Vaccines: Ethical, Just, and Inclusive Approaches in Public Health

1. Key Ethics Themes and Questions from CVEP Philadelphia May, 202X Meeting Preliminary Caplan summary!!

2. What is the Ethic of Vaccines? • All lives will be treated as of equal value • Are vaccines public goods and when and why? • Is a human rights framework constructive? • What is a population and public health ethics for vaccines and do we really mean to continue to use/insist upon it in a world where individualistic thinking may be on the rise?

3. What is the Right Ethic for Vaccines? • Can a focus on vaccines stand alone as part of a broad public health ethic • Do children deserve priority in all vaccine policy and why?    • How does profit stack up morally in the realm of vaccines?

4. How to Have Fair Participation • Is local control the best strategy for input and accountability as against regional? •  Does proliferation of local bodies help or hinder access to safe and effective vaccines? • How should civil society voices be heard in vaccine policy? • Is their sufficient accountability and transparency in a Gates funded world?

5. Justice • How does the emphasis on vaccines complement or distort need to improve health care infrastructure in very poor nations? • Does asking govts to match Gates goals unduly distort other public health needs being met? • Is industry doing enough in terms of charitable behavior toward those in need.   • What are the long term fiscal/infrastructure strategies that can sustain cost-effective and locally desired vaccines?

6. Justice • Should international vaccine policy be disconnected from vaccine policy in developed world • Justice of eradication efforts   • Are the ‘distribution’ ethics of getting access to proven vaccines where there is a huge need the same as getting vaccine to meet a limited but real need in a poor nation or poor populations?

7. Justice • How can internal access and equity be achieved within nations? Who enforces it? With what degree of respect for local values?

8. Choice • Does the vaccine community need to adopt a new moral stance toward personal choice regarding vaccines? • Is ‘choice’ by countries, communities and individuals to be real? How informed, how voluntary?  Mandates? • What factors build public trust in vaccines and how do they vary by community and context? • New risk/benefit calculus in doing research including new vaccines but also social and economic experiments

9. Evidence and COI • What is COI in the vaccine domain and how should it be thought about and managed? • Is industry all of a piece in thinking of conflict of interest vaccine scientists vs. marketing •  Is evidence being used properly in setting vaccine policy comparisons of what? • Are we using the right tools and metrics for vaccines QALYs, DALYs, what??? NHS v USA

10. Emerging Challenges •  How do new behavioral and therapeutic vaccines challenge ability of existing regulatory bodies and public understanding and attitudes about vaccines?  • How will rapid development of India, China, Brazil, Argentina and other nations alter traditional norms about vaccine policy outside North America and Europe?  • Can existing vaccine organizations do their jobs in the wake of the Gates’ initiatives • Who is left standing in a post-Gates, 202x world?

11. Emerging Challenges •  Are we learning from failure, i.e., Have we resolved emergency ethics for pandemics including sharing of samples and access for all or those most in need in public health crises?

12. Thank You for Coming!