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Gesundheitswesen 2019; 81(07): e121-e126
DOI: 10.1055/s-0043-111235
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Childhood Vaccination Against Seasonal Influenza to Reduce the Overall Burden of Disease: Ethical Perspectives

Impfung gegen saisonale Influenza im Kindesalter zur Reduktion der allgemeinen Krankheitslast – Ethische Perspektiven
Kyriakos Martakis
1   Department of International Health, School CAPHRI (Care and Public Health Research Institute), Maastricht University, Niederlande
2   Klinik und Poliklinik für Kinder- und Jugendmedizin, Uniklinik Köln, Köln
3   UniReha GmbH, Zentrum für Prävention und Rehabilitation der Uniklinik Köln, Köln
,
Kruthika Thangavelu
1   Department of International Health, School CAPHRI (Care and Public Health Research Institute), Maastricht University, Niederlande
4   Klinik für Hals-Nassen und Ohrenheilkunde, Universitätsklinikum Essen, Essen
,
Peter Schröder-Bäck
1   Department of International Health, School CAPHRI (Care and Public Health Research Institute), Maastricht University, Niederlande
5   Fachbereich Human- und Gesundheitswissenschaften, Universität Bremen, Deutschland
› Author Affiliations
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Publication History

Publication Date:
11 July 2017 (online)

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Abstract

Introduction Childhood immunisation against seasonal influenza promises to reduce the burden of disease through herd immunity. The option of intranasal vaccination seemed to offer a more acceptable vaccination for children, as they are perceived to be less invasive. Yet, intranasal vaccines have been recently proven not to be as effective as presumed. In Germany, contradictory recommendations of the Standing Committee on Vaccination (STIKO) first, to use and then, in October 2016, not use these vaccines have been issued for the 2016–2017 season, whereas recommendations not to use them were already issued in the USA (CDC, ACIP). This controversy spurs the discussion of immunisation programmes for children again. Despite studies discussing the effectiveness of a comprehensive immunisation programme targeting children also in the German and wider European context, an accompanying ethical discussion is missing.

Methodology We discuss several policy options from different key ethical perspectives that are widely used in public health: if seasonal influenza vaccination should be intensively offered to or even made mandatory for children to decrease the societal burden of the disease.

Results Various ethical perspectives reflect the question how to balance individual autonomy, personal benefit and population benefit differently.

Discussion A convincing justification for suggestions on immunisation policies has to balance norms anchored in different ethical theories. There are good reasons to offer immunisation programmes against seasonal influenza to children, using a voluntary, possibly incentive-based approach.

Zusammenfassung

Ziel der Studie Die Impfung von Kindern gegen saisonale Influenza um möglichst Herdimmunität zu erreichen, könnte die allgemeine Krankheitslast verringern und wird international diskutiert. Nasale Impfstoffe bieten eine neue Methode, die als sanfter empfunden werden könnte und somit potenziell akzeptabler für Kinder und Eltern erscheinen könnte. Allerdings haben sich diese Impfstoffe in jüngster Zeit als nicht so effektiv herausgestellt, wie erhofft. So gab es für die Grippe-Impfsaison 2016/2017 von der STIKO schon 2 verschiedene Empfehlungen, zuerst, die Impfung mit dem nasalen Impfstoff durchzuführen und, ab Oktober 2016, sie doch nicht fortzuführen. Die aktuellen Entwicklungen befördern Diskussionen von Kinder-Impfprogrammen. Obwohl einzelne Studien die Effektivität umfassender Impfprogramme gegen saisonale Influenza bei Kindern in Deutschland und Europa diskutieren, fehlt die ethische Betrachtung des Themas.

Methodik Wir diskutieren aus ethischer Sicht mit Rückgriff auf zentrale und weithin im Bereich Public Health benutzte ethische Positionen, ob eine saisonale Influenzaimmunisierung im Kindesalter verstärkt angeboten werden oder sogar verpflichtend sein sollte, um die allgemeine Krankheitslast zu reduzieren.

Ergebnisse Bei der Anwendung diverser ethischer Perspektiven wird die Frage verschiedentlich beantwortet, wie man individuelle Autonomie, persönlichen und gesellschaftlichen Nutzen abwägen sollte.

Schlussfolgerungen Eine überzeugende und plausible Rechtfertigung von Impfpolitiken muss verschiedene ethische Normen berücksichtigen und abwägen. Es gibt gute Gründe, Kindern gezielt Impfprogramme zur saisonalen Influenzaprävention anzubieten. Die Impfungen sollten allerdings freiwillig bleiben. Gleichwohl könnte man Anreiz-orientierte Ansätze erwägen.

Key words

autonomy - vaccination - children - chronic diseases - influenza - ethics

Schlüsselwörter

Autonomie - Impfung - Kinder - Influenza - chronische Ekrankungen - Ethik
 

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