Allison Chamberlain, PhD, assistant professor of epidemiology at Emory University's Rollins School of Public Health, is lead author on a paper published in Science magazine proposing an interests-based approach to ethical decision-making about maternal vaccines.

The article's senior author was Saad Omer, MBBS, PhD, William H. Foege Professor of Global Health at Rollins and member of the Emory Vaccine Center. Other co-authors included James V. Lavery, PhD, Hilton Chair in Global Health Ethics at Rollins; as well as Amina A. White, MD, obstetrician/gynecologist, University of North Carolina at Chapel Hill.

In the paper, the authors examined the inadequacies of the conventional risk-benefit paradigm when considering the ethics of maternal vaccines—which traditionally weighs the individual and societal benefits of vaccination against the potential physical risks for the individual receiving the vaccine.  

"For expectant moms, physical harm associated with either a disease or a vaccine is undoubtedly important," says Chamberlain. "But what is just as important is a mother's desire and ability to make decisions that will protect the health of her future baby." 

After critically examining more risk-based approaches to the ethics of maternal vaccination, the authors proposed a new interests-based ethical paradigm for maternal vaccine programs. Their approach directly accounts for women's interests by calling for:

• Collection of more empirical evidence from women themselves about their values and opinions toward maternal vaccines
• Inclusion of more women in national-level discussions about vaccines
• Extension of the interests-based approach to developments currently underway in maternal vaccine research

"This field is expanding exponentially, especially with vaccines that have tremendous potential to protect newborns, but less direct benefit to moms," says Omer. "With this asymmetry of benefit, it is vital to understand what moms want.  Several of the previous models were not taking mothers' interests into account." 

Co-author, James Lavery, PhD, whose work in public health ethics focuses largely on community engagement, agrees. Lavery is the Hilton Chair in Global Health Ethics at Rollins.

"The way we frame ethical issues is important," says Lavery. "This approach addresses a potential weakness in individual-focused risk-benefit assessments and helps to reinforce the critical importance of paying proper attention to the perspectives of pregnant women in the development of vaccination policy." 

Chamberlain, who was pregnant while writing this paper, notes that she didn't have to put herself in anyone else's shoes. "I was in the shoes," she says. "The biggest takeaway from our article is, when in doubt about whether to promote certain vaccines during pregnancy, ask the women themselves."