Exploring the Ethical Dimensions of Mandatory Immunization Discourse for School Attendance in Indonesia

https://doi.org/10.22146/jkki.90869

Yosi Marin Marpaung(1*)

(1) Faculty of Medicine and Health Sciences, Krida Wacana Christian University
(*) Corresponding Author

Abstract


Mandating complete vaccination for school attendance is still in the discourse for the future policy in Indonesia. Like any other policy, this discourse needs to be given an open space to be looked in a critical point view of ethic. This article critically examines the ethical dimensions surrounding the discourse of implementing mandatory immunization for school attendance in Indonesia, employing a multi-faceted ethical analysis. A case study utilizing moral reasoning through the lenses of utilitarianism, Kantian ethics, virtue ethics, and principlism was employed. From a utilitarian standpoint, mandatory vaccination is ethically justifiable, emphasizing its potential to yield substantial health benefits for society, reduce healthcare spending, and contribute to economic growth. The straightforward nature of this intervention, unlike other complex public health measures, makes it an appealing strategy for increasing vaccination coverage. However, Kantian, non-maleficence, and autonomy perspectives introduces ethical complexities, as mandatory immunization may be perceived as infringing upon individual beliefs and personal choice. The article advocates for open and honest discussions, understanding religious perspectives, and fostering trust in governmental decision-making to address these concerns. Virtue ethics are explored to underscore the importance of cultivating social responsibility in the success of public health measures. It further emphasizes the need for a just implementation of the policy, treating the specific needs of regions. In conclusion, the article posits that while the benefits of mandatory immunization are substantial, ethical considerations demand a delicate balance between promoting public health goals and respecting individual freedom. It suggests that achieving immunization targets necessitates a comprehensive approach, including respecting individual choices, building trust, widespread education on vaccine benefits and risks, and ensuring sustainable financing and vaccine procurement across all segments of Indonesia.


Keywords


mandatory; immunization; Indonesia; school; vaccination

Full Text:

PDF


References

World Health Organization. Immunization coverage [Internet]. 2022 [cited 2023 Jul 18]. Available from: https://www.who.int/news-room/fact-sheets/detail/immunization-coverage

Ministry of Health Republic of Indonesia. Regulation of the Minister of Health of the Republic of Indonesia Number 13 of 2022 concerning Amendments to Regulation of the Minister of Health Number 21 of 2020 concerning the Strategic Plan of the Ministry of Health for 2020-2024 [Internet]. Indonesia; 2022. p. 1–592. Available from: https://peraturan.bpk.go.id/Home/Download/212694/Permenkes Nomor 13 Tahun 2022.pdf

World Health Organization. Indonesia targets low vaccination areas to tackle decline in childhood immunization during world immunization week, Indonesia recommits to increasing immunization [Internet]. 2023 [cited 2023 Jul 18]. Available from: https://www.who.int/indonesia/news/detail/03-05-2023-indonesia-targets-low-vaccination-areas-to-tackle-decline-in-childhood-immunization

Ministry of Health Republic of Indonesia. Regulation of the Minister of Health of the Republic of Indonesia Number 12 of 2017 concerning Implementation of Immunizations [Internet]. Ministry of Health Republic of Indonesia. 2017. p. 1–162. Available from: file:///C:/Users/yosip/Downloads/Permenkes Nomor 12 Tahun 2017.pdf

Chariris M. Imunisasi jadi syarat masuk PAUD dan SD. jawapos [Internet]. 2019 Jan 2; Available from: https://radarmojokerto.jawapos.com/read/2019/01/02/111223/imunisasi-jadi-syarat-masuk-paud-dan-sd

Nailufar NN. Imunisasi akan dikaitkan dengan Sekolah, KK, SIM, hingga Paspor. kompas.com [Internet]. 2018 May 21; Available from: https://megapolitan.kompas.com/read/2018/05/21/20480241/imunisasi-akan-dikaitkan-dengan-sekolah-kk-sim-hingga-paspor

Paramita R. Buku imunisasi diusulkan jadi syarat pendaftaran sekolah. beritagar [Internet]. 2018 Jan 14; Available from: https://beritagar.id/artikel/berita/buku-imunisasi-diusulkan-jadi-syarat-pendaftaran-sekolah%0ATanya

Abdi AP. Kemenkes: Sertifikat imunisasi bisa jadi syarat masuk SD. tirto.id [Internet]. 2019 Apr 30; Available from: https://tirto.id/kemenkes-sertifikat-imunisasi-bisa-jadi-syarat-masuk-sd-dnni

Harahap FD. Di Batam, Ada Syarat Imunisasi untuk Masuk Sekolah Dasar. batampos.com [Internet]. 2018 Jun 13; Available from: 9/8/2020 Di Batam, Ada Syarat Imunisasi untuk Masuk Sekolah Dasar - batampos.co.id%0ADi Batam, Ada Syarat Imunisasi untuk Masuk Sekolah Dasar%0ARabu, 13 Juni 2018 - 22:11 WIB https://batampos.co.id/2018/06/13/di-batam-ada-syarat-imunisasi-untuk-masuk-seko

Budianto EE. Imunisasi Dasar Lengkap Jadi Syarat Anak Masuk PAUD dan TK di Mojokerto. detiknews [Internet]. 2018 Oct 16; Available from: https://news.detik.com/berita-jawa-timur/d-4747888/imunisasi-dasar-lengkap-jadi-syarat-anak-masuk-paud-dan-tk-di-mojokerto

Carina J, Rastika I. Penjelasan Anis soal Kartu Imunisasi Anak yang Tak Jadi Syarat Masuk SD. kompas.com [Internet]. 2018 May 21; Available from: https://megapolitan.kompas.com/read/2018/05/21/18265011/penjelasan-anies-soal-kartu-imunisasi-anak-yang-tak-jadi-syarat-masuk-sd

Komara I. Kartu Imunisasi Anak Tak Lagi Jadi Syarat Masuk TK-SD. detiknews [Internet]. 2018 May 16;1–4. Available from: https://news.detik.com/berita/d-4023798/kartu-imunisasi-anak-tak-lagi-jadi-syarat-masuk-tk-sd

Riana F, Persada S. Nadiem Izinkan Siswa Belum Vaksin Sekolah Tatap Muka, P2G: Tak Taat Presiden. tempo.co [Internet]. 2021 Aug 21; Available from: https://nasional.tempo.co/read/1496792/nadiem-izinkan-siswa-belum-vaksin-sekolah-tatap-muka-p2g-tak-taat-presiden

Ministry of Education Republic of Indonesia. Kemendikbudristek Tegaskan Vaksinasi Bukan Syarat PTM [Internet]. Kementerian Pendidikan, Kebudayaan, Ristek, dan Teknologi Republik Indonesia. 2022 [cited 2023 Oct 23]. Available from: https://www.kemdikbud.go.id/main/blog/2022/03/kemendikbudristek-tegaskan-vaksinasi-bukan-syarat-ptm

Tim Merdeka. Sekolah Islam & Kristen di Merauke Sama- Sama Tolak Imunisasi. merdeka.com [Internet]. 2018 Dec 16; Available from: https://www.merdeka.com/peristiwa/sekolah-islam-kristen-di-merauke-sama-sama-tolak-imunisasi.html

Tanjung CA. Program Vaksin MR ke Sekolah di Pekanbaru Disetop. detiknews [Internet]. 2018 Sep 24; Available from: https://news.detik.com/berita/d-4225981/program-vaksin-mr-ke-sekolah-di-pekanbaru-disetop

Soetomo. Ortu Siswa Tolak Imunisasi MR dengan Beberapa Alasan. jppn.com [Internet]. 2018 Aug 3; Available from: https://www.jpnn.com/news/ortu-siswa-tolak-imunisasi-mr-dengan-beberapa-alasan

Fachri F, Hafil M. Sejumlah Orang Tua Siswa SD 10 Sungai Sapih Padang Tolak Kewajiban Vaksinasi Anak. republika [Internet]. 2022 Feb 13; Available from: https://news.republika.co.id/berita/r78953430/sejumlah-orang-tua-siswa-sd-10-sungai-sapih-padang-tolak-kewajiban-vaksinasi-anak

Belt H van den. Introduction to Ethics: three varieties of moral reasoning. Wageningen University; 2016. p. 1–18.

United Nations Children’s Fund. #LongLifeForAll: A love letter to those who have made vaccines possible [Internet]. UNICEF. 2023 [cited 2023 Nov 1]. Available from: https://www.unicef.org/long-life-for-all

Nelson R. US measles outbreak concentrated among unvaccinated children. Lancet Infect Dis [Internet]. 2019;19(3):248. Available from: http://dx.doi.org/10.1016/S1473-3099(19)30074-X

Pracoyo NE. Faktor penyebab terjadinya kejadian luar biasa (KLB) pada anak di Indonesia. J Ekol Kesehat [Internet]. 2020;19(3):1–6. Available from: http://ejournal2.litbang.kemkes.go.id/index.php/jek/article/view/4018

Duski OZ, Bantas K, Wahyono TYM. Hubungan status imunisasi campak dengan kejadian campak pada anak usia dibawah 5 tahun saat peristiwa wabah campak di Desa Pagerageung Kecamatan Pagerageung Kabupaten Tasikmalaya tahun 2000. University of Indonesia; 2000.

Kurniawati S, Martini S. Status gizi dan status imunisasi campak berhubungan dengan diare akut. J Wiyata. 2016;3(2):130.

University of Oxford. Herd Immunity [Internet]. University of Oxford. 2023 [cited 2023 Nov 11]. Available from: https://vaccineknowledge.ox.ac.uk/herd-immunity#More-information-about-herd-immunity

Ryu S, Kim JJ, Chen MY, Jin H, Lee HK, Chun BC. Outbreak investigation of pertussis in an elementary school: A case-control study among vaccinated students. Clin Exp Vaccine Res. 2018;7(1):70–5.

Torm S, Meriste S, Tamm E, Alusalu S, Jarviste A, Lang K. Pertussis outbreak in a basic school in Estonia: Description, contributing factors and vaccine effectiveness. Scand J Infect Dis [Internet]. 2009;37(9):664–8. Available from: https://www.tandfonline.com/doi/abs/10.1080/00365540510044454

Born K, Yiu V, Sullivan T. Provinces divided over mandatory vaccination for school children [Internet]. healthydebate.ca. 2014 [cited 2023 Nov 1]. Available from: https://healthydebate.ca/2014/05/topic/health-promotion-disease-prevention/mandatory-school-entry-vaccinations/

Wichmann O, Siedler A, Sagebiel D, Hellenbrand W, Santibanez S, Mankertz A, et al. Further efforts needed to achieve measles elimination in Germany: Results of an outbreak investigation. Bull World Health Organ. 2009;87(2):108–15.

Dinede G, Wondimagegnehu A, Enquselassie F. Rubella outbreak in the school children, Addis Ababa, Ethiopia: February-April 2018. BMC Infect Dis. 2019;19(1):1–7.

Tessier E, Campbell H, Ribeiro S, Andrews N, Stowe J, Nicholls M, et al. Investigation of a pertussis outbreak and comparison of two acellular booster pertussis vaccines in a junior school in South East England, 2019. Eurosurveillance [Internet]. 2021;26(12):1–8. Available from: http://dx.doi.org/10.2807/1560-7917.ES.2021.26.12.2000244

Huang H, Gao P, Gao Z, Wang L, Hao B, Liu Y, et al. A big pertussis outbreak in a primary school with high vaccination coverage in northern China: An evidence of the emerging of the disease in China. Vaccine [Internet]. 2018;36(52):7950–5. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0264410X18315184

Liu X, Li Q, Du X, Zhao X, Yin Z. Vaccine Coverage and Effectiveness in a School-Based Varicella Outbreak in Jinan Prefecture, Shandong Province. Vaccines. 2022;10(8):1–9.

Schleiss MR, John CC, Permar SR. Children are the key to the Endgame: A case for routine pediatric COVID vaccination. Vaccine. 2021;39(38):5333–6.

Gurdasani D, Alwan NA, Greenhalgh T, Hyde Z, Johnson L, McKee M, et al. School reopening without robust COVID-19 mitigation risks accelerating the pandemic. Lancet. 2021;397(10280):1177–8.

World Health Organization. Immunization. World Health Organization. 2019.

Ciolli A. Mandatory school vaccinations: The role of tort law. Yale J Biol Med. 2008;81(3):129–37.

Guimaraes EL, Chissaque A, Pecenka C, Clark A, Vaz B, Banze A, et al. Cost-effectiveness of rotavirus vaccination in Mozambique. Vaccine. 2022;40(36):5338–46.

Suwantika AA, Supadmi W, Ali M, Abdulah R. Cost-effectiveness and budget impact analyses of dengue vaccination in indonesia. PLoS Negl Trop Dis. 2021;15(8).

Gomez JA, Tirado JC, Navarro Rojas AA, Castrejon Alba MM, Topachevskyi O. Cost-effectiveness and cost utility analysis of three pneumococcal conjugate vaccines in children of Peru. BMC Public Health. 2013;13(1).

Ricciardi W, Toumi M. National Immunization Therapeutic Advisory Group: it is time for experience sharing and best practice learning. J Mark Access Heal Policy. 2015;3(1):1–4.

Si R, Yao Y, Zhang X, Lu Q, Aziz N. Investigating the Links Between Vaccination Against COVID-19 and Public Attitudes Toward Protective Countermeasures: Implications for Public Health. Front Public Heal. 2021;9(July):1–11.

Indonesian Pediatric Society. Jadwal Imunisasi Anak Umur 0 – 18 tahun [Internet]. Ikatan Dokter Anak Indonesia. 2023. Available from: https://www.idai.or.id/artikel/klinik/imunisasi/jadwal-imunisasi-anak-idai

Ministry of Health Indonesia. Hasil Utama Riset Kesehatan Dasar (RISKESDAS). 2018.

Ministry of Health Republic of Indonesia. Kemenkes Tambahkan 4 Jenis Vaksin Baru untuk Perlindungan Anak Indonesia [Internet]. Sehat Negeriku. 2023 [cited 2023 May 30]. Available from: https://sehatnegeriku.kemkes.go.id/baca/umum/20230327/5942664/kemenkes-tambahkan-4-jenis-vaksin-baru-untuk-perlindungan-anak-indonesia/

Milligan GN, Barrett ADT. Vaccinology: An Essential Guide. 1st ed. Milligan GN, Barrett ADT, editors. Oxford: John Wiley & Sons; 2015. 1–403 p.

Ministry of Health Republic of Indonesia. Riset Kesehatan Dasar (RISKESDAS) 2013 [Internet]. Ministry of Health Republic of Indonesia. 2013. Available from: https://repository.badankebijakan.kemkes.go.id/id/eprint/4467/1/Laporan_riskesdas_2013_final.pdf

Ministry of Health Republic of Indonesia. Waspada, Campak jadi Komplikasi Sebabkan Penyakit Berat [Internet]. Sehat Negeriku. 2023 [cited 2023 May 30]. Available from: https://sehatnegeriku.kemkes.go.id/baca/rilis-media/20230120/1642247/waspada-campak-jadi-komplikasi-sebabkan-penyakit-berat/

World Health Organization. Global Manual on Surveillance of Adverse Events Following Immunization. World Health Organization. 2016.

Syiroj ATR, Pardosi JF, Heywood AE. Exploring parents’ reasons for incomplete childhood immunisation in Indonesia. Vaccine [Internet]. 2019;37(43):6486–93. Available from: https://doi.org/10.1016/j.vaccine.2019.08.081

Principi N, Esposito S. Adverse events following immunization: real causality and myths. Expert Opin Drug Saf. 2016;15(6):825–35.

Puspitarani F, Sitaresmi MN, Ahmad RA. Adverse events following immunization of COVID-19 vaccine among children aged 6–11 years. Front Public Heal. 2022;10.

Carabin H, Edmunds WJ, Kou U, Hof S Van Den. The average cost of measles cases and adverse events following vaccination in industrialised countries. BMC Public Health. 2002;13:1–13.

Sim SY, Watts E, Constenla D, Huang S, Brenzel L, Patenaude BN. Costs of Immunization Programs for 10 Vaccines in 94 Low- and Middle-Income Countries From 2011 to 2030. Value Heal [Internet]. 2021;24(1):70–7. Available from: https://doi.org/10.1016/j.jval.2020.07.010

Gavi. Vaccine Funding Guidelines. Gavi. 2023. p. 1–98.

World Health Organization. Joint national/international expanded programme on immunization and vaccine preventable disease surveillance review: Indonesia, 10-18 February 2020 [Internet]. 2020. Available from: https://apps.who.int/iris/bitstream/handle/10665/339595/sea-immun-103.pdf?sequence=1

Fonjungo F, Banerjee D, Abdulah R, Diantini A, Kusuma ASW, Permana MY, et al. Sustainable financing for new vaccines in Indonesia: challenges and strategies. Sustainability. 2020;12(9265):1–14.

Wynia MK. Mandating vaccination: What counts as a “mandate” in public health and when should they be used? Am J Bioeth. 2007;7(12):2–6.

Rizki A, Anggraeni D. Penerapan pancasila sebagai dasar kehidupan bermasyarakat. Cive. 2021;1(2):34–9.

United Nations. Universal Declaration of Human Rights. 1948. p. 1–8.

Nadziroh C dan WP. Hak warga negara dalam memperoleh pendidikan. J Konstitusi. 2010;7(1):181–212.

Baron J. Thinking and deciding. 5th ed. Cambridge: Cambridge University Press; 2023. 1–523 p.

Saunders B. How Mandatory can We Make Vaccination? Public Health Ethics. 2022;15(3):220–32.



DOI: https://doi.org/10.22146/jkki.90869

Article Metrics

Abstract views : 48 | views : 17

Refbacks

  • There are currently no refbacks.


Copyright (c) 2024 Jurnal Kebijakan Kesehatan Indonesia : JKKI

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

The Jurnal Kebijakan Kesehatan Indonesia : JKKI [ISSN 2089 2624 (print); ISSN 2620 4703 (online)] is published by Center for Health Policy and Management (CHPM). This website is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License. Built on the Public Knowledge Project's OJS 2.4.8.1.
 Web
Analytics View My Stats