The Case for Pneumococcal Immunization Requirements in Long-Term Care Facilities
Open AccessPneumococcal disease is a major cause of morbidity and mortality in the United States. Since pneumococcal vaccination campaigns have had enormous success in reducing morbidity and mortality from pneumococcal disease in children, elderly persons (those 65 years and older) and chronically-ill adults now suffer the greatest burdens of these infections in this country. Moreover, the CDC reports that "adults in long-term care facilities are at an increased risk of pneumococcal disease due to their advanced age, the frequent presence of chronic illnesses, and residence in a setting that might increase the risk for bacterial transmission." Unfortunately, the effectiveness of the CDC recommended pneumococcal vaccine is being questioned. As a result, researchers have begun to explore a next generation of vaccines that would confer greater immunity and longer protection in long-term care facility populations. It can be reasonably expected that these vaccines will be developed and made available within the near future as several vaccines of this kind are already at late-stage clinical development or early-stage clinical trials. At the same time, the elderly population in the United States is expected to grow significantly in the next 20 years, likely resulting in an increased number of adults residing in long-term care facilities. Therefore, with the development of next generation vaccines and a burgeoning elderly population, the nature of vaccine policy can be expected to radically change in the coming years. In preparation for this imminent future, this paper addresses the bioethical implications of immunization requirements for adults residing in long-term care facilities and will hopefully initiate the conversation on whether such a possibility might be an ethically justifiable policy option.
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