MASS CHILDHOOD IMMUNIZATION - SOME ETHICAL DOUBTS FOR PRIMARY HEALTH-CARE WORKERS

The mass childhood immunization programme has traditionally been viewe d as a safe and effective preventative measure by health promoters, pr imary health care professionals and governments. This consensus has me ant that immunization has rarely been viewed as ethically problematic. A number of recent changes in the context of the delivery of health c are, particularly the emphasis on consumerism and the effect of the ma rketization of services, makes timely an examination of ethical, socia l and political issues. This article examines four main groups for pro blematizing the mass childhood immunization programme. These are: clin ical research evidence about the safety and efficacy of vaccines; the masking of wider social and political determinants of ill health; the contradictory strictures about collective and individual rights in rel ation to immunization; and the uniqueness of childhood immunization as a physical intrusion into a healthy body. The implications of these e thical issues are discussed in relation to informed consent and the ne ed for a 'greenfield' review that includes the views of dissenting par ents, lawyers and moral philosophers, as well as health professionals.