Ethics and immunization policy: Promoting dialogue to sustain consensus

The societal consensus that has supported the United States' universal chil dhood immunization programs for the past 50 years shows signs of eroding. T his article proposes a systematic approach to evaluate immunization policy options. Through a unifying framework that combines epidemiologic, economic , and ethical concerns, this approach promotes a clearer understanding of u nderlying issues and inherent tradeoffs between alternative policies. Such a systematic examination of policy options could facilitate the public dial ogue necessary to continually recreate a broad consensus on immunization pr actices and enable us to choose policies most in accord with our fundamenta l values.