疫苗接種之歷史發展與倫理議題

The History and Associated Ethical Issues of Vaccination

楊志偉(Chih-Wei Yang) ； 翁珮瑄(Pei-Hsuan Weng) ； 季瑋珠(Wei-Chu Chie)

《台灣醫學》 16卷1期 (2012/01) Pp. 26-33

https://doi.org/10.6320/FJM.2012.16(1).04

摘要

疫苗接種的歷史與天花疫苗的發展息息相關，人類雖然成功滅絕了此一可怕的傳染病，疫苗發展時的人體實驗卻也產生許多倫理爭議。在群體保護力不存在的情況下，根據「傷害他人原則」，個體應有義務接種疫苗；而在群體保護力已經存在的情況下，根據「no additional benefit argument」，不應該強迫個體接種疫苗。然而施打疫苗對預防傳染疾病仍然是很重要的群體共善，需要越多的個體參與投入，應該用更多的鼓勵以及教育來促進與維持群體保護力的效益。不同國家對於強制接種某些疫苗有不同的政策與考量，美國華盛頓州衛生部的疫苗接種委員會，曾提出九項指標用來評估特定疫苗是否適合列入學童的強制疫苗接種項目，本文以麻疹及子宮頸癌疫苗為例應用此九項指標進行評估。此外，在疾病大流行時，對於有限的疫苗資源如何分配，也有許多倫理的原則需要考量，包括「救最多條性命」、「生命週期原則」、以及「投資回報原則」等等。

關鍵字

倫理 ； 群體保護力 ； 共善 ； 疫苗接種

並列摘要

The success of smallpox eradication is an important milestone in the history of vaccination development, although the process of human experiments raised a variety of ethical dilemmas. According to the ”harm to others principle”, each individual is obligated to undergo vaccination in at least some situations to prevent potential harm to innocent others. However, under existence of herd protection, vaccination may be considered optional rather than mandatory, according to the ”no additional benefit argument”. Nonetheless, vaccination against contagious diseases is such an important public good that people should be encouraged to maintain or enhance herd protection via promotion and education. Some principles should be considered by governments to make certain types of vaccination compulsory. The immunization advisory committee of Washington State Board of Health suggested nice criteria to evaluate which vaccination should be considered mandatory for schoolchildren. This article applied these criteria to evaluate whether the measles vaccination and the human papilloma virus vaccination should be considered mandatory. Additionally, under circumstances of an outbreak of epidemic disease with limited amount of vaccine, several ethical principles, including ”save the most lives”, ”life cycle principle”, and ”the investment refinement”, should be considered for proper allocation.

並列關鍵字

ethics ； herd protection ； public good ； vaccination