大COVID時代的疫苗分配與接種政策倫理考量

The Ethics of Vaccine Allocation and Mandate in the COVID-19 Era

葉明叡(Ming-Jui Yeh)

公共衛生倫理 ； 疫苗分配 ； 疫苗強制接種 ； 共同體 ； COVID-19 ； public health ethics ； vaccine allocation ； vaccine mandate ； body politic ； COVID-19

應用倫理評論

71期（2021 / 10 / 01）

119 - 136

繁體中文

本文探討防疫政策之中的疫苗分配與強制接種倫理議題。本文主張，在談論疫苗於國內與全球的分配時，除了公平正義、效益主義與權利保障的倫理主張以外，也必須將「共同體的倫理」納入考量，特別是在下一階段，臺灣將成為COVID-19疫苗生產國，此議題更為重要。另外，本文認為不論是針對醫療人員或一般大眾的疫苗強制接種政策，都有合理倫理基礎，未來應適時考慮COVID-19疫苗強制接種，以盡速降低健康損失、預防未來損失。本文最後以探討公衛領域特有的群體倫理考量作結。

The article analyzes the ethical issues of vaccine allocation and vaccine mandate policies under the COVID-19 pandemic. The article argues that regarding the national and global vaccine allocation, along with the utilitarianism, equity and fairness, and the rights-based approach, the ethics of body politic should be considered. This consideration is timely and necessary as Taiwan becomes one of the few countries that are capable of vaccine production. The article also argues that, to save lives as many as possible and to prevent losses in the future, vaccine mandate policy should be considered for both health care workers and the general public. The article concludes with a discussion on the ethics of population perspective that is unique in the field of public health.

1. Abbasi, Mahmoud,Majdzadeh, Reza,Zali, Alireza,Karimi, Abbas,Akrami, Forouzan(2018).The evolution of public health ethics frameworks: systematic review of moral values and norms in public health policy.Medicine, Health Care and Philosophy,21(3),387-402.
2. Beauchamp, D.E.(1985).Community: the neglected tradition of public health.Hasting Center Report,15(6),28-36.
3. Bradfield, Owen M,Giubilini, Alberto(2021).Spoonful of honey or a gallon of vinegar? A conditional COVID-19 vaccination policy for front-line healthcare workers.Journal of Medical Ethics,47,467-472.
4. Childress, James F,Faden, Ruth R.,Gaare, Ruth D,Gostin, Lawrence O.,Kahn, Jeffrey(2002).Public health ethics: mapping the terrain.The Journal of Law, Medicine & Ethics,30(2),170-178.
5. Emanuel, Ezekiel J.,Persad, Govind,Kern, Adam,Buchanan, Allen,Fabre, Cécile(2020).An ethical framework for global vaccine allocation.Science,369,1309-1312.
6. Hotez, Peter J.,Narayan, K. M. Venkat(2021).Restoring Vaccine Diplomacy.The Journal of the American Medical Association,325(23),2337-2338.
7. Jecker, Nancy S.,Wightman, Aaron G.,Diekema, Douglas S.(2021).Vaccine ethics: an ethical framework for global distribution of COVID-19 vaccines.Journal of Medical Ethics,47,308-317.
8. Kass, Nancy E.(2001).An Ethics Framework for Public Health.American Journal of Public Health,91(11),1776-1782.
9. WHO, 2020, “Fair allocation mechanism for COVID-19 vaccines through the COVAX Facility,” The Official Website of WHO, URL=https://www.who.int/publications/m/item/fair-allocation-mechanism-for-covid-19-vaccines-through-the-covax-facility (Retrieved on 25 August, 2021).
10. Yeh, Ming-Jui,Cheng, Yawen(2020).Policies Tackling the COVID-19 Pandemic: A Sociopolitical Perspective from Taiwan.Health Security,18(6),427-434.
11. 弗林，2021，〈德國外長發言批評「疫苗外交」〉，法國國際廣播電台 ， URL=https://www.rfi.fr/tw/%E5%9C%8B%E9%9A%9B/20210515-%E5%BE%B7%E5%9C%8B%E5%A4%96%E9%95%B7%E7%99%BC%E8%A8%80%E6%89%B9%E8%A9%95-%E7%96%AB%E8%8B%97%E5%A4%96%E4% BA%A4（2021/08/25 瀏覽）。
12. 法務部，2017，《預防接種作業與兒童預防接種紀錄檢查及補行接種辦法》，法務部全國法規資料庫網站，URL=https://law.moj.gov.tw/LawClass/LawAll. aspx?pcode=L0050017（2021/08/25 瀏覽）。
13. 法務部，2019，《傳染病防治法》，法務部全國法規資料庫網站，URL=https://law.moj.gov.tw/LawClass/LawAll.aspx?pcode=L0050001（2021/08/25 瀏覽）。
14. 楊元傑,林映彤,嚴如玉(2020)。新冠肺炎疫苗的分配正義：臺灣疫苗分配模式之分析。北市醫學雜誌，03/27，1-12。
15. 葉明叡，2021，〈公共衛生的群體倫理觀點〉，自由時報，URL=https://talk.ltn.com.tw/article/paper/1456220（2021/06/22 瀏覽）。
16. 臺大醫院，2021，「醫事實習學生報到須知及線上學程」，國立臺灣大學醫學院附設醫院，URL=https://www.ntuh.gov.tw/ckfinder_file/EDU-education/files/1_%E5%AF%A6%E7%BF%92%E9%86%AB%E4%BA%8B%E5%AD%B8%E7%94%9F%E5%A0%B1%E5%88%B0%E9%A0%88%E7%9F%A5-1100615.pdf（ 2021/08/25瀏覽）。
17. 蔡甫昌,胡嘉輝,莊宇真,黃立民(2021)。傳染病大流行下的疫苗分配與倫理。台灣醫學，25(1)，1-23。

1. 葉明叡,李柏翰(2023)。效益主義的幽靈：大COVID時代的公共衛生倫理反思。應用倫理評論，74，21-39。