The Ethics of Parental Refusal to Vaccinate: Costs, Community Safety, and Individual Rights

Background: According to the World Health Organization (WHO), vaccination has reduced the burden of infectious diseases to a significant extent. In recent times, however, the focus has been more on vaccine safety rather than effectiveness. As with any other public health program, immunizations and associated policies are designed to protect the health of the public. Compared to minor risks of side effects of vaccination, the risk of infection often rationalizes the use of vaccination. In states like Georgia, with fewer outbreaks associated with non-vaccination, the need to access community immunity remains constant. Though some articles have assessed parental refusal of childhood vaccination as an ethical concern, few have addressed the economic burden to society as a result of parental rights to refuse vaccination in the ethical contexts of rights, outbreak costs, and community safety. Methods: A literature review was conducted on both qualitative and quantitative studies that described the ethical issues associated with parental refusal of child vaccinations. Electronic databases through PubMed and EBSCO search engines were examined for studies conducted between 2012-2018. Five reviewers independently assessed those articles for content and relevance. Results: Forty-seven articles were identified by a subject matter expert and assessed by the five reviewers. Nineteen articles, based on relevance and theme were selected by consensus to include in this review. Article themes of “rights of parents,” “community rights,” and “costs associated with outbreak or mitigation of outbreak” were examined. Conclusions: Ethical issues of community safety and costs of the outbreak, as well as the rights of the child, should be considered in the debate of childhood vaccination. Research, policy, and parental education strategies should also take ethical implications into account to encourage well-informed policy and parental decision-making.