Ethics of maternal vaccination

Innovations in vaccine science have given us an incredible opportunity to leverage the maternal immune system to improve maternal, fetal, and infant health outcomes. Maternal vaccination reduces the risk of infant infection primarily through the transfer of protective maternal antibodies to the fetus (1). Although a growing number of countries are adopting maternal vaccine programs against diseases like influenza and pertussis, and there is an increased focus on including pregnant women in trials for new vaccines, there is little discussion of the ethical underpinnings of maternal vaccine programs (2). We see the proposals thus far as being overly paternalistic, founded on a too-limited conception of risk-benefit analyses that has potential to derail the development and use of lifesaving vaccines. By contrast, an ethical approach focused on mothers’ primary interests in protecting themselves and their children could serve as the basis of the ethical framework that guides vaccine policies.