Public health: ethical issues
In Europe and other Western countries, death rates from infectious diseases have decreased over the past century. However, such diseases still account for over 10 per cent of deaths and around one in three general practitioner (GP) visits in the UK.
Surveillance and control
Information about rates of infection and the emergence of new diseases is crucial for planning public health interventions. Collecting information that does not reveal the identity of the person (anonymised data) is not seen as very intrusive. Non-anonymised data interferes more with a person’s privacy. When a serious outbreak emerges, it may be necessary for governments to introduce quite stringent, liberty-infringing policies to control its spread, for example by isolating those who are infected.
To assess and predict trends in infectious disease it is acceptable for anonymised data to be collected and used without consent, as long as any invasion of privacy is reduced as far as possible. It may be ethically justified to collect non-anonymised data about individuals without consent if this means that significant harm to others will be avoided.
Highly intrusive measures to control infectious diseases, such as quarantine and isolation, would only be justified where there is a real risk of harm to others that could be significantly reduced.
Outbreaks of infectious disease can have global implications. All cases of certain serious diseases such as SARS and new strains of influenza must be reported to the World Health Organization (WHO). However, different countries have different capacities for monitoring and reporting infectious disease.
Countries such as the UK should provide assistance to developing countries to enable effective surveillance of infectious disease.
Vaccination programmes protect individuals against infection and, in many cases, also bring about ‘population immunity’. If the number of people refusing vaccination rises, ‘population immunity’ may not be achieved, and this can increase the risk of outbreaks occurring. More directive policies, such as penalties for those who do not comply, may achieve higher levels of vaccine uptake.
Vaccination policies that go further than simply providing information and encouragement to take up the vaccine may be justified if they help reduce harm to others, and/or protect children and other vulnerable people. This would need to take account of the risks associated with the vaccination and the disease itself; the seriousness of the threat of disease to others; and whether a directive measure would be more effective than a voluntary one.
After weighing up the evidence and ethical considerations, we conclude that there is not sufficient justification in the UK for moving beyond the current voluntary system for routine childhood vaccinations.