David curry

Evidence, Ethical Imperatives and Policy Priorities: adult and

adolescent vaccination

Planning for Adult Vaccination in Middle and Low Income Countries – HIV, TB, and Malaria Workshop

Aeras, 4-5 September 2013

David R. Curry, MS Executive Director

Center for Vaccine Ethics and Policy Associate Faculty, Department of Medical Ethics

NYU Medical School, NYU Langone Medical Center [email protected]

mailto:[email protected]

Mission: Contribute to public health as the leading independent,

academically-based center focused on global immunization and vaccine

ethics and policy

Three Ideas: Evidence-based Policy Consensus Bioethics/Ethical Principles & Imperatives (Harsh) Realities of Immunization Priorities (GVAP)

Adapted from: Jason L. Schwartz, MBE, AM, Center for Bioethics; Department of History & Sociology of Science University of Pennsylvania

NVAC Health Care Personnel Influenza Vaccination Subgroup 31 May 2011

Evidence-based Policy Consensus

A threshold in policy evolution where available evidence and its analysis is

sufficient to drive broad alignment across relevant scholarly, professional and

regulatory communities



Bioethics Bioethics provides an orderly way of

thinking about where and how "values" should inform

policy, practice and action.

Ethical Principles Underlying Vaccine Policy Formation

Effectiveness Proportionality

Necessity Infringement

Public Justification

Laws Social Norms

Religious/Cultural Frameworks

Adapted from: Jason L. Schwartz, MBE, AM, Center for Bioethics;

Department of History & Sociology of Science University of Pennsylvania


Autonomy Beneficence

Non-maleficence Justice

Harm Principle



Are “values” and “social norms” forms of evidence?

How to portray the “available evidence” and

incorporate “values”?



Draft “Future State” Conceptual

Map ?2015

David R. Curry, MS Executive Director Center for Vaccine Ethics and Policy Associate Fellow, Center for Bioethics University of Pennsylvania [email protected]




“Values” grounded parameters


Draft “Future State” Conceptual Map ?2015




Ethical Imperatives



Ethical Imperative

An ethical imperative states a principle of action or a condition to be achieved which

is supported by compelling moral argument and difficult to challenge

on any grounds



CVEP: Ethical Imperative

We believe the ethical imperative for vaccine policy is to accelerate the development and delivery of needed

vaccines – producing sustained immunity and therapeutic benefit

for all people at risk – assuring affordable, equitable and effective access

regardless of circumstance or geography.



Ethical Imperative: Citizens and Immunization

As citizens, we share an ethical imperative to help assure the highest level of health in our communities and globally by protecting our fellow citizens through

personal immunization against geographically-relevant infectious diseases for which there are safe, effective

and available vaccines.

Science 12 May 2006: Vol. 312 no. 5775 pp. 854-855 DOI: 10.1126/science.1125347

Life-Cycle Allocation Principle

…Although the life-cycle principle favors some ages, it is also intrinsically

egalitarian (7). Unlike being productive or contributing to others’ well-being,

every person will live to be older unless their life is cut short.

…based on the idea that each person should have an opportunity to live

through all the stages of life…(8, 9). There is great value in being able to

pass through each life stage—to be a child, a young adult, and to then

develop a career and family, and to grow old—and to enjoy a wide range

of the opportunities during each stage…

…People strongly prefer maximizing the chance of living until a ripe old age,

rather than being struck down as a young person (10, 11).

[faint praise]

No substantive engagement of vaccines or immunization…at all…



“Values” grounded parameters


Draft “Future State” Conceptual Map ?2015




Questions/Comments/ Ideas

David R. Curry, MS Executive Director

Center for Vaccine Ethics and Policy Associate Faculty,

Department of Medical Ethics, NYU Medical School [email protected]

267.251.2305


David curry

Spiritual

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