From Immunology to Social Policy: Epistemology and Ethics in the creation and administration of paediatric vaccines

This thesis presents an extensive cross-disciplinary exploration of literature appraising epistemological and ethical issues relevant to the current status of paediatric immunisation. It encompasses immunology, epidemiology, medical practice, economics, public health and the formulation and administration of health policy at local, national and international levels. Original insights are drawn from the synthesis of information provided by each of these areas, and future directions are suggested for research and policy formulation. Recently advanced theories on the function of the immune system are evaluated in relation to trends in vaccine creation. The current state of knowledge regarding neonatal tolerance, immunological memory, and vaccine design is analysed. The complexities of both immunological and epidemiological measurements of vaccine efficacy are outlined, and suggestions are made on improvements to study design and comparability of data. Ethical issues such as community versus individual rights, the reporting of adverse events, financial incentive schemes, the linking of immunisation with access to other public services such as education and welfare, and the influence of the profit requirements of trans-national corporations are addressed. The effectiveness of immunisation as a prevention of infectious disease is evaluated in relation to broad-based socio-economic influences on public health. Immunisation is then placed in perspective with other public health measures. The concept of placing immunisation within a broader socio-economic approach to building population health resilience is proposed.