Jagadish Dhriti, Mamo Nathaniel, Pasadyn Felicia, Caplan Arthur
Division of Medical Ethics, NYU Langone Health, New York, NY, USA.
Hum Vaccin Immunother. 2025 Dec;21(1):2465116. doi: 10.1080/21645515.2025.2465116. Epub 2025 Feb 16.
Informed consent is an integral tenet of medical ethics. However, the United States lacks a standardized consent process for immunizations, with states and private companies instead reliant on Vaccine Information Statements (VISs) introduced by the 1986 National Childhood Vaccine Injury Act. VISs, rather than being developed with patient autonomy in mind, were a response to excessive vaccine injury litigation and resulting vaccine supply shortages. VISs do not provide meaningful information disclosures, with its producer - the Centers for Disease Control and Prevention - itself admitting that VISs should not be mistaken for informed consent forms. In its content, the VIS is too complex in its readability, does not situate immunization in a public health context, and does not present all alternatives. VIS delivery is also inadequate, with limited time given for patients to digest vaccine information and no documentation required to ensure that VISs were presented at all. Simply put, VISs do little to spark deliberation and increase vaccine confidence. This article recommends minor improvements to VIS content, delivery, and accountability mechanisms to ensure distribution. The authors argue that these patient-provider moments - for patients to better understand their health, the threat of disease, and the weight of their contribution to the public - should not be squandered.
知情同意是医学伦理的一项基本原则。然而,美国缺乏标准化的疫苗接种同意程序,各州和私人公司依赖的是1986年《国家儿童疫苗伤害法案》引入的疫苗信息声明(VIS)。VIS并非出于患者自主考虑而制定,而是对过度的疫苗伤害诉讼以及由此导致的疫苗供应短缺的一种回应。VIS并未提供有意义的信息披露,其制作方——疾病控制与预防中心——自己也承认,VIS不应被误认为是知情同意书。在内容方面,VIS的可读性过于复杂,没有将疫苗接种置于公共卫生背景下,也没有列出所有替代方案。VIS的发放也存在不足,留给患者消化疫苗信息的时间有限,而且没有要求提供文件以确保VIS已发放。简而言之,VIS在引发思考和增强疫苗信心方面作用甚微。本文建议对VIS的内容、发放和问责机制进行小幅改进,以确保其分发。作者认为,这些医患互动时刻——让患者更好地了解自身健康、疾病威胁以及他们对公众贡献的重要性——不应被浪费。