Ethical Issues Related to Childhood Vaccination Refusal

EthicalIssues Related to Childhood Vaccination Refusal

Itis without a doubt that vaccines have transformed medical care overthe years. Vaccines have been a critical topic in the field of modernscience for years now. These very products of science havefacilitated the eradication of diseases, which earlier on, claimedthe lives of many, majorly children. Because of their usage in modernscience, the reductions in the morbidities related to diseases whichcan be prevented through vaccinations are evident. Amid theadvantages that vaccines present to humans, their usage has been asubject matter for controversies. In fact, ethical concerns haveerupted in many parts of the world by some healthcare stakeholders,and the aftermath has been the refusal of the usage of the vaccinesby some members of the population. Individuals refuting the usage ofvaccines by their children present some views which they have stuckwith, and it is this issue which forms the basis of thispaper.Problem

Thehealthcare sector encounters a share of ethical issues particularlyin the instances where parents refuse to have their childrenvaccinated against diseases. The fears that are presented by theparents range from the perceptions that vaccination is related tooutcomes like autism and other adverse effects. Refusal to allowvaccination that is based on religious grounds is also evident. Thequestions that linger in the minds of the healthcare practitionersare quite a handful, and an example is what they ought to do next inthe event of parents’ refusal to vaccination, given that thechildren in question are minors and are not in a position to make adecision for, and by themselves. The other queries are whether theparents, in their refusal to vaccination, are acting in the of theirchildren’s best interests and whether the healthcare worker shouldproceed with treatment for the children who have not been vaccinatedprior.

Reviewof the Literature

Avast pool of literature exists regarding the topic of ethical issuesthat are related to refusal of childhood vaccination. Some of theliterature selected to understand the voice of scholars in the globalplatform is as follows.

Itis evident from this research that vaccines have significantlyreduced the adverse effects of vaccine-preventable diseases indeveloped countries as noted by Irene et al. (2016). The study wasaimed at understanding why some parents in Netherlands eitherquestioned or shunned the usage of vaccines on their children. Thisresearch employed the usage of online focus groups that were aimed atdiscussing the various reasons why parents refused vaccinationadministration to their children. This data collection method fromrandomly selected participants, who were drawn from the Netherlandsvaccinations database, was efficient because qualitative data wasidentified. The results indicated that parents refused childhoodvaccination because of some of the following reasons side effects,the immune system of the child, perceived disease risks, adverseexperience, vaccine efficacy, lifestyle and the environment on asocial perspective (Irene et al., 2016). The study outcome revealedthat the National Immunization Program in Netherlands was not quiteefficient in conveying information to the parents who were againstchildhood vaccination. Awareness of the fact that vaccination isrecommended though not mandatory ought to be done.

Personalautonomy is a critical ethical principal in the health sector andmost importantly, in the field of medicine. The alarming ethicalissue that looms, in the wake of exercising autonomy is theprotection of the larger population that becomes at risk. Despitetheir availability worldwide, vaccines continue to spark debates onthe appropriateness of the requirements of their usage. Theliterature by Alvin et al., (2016) revealed information concerningfive areas of programs associated with immunization that can beaddressed in the bid to mitigate conflict in the ethical principlesthat are involved in the development and implementation of vaccinerequirements. These are reviews of the existing mandates invaccination in the health sector, an increment in the usage ofnon-compulsory vaccine strategies, addressing the safety concerns,promotion of awareness of the risks of diseases that are preventableby vaccines and the promotion of herd immunity understanding. Thisstudy outcome revealed that the five areas mentioned earlier had thepotential of promoting acceptance of vaccination requirements.

Thestudy by Joan et al., (2011) revealed that a small group of parentsshunned the usage of vaccines because of matters related to theefficacy and safety of vaccines and whether immunization is animportant activity. This study drew input from the legal, ethical andclinical issues that were noted by three points of view of theparents’ refusal to have vaccines administered to their children.These are counseling of the physicians, decision making on theparents` perspectives and continuing relations between parents` andphysicians` after disagreements. At the end of the study, the authorsoffered recommendations for increasing the confidence levels in theimmunization activity. The recommendations were drawn from the needof the parents to understand that they are charged with theresponsibility of protecting their children. The recommendations wereas follows usage of full information in clear language, by thehealth practitioners in communicating with the parents. Policy makersidentifying compensation strategies if a child is harmed from vaccineusage is the other recommendation followed by the vast disseminationof immunization information. Educational programs offered to the CAMpractitioners about vaccines through professional, educational andregulatory institutions and the communication to parents, byphysicians, when their views on vaccinations are unsupported. This isbecause some users of the CAM have views that are parallel to theopinion of medical practitioners’, regarding childhood immunization(Lessin and Hackell, 2016). Finally, discontinuation of professionalservices to a patient can be done but must be in line the legal andethical requirements when severing the relationship.

Abalance ought to exist between the parents’ autonomy in making thedecision of having their children being immunized, as well as thebenefits of public health, from mandating vaccines (Kristin et al.,2016). The authors revealed that various ethical concerns aboutchildhood vaccination cut across some public health sector includingthe clinicians, other professionals, and policymakers. The authorsfocused on herd immunity as a public good, communication regardingvaccine usage, removal from the practice of those families thatrefuse vaccine usage and finally, mandates in vaccines. Theresearchers concluded on the need for having the policymakers and theclinicians to understand and consider the nature plus the timing ofdiscussions that are centered on the topic of vaccines.

Theauthors mentioned that policymaking approaches that are deliberativeought to be considered, and this would ensure that a limitation onthe inception of controversial policies occurs, an example being theschool requirement vaccine mandate. It is critical to note thatpolicy decisions in the US affects other regions worldwide, similarlyto the withdrawal of the rotavirus vaccine back in 1999 due tointussusception effects observed in infants and (Edwards and Hackell,2016). The ethical decision as mentioned above sparked challengeswhich arose in the rotavirus vaccine distribution particularly in thegrowing economies which had higher levels of morbidity. It is clearthat childhood immunization ethics is governed by the vaccinemandates, personal decisions of parents, and exemption that are inplace.

Identifyvarious contributions and roles the nurse holds in healthcare

Nurseshold contributions and functions that are critical for the deliveryof care to patients. The role of nursing has developed over time toaddress the rising settings of unmet healthcare conditions. Thehealthcare reform Act of 2010 gave nurses the ability to provide carein such a manner that they could play a significant role in promotingchange. As part of the roles that nurses undertake in healthcare isinnovations. Nurses support the access to care, and while doing so,they improve the quality of care while lowering its cost (Lathrop andHodnicki, 2014). Innovative models have been developed to facilitatethis role plus the presence of clinics that are led by nurses.

Nurses, apart from innovation, play a critical role in healthcareresearch by amassing evidence in the healthcare field of study.Nursing research has seen to it the collection of data that hasprovided a foundation for the prevention of disease and clinicalpractice (Canadian Nurses Association, 2013). The outcome is that animprovement in the patient health, given that patients are giveninsights on how to prevent and manage diseases upon their occurrence.

Nursesalso play a role in the redesigning of the nurses` education whichwould, in turn, have an impact in the administering of health care.The training that nurses acquire ought to have the capacity to offercompetence in caregiving and as a result, meet the demands of thepatients. The nursing training has seen the addition of concepts thattouch on quality, leadership, safety, research and evidence-basedpractice. The importance for the incorporation of the concepts asstated earlier is to ensure that continuous learning for the nursesis facilitated, which is critical given that they are responsible forthe care of other human beings (CNA, 2013).

Nursescontribute in the offering of primary care and as a result, diseaseswhether chronic or lifestyle can be managed. Special care offered bynurses as well as the general care ensures that patients in thecommunity appropriately and efficiently care for (CNA, 2013). Theincorporation of technology in the field of care, by nurses, haspromoted the effectiveness of care as mentioned earlier.

Nurses play a role in making sure that patients reach their healthgoals by the provision of practice that is evidence based. Coachingand motivational interviews techniques plus the guidelines that areprovided by nurses come in handy in this role (CNA, 2013). Compareand contrast selected healthcare policies

Healthcare policies constitute plans that are decision-based and areaimed at achieving a particular healthcare goal in the community.Different healthcare policies are present and are affected by certainfactors and are thus practiced differently in the global platform.The healthcare policy that is the basis for this discussion is onethat involves Tuberculosis vaccination. Insight on the policies thatare present regarding immunization of TB in the global perspective isas follows.

It is clear that Tuberculosis commonly abbreviated as TB, is acritical health concern given the morbidities and mortalities thatare attributed to it as noted by Zwerling et al., (2011). New casescontinue to be reported annually and given the global immigration,containing the disease is proving to be almost impossible for thehealthcare practitioners. The only vaccine that is known and which isnoted to prevent the disease is the Bacille Calmette-Guérin (BCG)vaccine (Zwerling et al., 2011). Given the fact that the BCG vaccinehas been existent since 1921 its controversial usage is present andis connoted to the presence sub-strain variation, efficacy of thevaccine, global practices and most importantly, policies that are inplace (Zwerling et al., 2011).

Countries,as noted by Zwerling et al., (2011), have developed variable BCGvaccination policies given the differences in efficacy of the vaccinein adults. Some countries like the UK, have for a long time now hadthe vaccination programs for BCG, others like the US only recommendthe vaccine for the groups that are either at high risk or is notemphasized countrywide. The vaccination policies vary by the dosage,the age that the vaccine can be administered to an individual and themode of administration (Zwerling et al., 2011). Immunization haschanged in countries over the years, and this shows possible evidencechanges, health policy transformation, public opinion, the incidenceof Tuberculosis, as well as HIV incidence. The variations in the BCGpolicies in countries prompt the need for conversancy with thepresent vaccination policies in BCG, the previous policies, and thechanges when looking at the adults who, during their childhood, hadthe BCG vaccination.

Adatabase was developed to facilitate the understanding of theinformation that portrays a country`s BCG immunization policy of thepast and present by navigating through the interactive map. Somerecommendations are in place concerning the BCG vaccination,especially in the highly endemic regions. As countries are showingtheir responses to the global recommendations that have beendeveloped, BCG vaccination policies changes regarding the HIV oughtto be noted in the future Atlas updates (Zwerling et al.,2011).Examineethical issues and decisions faced in healthcare

Ethicalissues are noted to impact healthcare in some ways. The dilemmas aremostly felt by the health care practitioners who offer direct care tothe patients. These dilemmas may be as follows:

Thesubject of acquiring informed consent that is practical is oftenmarred with an ethical dilemma. The dilemma comes in when addressingthe point of personal autonomy. In such a case, a nurse may be lostwhen it comes to making a choice between caring for a patient whowishes to exercise autonomy, a decision that may have troublingeffects e.g. refusals to acquire mandatory vaccines.

Theother ethical issue comes in when disagreements occur between patientand healthcare professionals regarding the care option that is to beprovided. In such differences, the patient`s family may be pushingfor a decision which the healthcare practitioners find to beunacceptable e.g. parent refusal to childhood vaccination.

Theother ethical issue revolves around a patient being a participant inresearch. This may happen when a vaccine research is carried out in ahealthcare setting. This dilemma becomes worse when a patient inquestion did not acquire proper guidance as to whether he/she wishedto be in the “guinea pig” situation.

Evaluatevarious global healthcare delivery systems

Healthcaresystems that are high performing are very critical in addressing thechallenges in healthcare that may be available. In fact, both thegovernments and health systems in the global platform are identifyingways of improving health care outcomes while reducing costs. Over thepast decade, as mentioned by Kim,Farmer, and Porter (2013), there has been an increment in the numberof initiatives aimed at attending to the needs of the underprivilegedand ill population. Thereis the interest that is growing rapidly regarding the topic ofintegrating the global healthcare delivery system. Healthcaredelivery seeks to provide people with services that are therapeuticand which are proven to exist. This kind of service provision isavailable in the local perspectives as well as inclusive efforts toprovide access to care to the reach of all population types isavailable. The current global health is characterized by innovationsthat are aimed at improving the delivery of care in the countries.

Thegoal of the world health system is the provision of services thatpromote access to care. With that notion in mind, gaining access tocare is critical for the acute health needs, healthcare planners havean obligation to address any existing disparities in access tovaccines, and to cater for the afflictions of both the old and newperspectives. The Alma-Ata Declaration back in 1978 addresses theneed for looking beyond the access to a fixed set or minimum packageof services. Focus ought to be emphasized in the delivery value topatients that can be assessed by the health outcome per the amountspent in whatever global currency. A strategic global healthcaredelivery ought to be in place which will move from the fragmentationof services that is evident and shift towards the integrated serviceprovision. Patient circumstances must be understood by the globalhealth practitioners, a topic which is brushed off in some regions inthe world stage. The global health organizations will have to movefrom evaluating the efficacy of interventions employed but ratherfocus on the assessment of the outcomes.

ProgramLevel Student Learning Outcomes

Ethicalissues that are presented to the healthcare practitioners form thebasis of the third learning outcome. The refusal of parents for theindulgent of their children in vaccination activities creates anethical roadblock for the healthcare workers. It is critical to notethat the best interest of the patient ought to be emphasized at alltimes. When a healthcare worker heeds to the parents’ refusal fornot vaccinating their children, various dilemmas ensue and are notedbelow. Are the healthcare workers taking charge of the best interestof the patient? Is it to try changing the minds of the parentsconcerning the importance of vaccination? Is it in order (ethicalperspectives) to deny treatment to a patient whose parents rejectedthe vaccination option? Answers to the above queries require goingback to the drawing board, to rest the case in the field of ethicsand healthcare by heeding to the recommendations presented above aswell as looking at other options.


Itis evident from the above findings that ethical issues surround thehealthcare industry. Among the many ethical issues present in thehealth sector, issues regarding childhood vaccination are among thetop of the list. The meaning of the above is that there is a long wayto go when it comes to ethics in the healthcare sector.Transformations regarding healthcare practitioners training, publicawareness, health policies and mandates concerning vaccinations, forinstance, have to take place to reduce the ethical dilemma cases inthe immunization activities.


Alvin,N. et al. (2016). Ethical Issues Concerning Vaccination Requirements.PublicHealth Reviews, 34(1). Retrieved from

CanadianNurses Association. (2013). Registered Nurses: Stepping up toTransform Healthcare. Retrieved October 03, 2016, from

Edwards,K., and Hackell, J. (2016). Committee on Infectious Diseases, &ampCommittee on Practice and Ambulatory Medicine. Countering vaccinehesitancy.Pediatrics,e20162146.

Irene,A. et al. (2013). Why parents refuse childhood vaccination: aqualitative study using online focus groups.BMCPublic Health, 13 (1183). Retrieved from

Joan,G. et al. (2011). Childhood Immunization: When Physicians and ParentsDisagree.€American Academy of Pediatrics, 128(4). Retrieved from

Kim,J. Y., Farmer, P., &amp Porter, M. E. (2013). Redefining globalhealth-care delivery. TheLancet,382(9897),1060-1069. RetrievedOctober 03, 2016, from

Kristin,S. et al. (2016). Ethics and Childhood Vaccination Policy in theUnited States.€American Journal of Public Health, 106(2): 273-278. Retrieved from, B., &ampHodnicki, D. R. (2014). The affordable care act: primary care and thedoctor of the nursing practice nurse. OJIN: The Online Journal ofIssues in Nursing, 19(2). Retrieved from

Lessin,H. and Hackell, J. (2016). Real world vaccine ethics. The Journal ofpediatrics

Zwerling,A., Behr, M. A., Verma, A., Brewer, T. F., Menzies, D., &amp Pai, M.(2011). The BCG World Atlas: a database of global BCG vaccinationpolicies and practices. PLoS Med, 8(3), e1001012.