Ethical aspects of immunisation services in South Africa: implications for legislation and policy review
Date
2009-09-16T10:47:40Z
Authors
Ngcobo, Ntombenhle Judith
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Abstract
Immunisation is the most cost-effective public health intervention currently available.
However, immunisation raises ethical conflicts as it may be considered a public good
with little individual benefits. Considering the effectiveness of immunisation in controlling
vaccine preventable infections and the constant threat of outbreaks from conditions like
measles, refusal to participate in a universal immunisation programme is morally
questionable. This research analyses the ethical issues brought up by universal
immunisation in South Africa. It focuses on local practice and on selected risk benefit
issues.
The research method used is literature search with analysis in the form of critical
thinking and moral reasoning. The findings are that universal immunisation is ethically
defensible based on various ethical theories and principles. South Africa’s experience
with the 2003 -2005 measles outbreak points to a social contract for individuals to
immunise their children. The argument of taking personal risk for public good and the no
additional benefit argument once herd immunity is reached (presented by Dawson), are
refuted. Risk-benefit elements for each infectious condition and vaccine are continually
changing. This demands an ongoing assessment of risk-benefit issues for each vaccine
and targeted infections to ensure the use of vaccines with optimal safety levels that are
appropriate in South Africa.
Recommendations are made on immunisation policy and legislation aimed at improving
ethical practices of the immunisation service. Implementation of the recommendations
will help ensure an immunisation programme that is proactive in addressing associated
risks and should help eliminate litigation. The main recommendation of a legislated
Compensation System for those who suffer severe adverse events following
immunisation is directed at just distribution of benefits and burdens.
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Keywords
immunisation services, ethics, South Africa