University of Adelaide (Australia) researchers and their government and industry
partners have identified a range of ethical issues with high
school-based immunisation programs in South Australia.
School-based
immunisation programs are commonly run in Australia and in other
countries around the world, with vaccines given to large groups of
students whose parents have provided consent.
Government-funded
vaccines given to students aged 12-13 include boosters for such
conditions as diphtheria and tetanus, as well as immunisation for
hepatitis B, chickenpox and three doses of the human papillomavirus
vaccine (HPV).
In a paper published in the American Journal of Public Health, University of Adelaide researchers highlight a number of ethical concerns with current practices.
"In
general, school-based immunisation programs in South Australia are well
organised and well accepted with good uptake by students. However we
identified ethical challenges in three main areas: informed consent,
restrictions on privacy, and harm to students in the form of fear and
anxiety," says the lead author of the paper and Head of the University's
School of Population Health, Professor Annette Braunack-Mayer.
"The
accepted elements of informed consent include the provision of
information, the capacity for people to make decisions, and voluntarily
submitting themselves to the immunisation. We found challenges in each
of these areas.
"A key challenge for parents and students alike
is the information they're provided. For many, this was hard to
understand and to remember, and this can affect their ability to make
informed decisions. A very small number of students were unwilling
participants in the immunisation program, even though their parents had
given permission. They had to be persuaded, usually very gently, to
receive the vaccines."
Professor Braunack-Mayer says the public
nature of the school setting creates significant challenges for privacy
and confidentiality. "To manage the student flow, immunisations are
typically conducted in gymnasiums or classrooms, where interactions
between students and nurses can be seen and heard by others. A
necessary question for the HPV vaccine is: 'are you pregnant?', and the
answer is sometimes overheard by peers."
She says student anxiety
about the immunisation program – and fear of the needle – is another
area of concern for students. "This poses the question of potential
harm, either real or imagined," she says.
"It is important that
we provide the best quality immunisation program we can for our students
and the wellbeing of the wider community. Identifying and addressing
these challenges will help to ensure that school-based immunisation
programs are both ethically acceptable and effective," Professor
Braunack-Mayer says.
This study has been supported by the
Australian Research Council (ARC) and the National Health and Medical
Research Council (NHMRC), in collaboration with the SA Departments of
Health and Education and Children’s Services, the Adelaide Women’s and
Children’s Hospital, CSL Ltd and GlaxoSmith Kline.