1. 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
david.r.curry@centerforvaccineethicsandpolicy.org

2. Mission:
Contribute to public health as the leading independent,
academically-based center focused on global
immunization and vaccine
ethics and policy

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

4. 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
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

5. Bioethics
Bioethics provides an orderly way of
thinking about where and how
"values" should inform
policy, practice and action.
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

6. Ethical Principles Underlying Vaccine Policy
Formation
Harm
Principle
Autonomy
Beneficence
Non-maleficence
Justice
Laws
Social Norms
Effectiveness
Proportionality
Necessity
Infringement
Public
Justification
Religious/Cultural
Frameworks
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

7. Are “values” and “social
norms” forms of evidence?
How to portray the
“available evidence” and
incorporate “values”?
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

8. Draft “Future
State” Conceptual
Map ?2015
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
David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
Associate Fellow, Center for Bioethics
University of Pennsylvania
david.r.curry@centerforvaccineethicsandpolicy.org

9. Draft “Future State”
Conceptual Map ?2015
“Values” Adapted from: Jason L. Schwartz, MBE, AM, Center for Bioethics; Department of History & Sociology of
Science University of Pennsylvania
grounded parameters Care Personnel Influenza Vaccination Subgroup
NVAC Health
31 May 2011
David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
Associate Fellow, Center for Bioethics
University of Pennsylvania
david.r.curry@centerforvaccineethicsandpolicy.org

10. Ethical Imperatives
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

11. 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
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

12. 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.
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

13. 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.
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

14. Science 12 May 2006:
Vol. 312 no. 5775 pp. 854-855
DOI: 10.1126/science.1125347
Life-Cycle Allocation Principle
…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).
…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.

17. [faint praise]

18. [faint praise]

21. No substantive engagement of
vaccines or immunization…at all…

22. Draft “Future State”
Conceptual Map ?2015
“Values” Adapted from: Jason L. Schwartz, MBE, AM, Center for Bioethics; Department of History & Sociology of
Science University of Pennsylvania
grounded parameters Care Personnel Influenza Vaccination Subgroup
NVAC Health
31 May 2011
David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
Associate Fellow, Center for Bioethics
University of Pennsylvania
david.r.curry@centerforvaccineethicsandpolicy.org

23. Questions/Comments/
Ideas
David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
Associate Faculty,
Department of Medical Ethics, NYU Medical School
david.r.curry@centerforvaccineethicsandpolicy.org
267.251.2305
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