Data from: The interactions of ethical notions and moral values of immediate stakeholders of immunisation services in two Indian states: a qualitative study

OBJECTIVES: This study examines the existing norms regarding immunization
within the communities and the ethical notions that govern the action of
different health professionals and their collective synergistic or
conflicting effect on governance of the programme. Design: We used
descriptive and analytical qualitative methods as it suited the research
question. SETTING: The data was collected from areas under 16 Primary
Health Centres in Kerala and Tamil Nadu identified through three-step
sampling process. PARTICIPANTS: This involved in-depth interview with
stakeholders including providers, beneficiaries and other stakeholders,
focus group discussions with mother of under five children and participant
and non-participant observations of vaccination related activities.
RESULTS: Unlike most other ethical analysis that looks at ethics of
vaccination policies, the interactions of normative principles and notions
are analysed in this article. Moral obligation of parents towards their
children, beneficence of health care providers and the utilitarian
aspirations of the state are the key normative principles involved. Our
analysis points to the interplay of both synergy and conflict in ethical
notions and moral values in the context of immunisation services.
Paternalistic interventions like special immunisation campaigns against
polio and Japanese encephalitis are a case in point: they generate
conflict at the normative level and create mistrust. CONCLUSIONS: Analysis
of vaccination policies and programmes need to go beyond factors that
assess monitory benefits or herd immunity. Understanding the interactions
normative notions that shape the social organisation of the providers and
the users of vaccination is important in creating a sustainable
environment for the programme.

研究目标：本研究旨在考察社区内现有免疫接种相关规范，以及支配不同卫生专业人员行为的伦理理念，及其对该免疫规划治理产生的协同或冲突性影响。
研究设计：鉴于该方法契合本研究问题的研究需求，我们采用描述性与分析性定性研究方法。
研究场景：数据采集自喀拉拉邦（Kerala）与泰米尔纳德邦（Tamil Nadu）的16个初级卫生保健中心（Primary Health Centres）所辖区域，该区域通过三步抽样流程确定。
研究对象：本研究包含对免疫接种相关利益相关方（stakeholders）的深度访谈，其中包括服务提供者（providers）、受益对象（beneficiaries）及其他利益相关方；同时开展了针对五岁以下儿童母亲的焦点小组讨论，以及对免疫接种相关活动的参与式与非参与式观察。
研究结果：与多数聚焦疫苗接种政策伦理的分析不同，本文聚焦规范原则与理念的互动关系。本研究涉及的核心规范原则包括：父母对子女的道德义务、医疗卫生服务提供者的行善原则（beneficence），以及国家的功利性诉求。分析表明，在免疫接种服务场景中，伦理理念与道德价值间同时存在协同与冲突的互动关系。以针对脊髓灰质炎（polio）与日本脑炎（Japanese encephalitis）的专项免疫接种运动这类家长式干预措施为例，此类举措会在规范层面引发冲突，并滋生信任危机。
研究结论：对疫苗接种政策与规划的分析，不应仅局限于评估货币收益或群体免疫（herd immunity）相关因素。理解塑造免疫服务提供者与使用者社会组织形态的各类规范理念间的互动关系，对于构建该免疫规划的可持续发展环境至关重要。