Paul Yash, Dawson Angus
A-D-7, Devi Marg, Bani Park, Jaipur-302016, India.
Bioethics. 2005 Aug;19(4):393-406. doi: 10.1111/j.1467-8519.2005.00451.x.
The World Health Organisation's programme for the eradication of poliomyelitis as currently practised in India raises many ethical issues. In this paper we concentrate on just two. The first is the balance to be struck between the risks and benefits generated by the eradication programme itself. The issue of risks and benefits arises in relation to the choice between two different vaccine types available for polio programmes: oral polio vaccine (OPV) and inactivated polio vaccine (IPV). OPV is the vaccine currently used in the eradication campaign in India. We argue that given the current risks/benefits profile of this vaccine, there is an urgent need to review the programme and take remedial action to address existing problems (at least in India). The second issue we discuss is the fact that there is little effort to gain the informed consent of the parents of vaccinated children, as they are not currently told about the potential limitations of OPV or the possibility of vaccine-induced harm. We suggest that such a policy might be justifiable, given the importance of polio eradication, but only if there is a system of compensation for vaccine-induced harm as part of the eradication programme itself. There is a real danger that if these issues are not addressed then public trust in the eradication programme and vaccination programmes as a whole will be lost.
世界卫生组织目前在印度实施的根除脊髓灰质炎计划引发了许多伦理问题。在本文中，我们仅关注其中两个问题。第一个问题是根除计划本身所产生的风险与益处之间的平衡。风险与益处的问题涉及到脊髓灰质炎计划可选用的两种不同疫苗类型之间的选择：口服脊髓灰质炎疫苗（OPV）和灭活脊髓灰质炎疫苗（IPV）。OPV是目前印度根除运动中使用的疫苗。我们认为，鉴于这种疫苗目前的风险/益处状况，迫切需要对该计划进行审查并采取补救措施来解决现有问题（至少在印度）。我们讨论的第二个问题是，几乎没有努力去征得接种疫苗儿童家长的知情同意，因为目前他们并未被告知OPV的潜在局限性或疫苗导致伤害的可能性。我们认为，鉴于根除脊髓灰质炎的重要性，这样的政策或许是合理的，但前提是根除计划本身要有一个针对疫苗导致伤害的补偿体系。如果这些问题得不到解决，那么公众对根除计划以及整个疫苗接种计划的信任将面临切实的风险。
