Ethics of school-based immunisation programs examined

Friday, 23 January 2015

University of Adelaide 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.

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