From an epidemiological perspective, the practice of universal vaccination of girls and young women in order to prevent human papilloma virus (HPV) infection and potential development of cervical cancer is widely accepted even though it may lead to the neglect of other preventive strategies against cervical cancer.

We thank Leo Lam and Taylor Nichols for their response1 to our paper ‘COVID-19 vaccine boosters for young adults: a risk–benefit assessment and ethical analysis of mandate policies at universities’.2 In our paper, we demonstrate that the risk–benefit calculus to mandate boosters for young adults aged 18–29 is a net risk intervention. The authors assert that we have made three inappropriate comparisons of benefits versus risks of the mRNA vaccine booster dose in this age group. We provide our response to (...) each below. We erred on the side of overestimating benefits of the booster dose against severe COVID-19 in this age group and still found net harms to outweigh net benefits. The conclusion of our paper holds, and university booster mandates for young people were—and remain—unethical. For the first comparison, we weighed predicted hospitalisations prevented by one booster dose of BNT162b2 with vaccine-associated SAEs from the manufacturer’s randomised trial (3/5055).3 We found that the rate of expected SAEs would outweigh the benefits of the booster against hospitalisation by at least 18-fold. Lam and Nichols suggest that this was an inappropriate comparison, as not all SAEs result in hospitalisation. However, the definition of SAE as used in the trial included death, hospitalisation, disability, permanent damage, life-threatening event or condition, which required medical or surgical intervention to prevent a serious outcome.4 While all comparisons include some degree of incommensurability, comparing these SAEs with hospitalisations prevented by the booster is more reasonable than Lam and Nichols’ suggestion of comparing SAEs to infections prevented. The COVID-19 infection hospitalisation risk in this age group was <0.5% (or <1/200)5 even prior to widespread immunity, thus comparing SAEs to infection risk is entirely inappropriate. Furthermore, a booster dose will only offer transient (if any) protection against infection6 and cumulative infection rates …. (shrink)

In 2022, students at North American universities with third-dose COVID-19 vaccine mandates risk disenrolment if unvaccinated. To assess the appropriateness of booster mandates in this age group, we combine empirical risk-benefit assessment and ethical analysis. To prevent one COVID-19 hospitalisation over a 6-month period, we estimate that 31 207–42 836 young adults aged 18–29 years must receive a third mRNA vaccine. Booster mandates in young adults are expected to cause a net harm: per COVID-19 hospitalisation prevented, we anticipate at least (...) 18.5 serious adverse events from mRNA vaccines, including 1.5–4.6 booster-associated myopericarditis cases in males (typically requiring hospitalisation). We also anticipate 1430–4626 cases of grade ≥3 reactogenicity interfering with daily activities (although typically not requiring hospitalisation). University booster mandates are unethical because they: (1) are not based on an updated (Omicron era) stratified risk-benefit assessment for this age group; (2) may result in a net harm to healthy young adults; (3) are not proportionate: expected harms are not outweighed by public health benefits given modest and transient effectiveness of vaccines against transmission; (4) violate the reciprocity principle because serious vaccine-related harms are not reliably compensated due to gaps in vaccine injury schemes; and (5) may result in wider social harms. We consider counterarguments including efforts to increase safety on campus but find these are fraught with limitations and little scientific support. Finally, we discuss the policy relevance of our analysis for primary series COVID-19 vaccine mandates. (shrink)

Mass vaccination has been a successful public health strategy for many contagious diseases. The immunity of the vaccinated also protects others who cannot be safely or effectively vaccinated—including infants and the immunosuppressed. When vaccination rates fall, diseases like measles can rapidly resurge in a population. Those who cannot be vaccinated for medical reasons are at the highest risk of severe disease and death. They thus may bear the burden of others' freedom to opt out of vaccination. It (...) is often asked whether it is legitimate for states to adopt and enforce mandatory universal vaccination. Yet this neglects a related question: are those who opt out, where it is permitted, morally responsible when others are harmed or die as a result of their decision? In this article, we argue that individuals who opt out of vaccination are morally responsible for resultant harms to others. Using measles as our main example, we demonstrate the ways in which opting out of vaccination can result in a significant risk of harm and death to others, especially infants and the immunosuppressed. We argue that imposing these risks without good justification is blameworthy and examine ways of reaching a coherent understanding of individual moral responsibility for harms in the context of the collective action required for disease transmission. Finally, we consider several objections to this view, provide counterarguments and suggest morally permissible alternatives to mandatory universal vaccination including controlled infection, self-imposed social isolation and financial penalties for refusal to vaccinate. (shrink)

Vaccination policy is an ethically challenging domain of public policy. It is a matter of collective importance that reaches into the most private sphere of citizens and unavoidably conflicts with individual-based ethics. Policy makers need to walk a tight rope in order to complement utilitarian public health values with individual autonomy rights, protection of privacy, non-discrimination and protection of the worst-off. Whether vaccination is voluntary or compulsory, universal or targeted, every option faces complex ethical hurdles because of (...) the interdependence of humans in infectious disease matters. In this article, we explore the following three policy questions. (i) Ethically, which policy measures should be addressed when vaccination coverage is insufficient in a population? Information campaigns, legal compulsion, or the use of financial incentives can all be effective, but also controversial policy options. (ii) Is it ethical to target vaccination programs at certain risk-groups? If such measures are necessary, we argue that policymakers will often have to decide which is more important to uphold: non-discrimination or the protection of privacy. And (iii), what is the ethical significance of adverse herd immunity effects? Some vaccination programs will improve average population health, but will at the same time increase the risk of severe morbidity and mortality for individuals in the worst-off groups of society. (shrink)

Trial participation in the proposed HIV Vaccine Trials in South Africa is discussed in the context of the ethical tension that exists between international ethical research standards and local standards of care and cultural norms in the Third World. The important concepts of informed consent, risk-benefit ratio and fair treatment of trial participants are interpreted differently in traditional, rural African communities, where a moderate form of communitarianism referred to as "Ubuntu" or "communalism" is still prevalent. Research is an altruistic endeavor (...) that benefits communities and societies as a result of risks taken by individuals. Universal ethical guidelines that are highly individualistic and fail to emphasize communalism may represent serious problems for the sort of research needed in Africa today. (shrink)

In order to fully understand the ethical, cultural, and political debate that moves around the papillomavirus vaccine, a bit of attention has to be paid to its history.In 2006 the first advertisements for Gardasil, the commercial name of the vaccine, started to appear in the United States. Merck pharmaceutical was the main dealer. Their “One Less” campaign was characterized by adolescent girls staring into the camera and saying, “I’m one less,” declaring their intention to be vaccinated against the human papillomavirus, (...) and to be one less victim of cervical cancer; all it would take was three injections over six months. A few months after the appearance of the advertisement, the HPV matter took another turn when Texas Governor Rick Perry decided to issue an executive order mandating vaccination of all sixth-grade girls in the state. Texas, a state with a conservative political culture and well-organized anti-vaccination movement, bypassed the legislature, overturned Perry’s order .. (shrink)

This Article examines whether policies—sometimes termed “vaccine mandates” or “vaccine requirements”— that consider vaccination status as a condition of employment, receipt of goods and services, or educational or other activity for participation are legally permitted, and whether such policies may even sometimes be legally required. It does so with particular reference to COVID-19 vaccines. -/- Part I explains the legality of private actors, such as employers or private universities, considering vaccination status, and concludes that such consideration is almost (...) always legally permissible unless foreclosed by specific state legislation. Part II examines the consideration of vaccination status by state or federal policy. It concludes that such consideration is similarly allowed at the state level unless expressly foreclosed, and is allowed at the federal level if appropriately supported by federal regulatory authority. Part III examines what may be a future front in these debates: whether policies considering vaccination status may be required rather than merely permitted, just as some courts have found that mask requirements may be federally required in certain circumstances. (shrink)

What does vaccine justice require at the domestic and global levels? In this essay, using the COVID-19 pandemic as a backdrop, we argue that deliberative-democratic participation is needed to answer this question. To be effective on the ground, abstract principles of vaccine justice need to be further specified through policy. Any vaccination strategy needs to find ways to prioritize conflicting moral claims to vaccine allocation, clarify the grounds on which low-risk people are being asked to vaccinate, and reach a (...) balance between special duties toward countrymen and universal duties toward foreigners. Reasonable moral disagreement on these questions is bound to exist in any community. But such disagreement threatens to undermine vaccine justice insofar as the chosen vaccination strategy (and its proposed specification of vaccine justice) lacks public justification. Inclusive democratic deliberation about vaccine justice is a good mechanism for tackling such moral disagreement. By allowing residents and citizens to participate in the specification of abstract principles of vaccine justice, and their translation into policy, democratic deliberation can enhance the legitimacy of any vaccination strategy and boost compliance with it. (shrink)

Human Papilloma Virus (HPV) infection causes death of 270,000 people die from every year. Sexually transmitted HPV was found one of the major causes of cervical cancer. World Health Organization (WHO). Cervical cancer (CC) is one of the top five cancers that affect women around the world. In June 2006, the Food and Drug Administration (FDA) approved a new vaccine for women, Gardasil, produced by the pharmaceutical company Merck that protects against infection by certain strains of HPV, including the two (...) strains that cause most cases of cervical cancer. Vaccinations are counted as one of public health’s important development but there is an ethical dilemma between balancing personal autonomy and protection of the entire at risk population. The vaccine caused very few side effects like local reactions whereas signs or symptoms of greater importance were very. Moreover it was considered that the vaccine is has an efficacy of practically 100% in prevention of precancerous lesion caused by the viral genotypes included in the vaccine. Bioethicists were not convinced about compulsory vaccination laws as the values of patient autonomy and informed consent to be preeminent to them. Not surprisingly, some have expressed wariness about or opposition to mandating HPV vaccination. A critical question is whether achieving a higher level of coverage justifies the infringement on parental autonomy that compulsory vaccination inevitably entails. Recommendation of the universal vaccination of girls and young women may evolve ethical challenges which might make it difficult for smooth implementation of the vaccination campaigns. Review of the ethical issues in HPV vaccination will constitute the main part of our paper. (shrink)

The Faculty of Medicine and Health Sciences of the University of Sherbrooke has observed year after year, that certain students have not started and or completed their immunizations for common infectious diseases, which in effect makes them inadmissible for their clinical internships in healthcare establishments. The program administrators have posed a series of questions on the best way to proceed with these students as, a certain number remain reluctant to vaccination. They are often confronted with ethical dilemmas, are not (...) necessarily comfortable with their rights and responsibilities and wish to be guided throughout the process. This article aims to put forth a procedure that would be put in place to support the administrators in a way for them to obtain a more favorable vaccination level for all of their students in the most reasonable amount of time possible. The interest of the procedure is to move forward in a few simple and well defined steps that are supported by a rigorous legal framework, while respecting the rights and freedoms of the students. It is also designed so that it could be replicated in other faculties of medicine. (shrink)

Applying the Roman Catholic Church's set of moral principles on social concerns called Catholic social teaching (CST) on charity, distributive justice, private property and the common good, and utilising some secondary data and scientific literature, this article argues that establishing distributive justice for the global distribution of the COVID-19 vaccines must be a priority than donating millions of doses in the name of charity to address vaccine scarcity. Catholic social teaching teaches that the right to private property is a basic (...) right but has moral limits and is subordinated to the moral principles on the universal destination of earth's goods and the common good. CONTRIBUTION: The current COVID-19 vaccines are developed by people and organisations outside the pharmaceutical companies and largely funded using taxpayers' money. Thus, by virtue of justice, these vaccines must belong to all nations as global public health goods. Patents are to be suspended to allow poor countries to reproduce the popular vaccines and address the current vaccine shortage. (shrink)

While the unprecedented lockdown measures were at the heart of the debate in the first year of the pandemic, the focus since then has shifted to vaccination issues. The reason, of course, is that vaccines and vaccinations have become available by now. All experts agree: If mankind had failed to develop vaccines against SARS-CoV-2, the death toll would have been much higher. This issue seeks to explore what could be described as a “generational approach to vaccinations”. The question “What (...) can we do to avoid future pandemics?” is related to different aspects of the failures and successes of humanity’s vaccination strategy against SARS-CoV-2. Pathogens are among the existential risks to humanity that could potentially kill a large part of it in a very short time. For all the tragedy and horror it has brought upon the world, the Corona virus has not been lethal on such a large, all-encompassing scale. But it could serve as a wake-up call for more and better prevention in the future, put differently: as a call to build a “preventive society”. When people look back to the year 2022 from the year 2200, will they think of the absence of mandatory vaccination as a dangerous anachronism? And will the unequal global distribution of vaccines be seen as an unbearable vice of our epoch? And will “human infection studies” still be dismissed as unethical if a dangerous new virus boards human bodies? If intergenerational justice means improving the life chances and living conditions of future generations to the largest possible extent, then its link to (the avoidance) of infectious diseases is obvious. We should protect future generations from foreseeable damage if we have the power to do so. “We” is humankind in its entirety. Politically, humanity is divided into many single nations. But biologically, as members of the same species, we share the same vulnerability regardless of ethnicity. The regular reader of this journal might wonder why this issue of IGJR has a different structure. An unprecedented pandemic calls for an unprecedented reaction and therefore IGJR 1/2021 and 2/2021 are special issues that deal with this disruptive event. We have invited several health experts, politicians and scholars alike to share their perspectives in short opinion pieces (instead of regular peer-reviewed articles). And we are exploring something new: the publication of a FRFG policy paper. This policy paper starts off with a historical overview on how pandemics have afflicted humanity in the past. It separates moral from legal duties and formulates “epidemiological imperatives” – the way of thinking of a responsible and solidary individual facing the task of preventing an outbreak of epidemics in a community. With the discovery of vaccines, and their availability, the catalogue of duties is increased by one more: to get the jabs as an act of solidarity with others, including future generations. This would prevent states from being forced to take disease control measures that bring about drastic collateral damage. During the first two years of the Corona pandemic, states have imposed lockdowns. The closure of schools has put a special burden on the youngest members of society. This could have been prevented during the second and the further waves. The policy paper also calls for more government funding for prophylactic vaccine research and for the designation of vaccines as “global public goods”. The issue then moves on to a section dedicated to opinion papers by various different authors. The first paper, written by Agnes Binagwaho and Kedest Mathewos (both from University of Global Health Equity, Rwanda), focuses on the issue of health inequity, a concern which has gained more and more traction during the Covid-19 pandemic. The paper examines how vaccine distribution during the pandemic was mainly focused on the global north and how such actions might affect future generations’ perception of what is just, fair and morally correct. The second paper, by Samantha Vanderslott (University of Oxford), focuses on the right and wrongdoings connected to pandemic preparedness and response. The third paper, authored by Rajeev Sadanandan (Health Systems Transformation Platform, India), talks about the lessons that can and should be drawn from child immunisations. The fourth paper, by Adriano Mannino (LMU and Parmenides Foundation, Munich), delves into the question how future generations will assess our actions and our response to the current pandemic. The fifth and final paper, written by Jörg Tremmel (FRFG and University Tübingen), is centered around the question whether human infection studies could have been implemented during the early stages of the pandemic to minimise deaths and severe infections. The issue concludes with two reviews on recent books by Alberto Giubilini and Katie Wright. In his review of Giubilini’s The Ethics of Vaccination, Marius Kunte notes that it contains a “thought-provoking plea” for individual, collective and institutional obligations to reach high vaccination rates. Judith Kausch-Zongo concludes her review of Wright’s Gender, Migration and the Intergenerational Transfer of Human Wellbeing with a special emphasis on the book’s empirical findings, and praises it in its entirety as “undoubtedly important”. Both books serve as poignant reminders of how sustainable societies can only emerge once the challenges revolving around its most vulnerable members have been properly addressed. (shrink)

Two conundrums puzzle COVID‐19 investigators: 1) morbidity and mortality is rare among infants and young children and 2) rates of morbidity and mortality exhibit large variances across nations, locales, and even within cities. It is found that the higher the rate of pneumococcal vaccination in a nation (or city) the lower the COVID‐19 morbidity and mortality. Vaccination rates with Bacillus Calmette–Guerin, poliovirus, and other vaccines do not correlate with COVID‐19 risks, nor do COVID‐19 case or death rates correlate (...) with number of people in the population with diabetes, obesity, or adults over 65. Infant protection may be due to maternal antibodies and antiviral proteins in milk such as lactoferrin that are known to protect against coronavirus infections. Subsequent protection might then be conferred (and correlate with) rates of Haemophilus influenzae type B (Hib) (universal in infants) and pneumococcal vaccination, the latter varying widely by geography among infants, at‐risk adults, and the elderly. Also see the video abstract here https://youtu.be/GODBYRbPL00. (shrink)

Luigi Sacco (1769–1863) was the main protagonist of early vaccination campaign in Italy. He found a native source of vaccine lymph: with that, he personally vaccinated more than 500,000 people and furnished all Italy and some Middle East countries too. Starting from the pictures of his books, Sacco proposed to create wax models of real and spurious smallpox pustules in human, cow, sheep and horse; just to permit, not only to doctors, but also to all other health operators, the (...) identification of the right pustules from where to extract active lymph for vaccination. In the Museum of Pathological Anatomy of the Padua University Medical School, we have four anatomical waxes which corresponded exactly to the explicative pictures in 1809 Sacco’s treatise on Vaccine. We have found the same models also at the University of Milan, Pavia and Bologna—the main cities of Cisalpine Republic , the state of North Italy formed at the epoch of Sacco following the Napoleon conquest. The history of the diffusion of these models presented in this text will be a starting point to develop wider questions. In particular, this history could be useful to improve our understanding of the birth of scientific and experimental medicine through XIX and XX Century. (shrink)

Accelerated COVID-19 vaccine development represents an important accomplishment and a milestone in the history of vaccine evolution. However, the vaccine’s scarcity made its equitable global allocation and distribution ambiguous. Despite the initial pledges from wealthy countries for fairness and inclusivity towards the poorer ones, the policies followed diverged significantly. Wealthy countries have vastly superior access to vaccines in a reality likened to an ethical disaster. This paper calls for the need for fair global vaccine allocation and distribution and examines the (...) barriers that were met along the way, originating from different points, such as the nationalistic approach on the matter that most wealthy countries have adopted or the inability of poor countries to purchase or manufacture vaccines. Further, a suggestion regarding the ethical principles and values that ought to guide global vaccine allocation and distribution is provided with a higher priority given to helping the worst-off, saving the most lives, protecting people in high risk, such as frontline healthcare professionals, and minimising social gaps, along with an ethical theoretical background for each prioritisation. It is not too late for wealthy countries to realise that vaccine inequity prolongs pandemics, so that they change their policies in favour of the global common good that will not only provide immediate universal benefits but will also serve as a guide for future pandemic crises. (shrink)

In the paper ‘COVID-19 vaccine boosters for young adults: a risk–benefit assessment and ethical analysis of mandate policies at universities,’ Bardoshet alargued that college mandates of the COVID-19 booster vaccine are unethical. The authors came to this conclusion by performing three different sets of comparisons of benefits versus risks using referenced data and argued that the harm outweighs the risk in all three cases. In this response article, we argue that the authors frame their arguments by comparing values that are (...) not scientifically or reasonably comparable and that the authors used values that represent grossly different risk profiles and grouped them into a set of figures to create an illusion of fair comparisons. We argue that absent the falsely skewed portrayals of a higher level of risk over benefit in their misrepresented figures, the five ethical arguments they presented completely fall apart. (shrink)

The Catholic Church’s reflection on and assessment of the Covid-19 pandemic has developed in several areas. Inspired by the tradition of its social teaching, specifically by the values of the dignity of the human person, justice, solidarity, and the common good, a strong sense of responsibility—on the part of all to prevent the spread of the pandemic and care for the affected sick—was called for. This resulted in a series of interventions and documents on the various medical and spiritual issues (...) involved, particularly concerning the vaccines again Covid-19. In this short article, I draw out these insights from the official and universal reference point of the Catholic Church (i.e., Vatican sources in their various expressions and expertise). Interventions from other religions have also played a significant role during the Covid-19 pandemic as exemplified by the close relationship between certain religious actors and the World Health Organization. However, these alternative viewpoints, while important in and of themselves, do not find a suitable place within this work, which focuses on the Catholic Church’s perspective. (shrink)

Introduction No consent for health and medical research is appropriate when the criteria for a waiver of consent are met, yet some ethics committees and data custodians still require informed consent. Methods A single-blind parallel-group randomised controlled trial: 1129 families of children born at a South Australian hospital were sent information explaining data linkage of childhood immunisation and hospital records for vaccine safety surveillance with 4 weeks to opt in or opt out by reply form, telephone or email. A subsequent (...) telephone interview gauged the intent of 1026 parents (91%) in relation to their actions and the sociodemographic differences between participants and non-participants in each arm. Results The participation rate was 21% (n=120/564) in the opt-in arm and 96% (n=540/565) in the opt-out arm (χ2 (1 df) = 567.7, p<0.001). Participants in the opt-in arm were more likely than non-participants to be older, married/de facto, university educated and of higher socioeconomic status. Participants in the opt-out arm were similar to non-participants, except men were more likely to opt out. Substantial proportions did not receive, understand or properly consider study invitations, and opting in or opting out behaviour was often at odds with parents' stated underlying intentions. Conclusions The opt-in approach resulted in low participation and a biased sample that would render any subsequent data linkage unfeasible, while the opt-out approach achieved high participation and a representative sample. The waiver of consent afforded under current privacy regulations for data linkage studies meeting all appropriate criteria should be granted by ethics committees, and supported by data custodians. Trial registration number Australian New Zealand Clinical Trials Registry ACTRN12610000332022. (shrink)

Laws and policies are vital tools in preventing outbreaks and limiting the further spread of disease, but they can vary in content and implementation. This manuscript provides insight into challenges in responding to recent vaccine-preventable disease outbreaks by examining legislative changes in California, policy changes on certain university campuses, and the laws implicated in a measles outbreak in Minnesota.

We argue that the universal recommendations against “off-label” pediatric use of approved COVID-19 issued by the FDA, CDC, and AAP are overbroad. Especially for higher-risk children, vaccination can be ethically justified even before FDA authorization or approval – and similar reasoning is relevant for even younger patients. Legal risks can also be managed, although the FDA, CDC, and Department of Health and Human Services (HHS) should move quickly to provide clarity.

PurposeThis study aims to describe the adverse events following immunization of SARS-CoV-2 vaccination in cancer patients/survivors associated with their psychological distress.MethodsA cross-sectional study was conducted to assess AEFIs after the receipt of SARS-CoV-2 vaccines in cancer patients/survivors attending a university hospital in Malaysia. Psychological distress was measured using the Hospital Anxiety and Depression Scale before and after the first and second doses of COVID-19 vaccine.ResultsA total of 217 complete responses were received. Compared with before vaccination, both HADS Anxiety (...) and HADS Depression scores were significantly reduced after the first and second dose of the SARS-CoV-2 vaccine. Most of the participants had mild-or-moderate systemic and local AEFIs, with the most common being pain at the injection site, tiredness, and headache for both the first and second doses of the vaccine. Positive correlations between the total AEFI score and HADS-A and HADS-D scores were observed after the first dose of the SARS-CoV-2 vaccine. Similarly, positive associations were observed between the total AEFI score and HADS-A and HADS-D scores after the second dose of the SARS-CoV-2 vaccine.ConclusionMild-to-moderate AEFIs found in this study help address vaccine hesitancy in cancer patients/survivors. Receiving the SARS-CoV-2 vaccine had a positive effect on decreasing psychological distress in cancer patients/survivors. High severity of an AEFI was associated with higher anxiety and depressive symptoms. (shrink)

In the United States, the COVID-19 pandemic has become highly politicized and highly moralized. The current study explored whether participants’ endorsements of binding versus individualizing moral foundations explained partisan differences in views and behaviors regarding COVID-19. Participants completed the Moral Foundations Questionnaire before they indicated how morally permissible they thought it was to violate COVID-19 mandates, report others’ violations, or not get vaccinated. Additionally, they indicated their own prevention behaviors. Results show that endorsement of both individualizing and binding foundations explain (...) partisan differences in moral permissibility ratings. Political conservatism predicted greater endorsement of binding foundations which in turn predicted seeing COVID-19 violations and not getting vaccinated as more morally permissible, and predicted fewer self-reported prevention behaviors. Endorsement of individualizing foundations predicted seeing violations as less morally permissible and reporting others’ violations as more morally permissible. (shrink)

While visiting relatives in northern England in October 1865 the London chemist William Crookes witnessed firsthand the economic devastation of farming communities blighted by the cattle plague that had been sweeping Britain since June. Crookes delayed his return to London for several months and obtained official permission to begin experimenting on eradicating the disease with a new disinfectant, carbolic acid. In his report to the British government in 1866, Crookes was explicit that his experiments had been based on a germ (...) or contagion theory of the disease. Germs were considered to be airborne particles that might either be “living” material that “germinated” in the soil of animal flesh and blood or chemical poisons that decomposed flesh and blood.In the opening chapter of this fine study of the construction of British germ theories between the 1860s and 1900, Michael Worboys makes it clear that the cattle plague was a keystone in the long process of germ theory construction. Rinderpest was readily accepted by veterinary surgeons as a contagious disease to be controlled by wholesale culling with the poleax. On the other hand, they ignored or actively opposed the practical implications of a germ theory—disinfection , vaccination, and laboratory research—because these procedures posed a threat to the power and control of the veterinary profession. Plus ça change? In Britain, we are currently witnessing a similar example of party interest as a powerful Farmers' Union culls millions of cattle and sheep but prevents the use of vaccination in fighting a foot and mouth epidemic.Although a number of studies have celebrated the germ theory as the key development in producing scientific medicine in the late nineteenth century, this is the first critical book‐length study of its diffusion. The separate professional communities of veterinary practitioners, surgeons, and sanitarians are disarmingly shown to have developed different germ theories and differed over the practical consequences of their commitments. The closed subcultures inhabited by these groups meant that it took several decades before the germs of sanitarians were linked with those of surgeons and with the bacteria of microbiologists. Anyone who made a connection, such as the physicist John Tyndall, was dismissed as an inexpert interloper. Clearly, the singular specific disease germ theory was evolutionary in construction, not revolutionary.Worboys's ambitious monograph offers many fresh insights, including a finely tuned account of Joseph Lister's vacillating ideas and practices concerning wound management, and a splendid analysis of the problematic identification of specific germs causing cholera, smallpox, tuberculosis, diphtheria, typhoid fever, and scarlet fever. His meticulous survey of the contemporary literature unravels the deep uncertainty over whether “germs” were living organisms or chemicals, spontaneously generated or ancestral, causes or concomitants of disease. The fact that unpleasant wounds and the sick sometimes recovered spontaneously made sense only if patients constitutionally differed as an appropriate or inappropriate “soil” for “germ seeds” to blossom or perish. In this way ontological germ theories complemented the traditional medical concepts of constitutional strength and weakness and the healing power of nature. This insight underlines one of the strengths of the book, namely, its recognition of continuities in the construction of disease concepts and practices.Worboys successfully challenges the view that the British medical communities acted largely as onlookers while French and German practitioners honed a laboratory‐based medicine for the twentieth century. Overall, Worboys's monograph is a challenging and extremely readable medical history of germs. It will be essential reading for students taking history of medicine programs. (shrink)

Perhaps nothing symbolizes the current polarized political climate in the United States more than the world of public health. Public health schools and health departments are full of “true believers,” people willing to crusade for any program designed to reduce morbidity and mortality. But in the “real world,” proven programs and strategies—such as gun-control measures, universal vaccination, and improved traffic safety—are routinely thwarted. Why do critics oppose efforts to improve the public's health? History can provide some answers.

The HPV (human papillomavirus) vaccine Gardasil (Merck & Co.) was licensed for use by the FDA on June 8, 2006. The Centers for Disease Control and major physician professional organizations have recommended routine universal vaccination in young girls. However, questions remain regarding the safety and efficacy of the vaccine in this age group. Also, vaccine use will not eliminate the need for routine Pap screening, and it may not decrease future cervical cancer rates. This paper surveys the natural (...) history of HPV infection as well as the controversies surrounding the vaccine’s use as currently recommended. National Catholic Bioethics Quarterly 10.3 (Autumn 2010): 459–469. (shrink)

A clear and provocative introduction to the ethics of COVID-19, suitable for university-level students, academics, and policymakers, as well as the general reader. It is also an original contribution to the emerging literature on this important topic. The author has made it available Open Access, so that it can be downloaded and read for free by all those who are interested in these issues. Key features include: -/- A neat organisation of the ethical issues raised by the pandemic. An exploration (...) of the many complex interconnections between these issues. A succinct case for a continued lockdown until we develop a vaccine. An original account of the Deep Moral Problem of the Pandemic, and a Revolutionary Argument for how we should change society post-pandemic. References to, and engagement with, many of the best writings on the pandemic so far (both in popular media and academic journals). -/- ISBN: 978-0-6489016-0-0. (shrink)

Department of Economics, University of Calgary, 2500 University Dr NW, Calgary AB, T2N 1N4, Canada. Tel.: +1403220 5861; Fax: +1403220 5861; Email: ahollis{at}ucalgary.ca ' + u + '@' + d + ' '//--> . Abstract The Health Impact Fund has been proposed as an optional, comprehensive advance market commitment system offering financial payments or ‘prizes’ to patentees of new drugs, which are sold globally at an administered low price. The Fund is designed to offer payments based on the therapeutic impact (...) of the drugs or vaccines, so that innovators will have efficient incentives to develop drugs that maximize health gains. Consumers would have improved access to such drugs because of low prices. CiteULike Connotea Del.icio.us What's this? (shrink)

Two articles in the September–October 2022 issue of the Hastings Center Report discuss health‐related reasons that people might have to actively bring their lives to an end. In one, Brent Kious considers the situation of a person who, because of illness, becomes a burden on loved ones. A person in such a situation might prefer to die, and Kious argues that, while there is no obligation to hasten one's death, the choice to do so could sometimes be reasonable. In a (...) second article, Henri Wijsbek and Thomas Nys discuss a case in the Netherlands in which a woman with severe dementia was euthanized at a point when her advance euthanasia directive did not align with what she said, when asked, about death. Wijsbek and Nys defend the authority of her advance directive against a range of objections.In a third article, Henry Silverman and Patrick Odonkor, physicians at the University of Maryland Medical Center, where the first pig‐to‐human heart transplantation was performed in early 2022, develop recommendations for clinical trials of porcine heart transplantation. And an essay in the issue criticizes the allocation recommendations developed for Covid‐19 vaccines by the U.S. Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices. (shrink)

The COVID-19 pandemic has helped to clarify the fair and equitable allocation of scarce medical resources, both within and among countries. The ethical allocation of such resources entails a three-step process: (1) elucidating the fundamental ethical values for allocation, (2) using these values to delineate priority tiers for scarce resources, and (3) implementing the prioritisation to faithfully realise the fundamental values. Myriad reports and assessments have elucidated five core substantive values for ethical allocation: maximising benefits and minimising harms, mitigating unfair (...) disadvantage, equal moral concern, reciprocity, and instrumental value. These values are universal. None of the values are sufficient alone, and their relative weight and application will vary by context. In addition, there are procedural principles such as transparency, engagement, and evidence-responsiveness. Prioritising instrumental value and minimising harms during the COVID-19 pandemic led to widespread agreement on priority tiers to include health-care workers, first responders, people living in congregate housing, and people with an increased risk of death, such as older adults and individuals with medical conditions. However, the pandemic also revealed problems with the implementation of these values and priority tiers, such as allocation on the basis of population rather than COVID-19 burden, and passive allocation that exacerbated disparities by requiring recipients to spend time booking and travelling to appointments. This ethical framework should be the starting point for the allocation of scarce medical resources in future pandemics and other public health conditions. For instance, allocation of the new malaria vaccine among sub-Saharan African countries should be based not on reciprocity to countries that participated in research, but on maximally reducing serious illness and deaths, especially among infants and children. (shrink)

Researchers from the Universities of Oxford, Nairobi, and Manitoba are collaborating on a project to develop an HIV vaccine based on the immunological protection mechanisms found in commercial sex workers from the Majengo slum in Nairobi. This group consists of educationally and economically disadvantaged women who resort to commercial sex work for a living. A clinic was established in the slum to study sexually transmitted diseases, which now includes HIV/AIDS. The clinic serves as a research facility for the collaborating researchers (...) who have been using the women's blood, cervical, vaginal, and saliva samples for the ongoing studies. The clinic runs two HIV-integrated activities: HIV research and HIV care and treatment. For HIV negative participants, samples are collected and used for research and care after they give informed consent. (shrink)

Several countries have implemented COVID-19 health passes or certificates to promote a safer return to in-person social activities. These passes have been proposed as a way to prove that someone has been vaccinated, has recovered from the disease, or has negative results on a diagnostic test. However, many people have questioned their ethical justification. This article presents some practical and ethical problems to consider in the event of wishing to implement these passes. Among the former, it is questioned how accurate (...) diagnostic tests are as a means of ensuring that a person is not contagious, whether vaccination guarantees immunity, the fact that health passes can be forged, whether they encourage vaccination, and the problem that there is no universally recognized health pass. Among the ethical issues, it is discussed whether health passes promote discrimination and inequality and whether they violate rights to privacy and freedom. It is concluded that health passes have enough ethical justification to be implemented. (shrink)

AbstractDuring the Covid-19 pandemic, ethicists and researchers proposed human challenge studies as a way to speed development of a vaccine that could prevent disease and end the global public health crisis. The risks to healthy volunteers of being deliberately infected with a deadly and novel pathogen were not low, but the benefits could have been immense. This essay is a history of the three major efforts to set up a challenge model and run challenge studies in 2020 and 2021. The (...) pharmaceutical company Johnson and Johnson, the National Institutes of Health in the United States, and a private-public partnership of industry, university, and government partners in Britain all undertook preparations. The United Kingdom’s consortium began their Human Challenge Programme in March of 2021.Beyond documenting each effort, the essay puts these scientific and ethical debates in dialogue with the social, epidemiological, and institutional conditions of the pandemic as well as the commercial, intellectual, and political systems in which medical research and Covid-19 challenge studies operated. It shows how different institutions understood risk, benefit, and social value depending on their specific contexts. Ultimately the example of Covid-19 challenge studies highlights the constructedness of such assessments and reveals the utility of deconstructing them retrospectively so as to better understand the interplay of medical research and research ethics with larger social systems and historical contexts. (shrink)