Centre for Chronic Disease Control, New Delhi, India.
BMJ Open. 2013 Mar 1;3(3):e001905. doi: 10.1136/bmjopen-2012-001905.
This study examines the existing norms regarding immunisation within the communities and the ethical notions that govern the actions of different health professionals and their collective synergistic or conflicting effects on the governance of the programme.
We used descriptive and analytical qualitative methods as it suited the research question.
The data were collected from areas under 16 primary health centres in Kerala and Tamil Nadu identified through a three-step sampling process.
This involved in-depth interviews with stakeholders including providers, beneficiaries and other stakeholders, focus group discussions with mothers of under-five children and participant and non-participant observations of vaccination-related activities.
Unlike most other ethical analyses that look at the ethics of vaccination policies, the interactions of normative principles and notions are analysed in this article. Moral obligation of parents towards their children, beneficence of healthcare providers and the utilitarian aspirations of the state are the key normative principles involved. Our analysis points to the interplay of both synergy and conflict in ethical notions and moral values in the context of immunisation services. Paternalistic interventions like special immunisation campaigns against polio and Japanese encephalitis are a case in point: they generate conflict at the normative level and create mistrust.
Analysis of vaccination policies and programmes needs to go beyond factors that assess monetary benefits or herd immunity. Understanding the interactions of normative notions that shape the social organisation of the providers and the users of vaccination is important in creating a sustainable environment for the programme.
本研究考察了社区内现有的免疫规范以及指导不同卫生专业人员行动的伦理观念，以及这些观念对规划治理的集体协同或冲突影响。
由于研究问题适合，我们使用了描述性和分析性定性方法。
通过三步抽样过程，从喀拉拉邦和泰米尔纳德邦的 16 个初级保健中心以下地区收集数据。
这包括对利益攸关方（包括提供者、受益者和其他利益攸关方）进行深入访谈、对五岁以下儿童的母亲进行焦点小组讨论以及对与疫苗接种相关活动进行参与式和非参与式观察。
与大多数其他着眼于疫苗接种政策伦理的伦理分析不同，本文分析了规范原则和观念的相互作用。父母对子女的道德义务、医疗保健提供者的善行以及国家的功利主义愿望是涉及的关键规范原则。我们的分析指出，在免疫服务背景下，伦理观念和道德价值观既存在协同作用，也存在冲突。像针对小儿麻痹症和日本脑炎的特别免疫运动这样的家长式干预就是一个很好的例子：它们在规范层面上产生冲突，并造成不信任。
对疫苗接种政策和规划的分析需要超越评估货币收益或群体免疫的因素。了解塑造疫苗接种提供者和使用者的社会组织的规范观念的相互作用，对于为该规划创造一个可持续的环境至关重要。
