Centre for Biomedical Ethics, National University of Singapore, Yong Loo Lin School of Medicine, Block MD11, Clinical Research Centre, #02-03, 10 Medical Drive, Singapore 117597, Singapore.
Oxford Uehiro Centre for Practical Ethics, University of Oxford, Murdoch Children's Research Institute, Littlegate House, St Ebbes St, Oxford OX1 1PT, UK.
Vaccine. 2022 Aug 26;40(36):5333-5337. doi: 10.1016/j.vaccine.2022.06.051. Epub 2022 Jun 23.
Numerous countries and jurisdictions have implemented differential COVID-19 public health restrictions based on individual vaccination status to mitigate the public health risks posed by unvaccinated individuals. Although it is scientifically and ethically justifiable to introduce such vaccination-based differentiated measures as a risk-based approach to resume high-risk activities in an ongoing pandemic, their justification is weakened by lack of clarity on their intended goals and the specific risks or potential harms they intend to mitigate. Furthermore, the criteria for the removal of differentiated measures may not be clear, which raises the possibility of shifting goalposts without clear justification and with potential for unfairly discriminatory consequences. This paper seeks to clarify the ethical justification of COVID-19 vaccination-based differentiated measures based on a public health risk-based approach, with focus on their deployment in domestic settings. We argue that such measures should be consistent with the principal goal of COVID-19 vaccination programmes, which is to reduce the incidence of severely ill patients and associated healthcare burdens so as to protect a health system. We provide some considerations for the removal of vaccination-based differentiated measures based on this goal.
许多国家和司法管辖区根据个人疫苗接种状况实施了差异化的 COVID-19 公共卫生限制措施，以减轻未接种疫苗者带来的公共卫生风险。虽然从科学和伦理的角度来看，引入基于疫苗接种的差异化措施作为一种基于风险的方法，以恢复大流行期间的高风险活动是合理的，但由于缺乏对其目标的明确性以及它们旨在减轻的具体风险或潜在危害的明确性，其合理性受到削弱。此外，取消差异化措施的标准可能不明确，这使得在没有明确理由的情况下改变目标成为可能，并可能产生不公平的歧视后果。本文旨在根据基于公共卫生风险的方法，阐明 COVID-19 基于疫苗接种的差异化措施的伦理依据，重点是在国内环境中的部署。我们认为，这些措施应该符合 COVID-19 疫苗接种计划的主要目标，即减少重症患者的发病率和相关的医疗保健负担，从而保护卫生系统。我们根据这一目标为取消基于疫苗接种的差异化措施提供了一些考虑因素。
