoid risk information as such.

In addition to the media, government agencies inform the public about risks. The Swedish National Food Agency encourages people to eat fish because of its potential to reduce the risk of cardiovascular disease. But we should also reduce the intake of wild-caught salmon and herring due to the health risks associated with mercury.

Contemporary society has been described as a risk society, simply put a society preoccupied with risks. We invest a great amount of our common resources in risk management and communication. Sometimes, it appears as though risks are communicated in a hasty way. As soon as a risk is “found,” it is assumed that the responsibility of the government and possibly of the media is to inform the public. It is not acknowledged that what is considered to be a risk is not always straightforward and value neutral.

Whereas experts define risk as probability multiplied by negative outcome and weigh risks against benefits, several studies have shown that lay people conceive of risk in a much more complex and nuanced way. According to the expert notion, a risk is acceptable if the benefits outweigh the risks. However, individual lay people include other factors, for example, whether risks and benefits are distributed fairly and whether the risk has been taken voluntarily or it is one person exposing another to the risk. Studies in risk perception have also been acknowledged by ethicists and philosophers, who point out that not only do factors like voluntariness and fairness de facto influence people’s notion of the acceptability of risk, but we should care about these values. They are normatively important.

These insights about risk as ethically relevant and value-laden should influence how risks are managed and communicated in society. One example is how government agencies view risks and benefits in the case of infant feeding. Breastfeeding is seen as the best option in terms of risks and benefits. Mothers are expected to breastfeed their babies if they want to do what is best for their baby. Scientific and value-laden statements are mixed in the information provided to new parents. Women, adoptive parents and male gay couples who cannot breastfeed are negatively affected by this message. Women who cannot breastfeed oftentimes feel guilty and think that they are harming their babies for life by not breastfeeding. This should be taken into account when communicating with parents-to-be and new parents. The relationship between government agencies and ordinary people is inevitably unequal and the former should take responsibility for the effects of risk communication.

Another example is the H1N1 virus and the Pandemrix vaccination program in Sweden in 2009. The government informed the public that the vaccine was completely safe and that everybody should get vaccinated for solidarity reasons. After some time, it turned out that a group of teenagers had their lives more or less destroyed because they got narcolepsy probably due to the vaccination. This deserves a thorough ethical discussion.

There are currently signs that some people now hesitate to have their children take part in the regular vaccination program, including protection against, for example, measles. The regular vaccines are much more tested and substantially safer than Pandemrix. The opposition against vaccines are generally based on misconceptions and deficient studies. However, instead of mocking “ignorant” people and thinking that it is possible to change the perception and attitude of anxious parents by informing more about numbers, the anxiety and the lacking trust should be taken seriously. A respectful dialogue is needed.

This does not mean that the opponents of vaccination have the same and as accurate information as proponents of vaccination, who have science on their side. However, risks are not just about numbers!

Read more:

Jessica Nihlén Fahlquist

We care about communication - the Ethics Blog


Vaccine prioritization and the new Japanese pandemic law (by Yusuke Inoue)

Yusuke InoueFor many years, balancing individual human rights against social benefits has been the standard theme for public health ethics. Here I would like to update you on a recent discussion in Japan.

Last month a new law was introduced in Japan. Originally the enactment was planned later, but it was speeded up because of the recent series of death cases from emerging bird flu in neighboring Asian countries. This new law is entitled,

  • Act in response to new flu strains and other diseases

Unlike existing laws, such as the Immunization Act and the Act on Infectious Diseases, this new law is clearly intended to empower national and areal authorities to take substantial action. For example, in order to,

  • “prevent the spread of a disease,”
  • “protect a citizen’s rights or health,” or
  • “avoid social and economic confusion,”

these authorities can close public spaces or meetings, take special actions to sustain infrastructures, and direct medical staff to treat patients. This law was mainly drafted by bureaucrats and passed lacking sufficient explanation and public debate on the draft.

Based on the act, a national plan for prioritizing vaccine has become a matter of discussion. There are more than one hundred million people living in Japan, and securing vaccine for them quickly has been regarded as difficult. Therefore, this topic can be understood as a matter of distributive justice, and various methods for achieving justice have been discussed.

According to the recent draft plan, medical and caring staff, public officers, and manpower to sustain infrastructure are included in the prioritized class. It is not surprising that the longer the discussion goes on, the more people insist that they should be included in this class. For example, food industry workers are also suggested to be added to the class. Until now the targeted population has already reached more than 20 million! There was a similar discussion during the A/H1N1 swine flu “pandemic” in 2009, and many groups argued that they should have priority getting immunized.

Discussion on vaccine allocation is not unique to Japan. Until now, various ways of rationing, such as utility-based or justice-based allocation, have been suggested, as recently summarized by Buccieri and Gaetz in Public Health Ethics.

The nature of virus complicates the problem. It is difficult to know the nature of each flu virus just after outbreak of the pandemic. At least we can say that the scientific validity of a vaccine rationing plan should be continually tested, and flexible and practical interpretation will be needed. Furthermore, whichever principle for rationing we chose, the principle has to be shared and understood by the society in order to be effective in a real situation. On this point, today’s planning concerning the “prioritized class” in Japan needs further transparency about the evidence of setting the class – for rational policy making.

I also consider that cooperation between northern and southern countries should be more in focus. We remember concerns shown by some southern countries that pandemic vaccine was mainly occupied by the developed countries, and it was difficult for them to secure vaccine for their own citizens. Some emerging flu viruses lead to fatal conditions in developing countries, but do not have so serious consequences in developed countries. Nevertheless, vaccine allocation has been independently coped with by many countries.

Considering the global context of pandemic flu, I think that rationing vaccine as a domestic matter cannot be morally justified from the “justice” or “utility” point of view.

We are not sure that a pandemic will come or what will it be like. Fickle viruses haunt our thinking and test core value of our civilized society and the way of justice.

Yusuke Inoue

We want to be just - the Ethics Blog