PoPulationand Public HealtH etHics

policy
the degree of infringement of rights; and it must be demonstrably justified
(scientific evidence should support that these measures are warranted). 4
The Oakes test exposes some of the scientific knowledge necessary to address
the conflict in ethical principles. More explicitly, in the case of mandatory
vaccination, I believe the following scientific questions pertaining to the
problem are particularly salient:
» Is the agent being vaccinated against highly infectious and likely to
spread to patients?
» Can the condition be spread in the asymptomatic phase?
» Are there high levels of morbidity and mortality associated with the
condition being vaccinated against?
» Is there a strong body of evidence for the benefits of the vaccine to
prevent disease in patients?
» Is there evidence that other mechanisms for controlling spread of
the disease do not work.
» Are there minimal harms associated with the vaccine?
» Are there mechanisms in place to provide compensation to individuals
who may be harmed by the vaccine?
The greater number of these questions that can be answered in the affirmative,
the more justifiable the infringements on civil liberties. Conversely, the
greater the numbers of negative answers, the less justifiable are the infringements.
Ultimately, societal values will dictate where along the spectrum of
affirmative and negative responses the decision to allow infringements of
liberty and permit mandatory vaccination is located.
Using this approach to examine the question of mandatory vaccination for influenza
demonstrates that such vaccination is justifiable, although with some
provisos. Influenza is moderately infectious and transmissible to patients and
influenza illness in the elderly can have serious sequelae. Vaccination is moderately
effective in preventing illness and, more importantly, vaccination of
5, 6
health care workers has been demonstrated to prevent illness in patients.
The most serious consequence of vaccination of health-care workers, the development
of Guillain-Barre syndrome, is extremely rare and estimated as a
one in one million risk. 7 Less restrictive measures, such as education programs
PoPulation anD Public HealtH etHics
120