Background: Despite much scholarship and public discourse on risk and vaccines over the last decades, arguments about how to balance the interests of various groups who may perceive differently the risks and benefits of vaccine policies are generally divorced from the normative ethics theories related to ethical risk imposition and the just distribution of risk. This paper seeks to explore how the normative theories on just risk imposition and distribution fit or not with the preexisting literature on ethics and vaccine policy.
Methods: We conducted a scoping review, searching across bioethics, public health ethics and related fields. We identified over 1,600 articles, 57 of which were review using qualitative content analysis.
Results: Approaches varied in the way risk imposition and distribution are justified in vaccine ethics literature, according to the context in which a given vaccine policy is implemented, the source of the risk (whether vaccine uptake or refusal) and the normative perspective adopted (where adopted in the first place). Key considerations include the tensions between the value of autonomy and avoidance of harm of others, as well as between individual and collective benefits and the extent to which some may be used a means to others’ ends.
Discussion: This review maps current literature and aims inform future research on risk and vaccines in manner more considered of existing normative ethics work. Attention to ethical risk imposition and just risk distribution is critical to supporting equitable vaccine policy and improving public trust, whether in routine programs or emergency outbreak response.