At the intersection of science, morality and law
In the modern world, where global pandemics demonstrate humanity's vulnerability to infectious diseases, issues of infectology and vaccine prevention extend far beyond pure medicine. They touch on deep ethical dilemmas and require complex legal regulation. How to balance individual freedom and collective safety? Who should make decisions about compulsory vaccination? How to ensure fair access to vital vaccinations for all segments of the population? These questions are central to discussions among doctors, lawyers, bioethicists and politicians worldwide.
Epidemiology is not only the science of the spread of infectious diseases, as is often mistakenly believed in Russia 2 . Modern epidemiology has become the science of evaluating everything related to health and medicine from the perspective of improving health and enhancing people's quality of life 2 . Epidemiologists develop methodology for quantifying factors affecting the health of the human population, plan studies to evaluate the effectiveness of medical interventions, including vaccines 2 .
Gathering historical vaccination coverage data for 14 diseases since 1974 4
Creating counterfactual scenarios (what would have happened without vaccination) 4
Examining demographic data and mortality rates 4
Determining years of full health preserved through immunization 4
One of the central ethical principles is social justice in infectious pathology 1 . This principle requires ensuring equal access to prevention and treatment of infectious diseases for all segments of the population, regardless of social status, income, or place of residence.
An acute ethical problem arises when individual right to refuse medical interventions clashes with the need to protect public health. Herd immunity, typically achieved with 95% vaccination coverage, protects those who cannot be vaccinated for medical reasons 3 .
The principle of informed consent requires that patients understand the benefits and risks of medical interventions, including vaccination. However, as noted in sources, fears related to vaccination are often fueled by reports of complications that may actually be simple coincidences in time 3 .
Global immunization programs demonstrate the implementation of this principle: if in 1974, when WHO's Expanded Program on Immunization was launched, less than 5% of infants worldwide had access to routine immunization, today 84% of infants are protected by three doses of DTP vaccine 4 .
In the Russian Federation, the legal basis for immunoprophylaxis is established by Federal Law No. 157-FZ of September 17, 1998 "On Immunoprophylaxis of Infectious Diseases" 3 . This law defines the rights and obligations of citizens during vaccine prevention, establishes the national vaccination calendar, and regulates issues of social protection in case of post-vaccination complications.
The current National Calendar of Preventive Vaccinations includes vaccination against 12 infectious diseases: viral hepatitis B, tuberculosis, pneumococcal infection, diphtheria, pertussis, tetanus, Haemophilus influenzae infection, polio, measles, rubella, mumps, and influenza 3 . Additionally, there is a vaccination calendar for epidemic indications, which includes 16 more infections 3 .
| Disease | Vaccine Type | Schedule |
|---|---|---|
| Hepatitis B | Recombinant | 0-1-6 months |
| Tuberculosis | BCG | 3-7 days |
| Pneumococcal | Conjugate | 2-4.5-15 months |
| Diphtheria, Pertussis, Tetanus | DTP | 3-4.5-6-18 months |
| Polio | IPV/OPV | 3-4.5-6-18-20 months |
| Measles, Mumps, Rubella | MMR | 12 months, 6 years |
In 2024, the authoritative medical journal "The Lancet" published results of a landmark study led by the World Health Organization, assessing the global impact of immunization over the past 50 years 4 . This study became the most comprehensive analysis of the global and regional impact of the Expanded Program on Immunization (EPI) on population health over five decades.
The study showed that over 50 years, global immunization efforts saved at least 154 million lives, equivalent to six lives saved every minute throughout each year 4 . The vast majority of lives saved - 101 million - were infants.
| Indicator | Result | Significance |
|---|---|---|
| Lives Saved | 154 million | 6 lives per minute |
| Infant Lives Saved | 101 million | Mainly due to measles vaccine |
| Years of Full Health | 10.2 billion | 66 years per saved life |
| Paralysis Prevention | Over 20 million cases | Thanks to polio vaccine |
In vaccine evaluation, it's important to distinguish between two types of effectiveness :
Evaluated within controlled conditions of clinical trials. For example, if the clinical effectiveness indicator is 80%, this means that the vaccinated group had an 80% lower risk of getting sick than the unvaccinated group.
Effectiveness of vaccine action in real life. The epidemiological effectiveness indicator may differ from clinical effectiveness as it reflects vaccine action on diverse populations in practical conditions.
The priority method for modern epidemiologists is the skill of critical data assessment 2 . This is especially important in the context of vaccine prevention, where it's necessary to distinguish real post-vaccination complications from simple coincidences in time of two events 3 .
| Tool/Concept | Function/Purpose | Example Application |
|---|---|---|
| Threat Matrix | Assessing severity of consequences and probability of disease occurrence | Prioritizing vaccines for development 2 |
| Clinical Trials | Evaluating safety and effectiveness of vaccines in controlled conditions | Determining clinical effectiveness |
| Post-marketing Surveillance | Monitoring vaccine safety in real conditions | Identifying rare side effects |
| Statistical Analysis | Processing data on incidence and effectiveness | Proving 40% mortality reduction 4 |
Ethical and legal aspects of infectology and vaccine prevention represent a complex set of problems at the intersection of medicine, law, philosophy, and social policy. On one hand, we have unprecedented successes in the fight against infectious diseases: 154 million lives saved in 50 years 4 . On the other - the need to balance between individual rights and collective safety, ensuring fair access to scientific achievements for all segments of the population.
The development of epidemiology as a science capable of critically evaluating data and forming an evidence base for decision-making 2 , improvement of legal norms regulating immunoprophylaxis 3 , and global cooperation in the spirit of justice - all these are necessary elements for solving complex ethical and legal dilemmas in the field of infectology and vaccine prevention.
As the COVID-19 pandemic has shown, these issues remain extremely relevant and require continued dialogue between the scientific community, legislators, and society as a whole. The future of the fight against infectious diseases depends not only on the development of new vaccines but also on the creation of ethical and fair systems for their distribution and application.