By Felicitas Colombo, MPA – Public Affairs, Intelligethics
Vaccines represent one of humanity’s greatest public health achievements. Since the establishment of the World Health Organization’s Expanded Programme on Immunization (EPI) in 1974, vaccination has saved an estimated 154 million lives over the past five decades, making immunization one of the most successful public health interventions in history.1
Vaccination has prevented millions of deaths annually, eliminated smallpox, brought polio to the brink of eradication, and dramatically reduced the burden of diseases such as measles, meningitis, hepatitis B, pneumococcal disease, rotavirus, and human papillomavirus (HPV). Yet unlike many medical innovations, vaccines depend on something that cannot be manufactured in a laboratory: trust.
Trust is built on science but sustained by ethics.
As the global vaccine ecosystem becomes increasingly interconnected -with governments, biotechnology companies, pharmaceutical manufacturers, academia, international organizations, philanthropic foundations, healthcare professionals, and civil society working together- ethical conduct has emerged as a strategic determinant of successful immunization programmes. Scientific excellence alone is no longer sufficient. Transparency, accountability, equity, and integrity now define whether innovations translate into public confidence and high vaccination coverage.
The COVID-19 pandemic is a good example of the extraordinary capabilities of public-private collaboration while simultaneously exposing vulnerabilities that continue to shape vaccine confidence worldwide. It reminded us that ethical leadership is not an abstract philosophical concept but a practical necessity for global health security.
Ethics Beyond Compliance
Ethics is often mistakenly viewed as synonymous with regulatory compliance. In reality, ethical leadership extends well beyond legal obligations.
Health ethics is grounded in universally recognized principles including beneficence, non-maleficence, justice, autonomy, transparency, solidarity, and accountability.2 These principles guide decisions that affect not only individual patients but also entire populations.
Vaccination differs fundamentally from many therapeutic interventions because it generates both personal protection and collective benefit through herd immunity. Consequently, ethical decision-making extends beyond the physician-patient relationship to encompass resource allocation, procurement, manufacturing priorities, emergency authorizations, communication strategies, surveillance, and equitable access.
Every stakeholder within the vaccine ecosystem shares responsibility for protecting public confidence.
Public-Private Partnerships require Public Trust
The rapid development of COVID-19 vaccines demonstrated what can be achieved when governments, research institutions, regulators, manufacturers, multilateral organizations, and investors work toward a common objective.
Within a year of the identification of SARS-CoV-2, multiple highly effective vaccines had been developed, evaluated, authorized, manufactured, and distributed globally -an unprecedented scientific accomplishment made possible through decades of investment in vaccine research and robust public-private partnerships.3 However, the pandemic also illustrated that speed must never compromise transparency.
Emergency Use Authorizations required regulators to communicate evolving evidence clearly and transparently, while manufacturers navigated heightened attention to clinical trial data, manufacturing quality, adverse event reporting, and production capacity. The lesson is clear: accelerated innovation demands equally strong ethical governance.
Public-private partnerships succeed only when each participant maintains scientific independence, transparent decision-making, clearly managed conflicts of interest, and open communication regarding risks and uncertainties.2
When Ethics Fail, Public Health Suffers
History offers numerous examples of how unethical conduct can undermine decades of scientific progress. Many examples come to mind. And what they all have in common is that the damage continues until today.
Consequences extend far beyond one isolated incident, illustrating how scientific or institutional misconduct creates long-lasting public health harm.
Ethical failures need not involve outright fraud. Selective reporting of positive findings, delayed disclosure of safety information, inadequate informed consent, undisclosed conflicts of interest, misleading communication, or inequitable distribution policies can all weaken confidence in immunization programmes.2
Trust, once lost, can require generations to rebuild.
Transparency is the New Standard
Today’s healthcare professionals expect more than regulatory approval… they expect openness.
Clinical trial protocols, safety monitoring plans, pharmacovigilance data, effectiveness studies, benefit-risk assessments, and post-marketing surveillance increasingly shape professional confidence. Transparency should also characterize relationships between industry, governments, academic institutions, and international organizations.2
Public-private partnerships inevitably involve financial investments, intellectual property considerations, and shared governance. Transparent disclosure of funding arrangements, advisory roles, procurement processes, and potential conflicts of interest strengthens the credibility of scientific collaboration.
The willingness to acknowledge uncertainty also represents ethical leadership. Scientific knowledge evolves continuously, particularly during emerging infectious disease outbreaks. Communicating evolving evidence honestly reinforces confidence because it demonstrates that decisions are guided by data rather than ideology.
Equity: an Ethical and Strategic Imperative
The COVID-19 pandemic highlighted one of the greatest ethical challenges in modern vaccinology: unequal access.
While many high-income countries rapidly secured sufficient doses to immunize their populations several times over, numerous low- and middle-income countries waited months for meaningful access despite facing severe disease burdens. This imbalance exposed weaknesses in global manufacturing capacity, supply chains, procurement mechanisms, and technology transfer.
Ethical vaccine ecosystems should prioritize equitable access through regional manufacturing, diversified supply chains, voluntary technology transfer, sustainable financing, and stronger regulatory systems.
Initiatives led by WHO, Gavi, CEPI, UNICEF, and regional organizations have demonstrated that global collaboration can substantially improve vaccine access.1,8,9 However, long-term resilience requires building manufacturing capacity closer to where vaccines are needed. Latin America and Africa have increasingly recognized this strategic priority.
Developing regional manufacturing hubs is no longer simply an economic objective, it is an ethical commitment to reducing dependency, improving preparedness, and ensuring more equitable access during future pandemics.
Ethics in the Era of Pandemic Preparedness
Negotiations surrounding the WHO Pandemic Agreement have reinforced the central role of ethics in global health governance.10
Discussions regarding equitable access to pathogens, benefit-sharing mechanisms, technology transfer, surveillance, and manufacturing capacity all reflect broader ethical questions concerning solidarity and shared responsibility.
Similarly, initiatives to strengthen regional regulatory authorities and organizations such as the African Medicines Agency represent important efforts to improve accountability, regulatory harmonization, and equitable access across regions.11
Preparedness cannot be measured solely by stockpiles or manufacturing capacity. It must also be measured by the strength of ethical governance before the next emergency occurs.
Countries that establish transparent regulatory systems, trusted communication strategies, resilient public-private partnerships, and equitable procurement mechanisms will be better positioned to respond effectively to future outbreaks.3
Artificial Intelligence and New Ethical Frontiers
The vaccine ecosystem is entering another period of rapid transformation… it’s called Artificial Intelligence.
AI is accelerating antigen discovery, optimizing clinical trial design, improving pharmacovigilance, and strengthening outbreak prediction. Genomic surveillance is enabling faster identification of emerging pathogens, while messenger RNA technologies continue expanding beyond COVID-19 toward influenza, respiratory syncytial virus (RSV), cancer therapeutics, and neglected tropical diseases.12
All these innovations bring new ethical questions.
Who owns health data used to train AI systems? How should algorithmic bias be addressed? How can genomic information be protected while enabling scientific collaboration? What constitutes equitable access to next-generation vaccine technologies? How do I discern which information is accurate?
And, in an increasingly complex information environment… Who can we trust?
Looking Ahead
The future of immunization will depend upon unprecedented collaboration between governments, industry, academia, multilateral organizations, and healthcare professionals.
Scientific innovation will undoubtedly continue producing safer, more effective, and increasingly sophisticated vaccines. However, innovation alone will not determine success. As science advances, stakeholders’ commitment to ethical principles must advance alongside.
The defining challenge of the coming decade will be sustaining public trust amid rapid technological change, evolving misinformation, geopolitical uncertainty, and persistent inequities.
Ethics provides the foundation upon which this trust can be built.
References
- World Health Organization. Expanded Programme on Immunization (EPI): 50 years of saving lives. Geneva: WHO; 2024.
- World Medical Association. Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Subjects. 2024 Revision.
- World Health Organization. COVID-19 Strategic Preparedness and Response Reports. Geneva: WHO; 2021–2023.
- Godlee F, Smith J, Marcovitch H. Wakefield’s article linking MMR vaccine and autism was fraudulent. BMJ. 2011;342:c7452.
- Hviid A, Hansen JV, Frisch M, Melbye M. Measles, mumps, rubella vaccination and autism: a nationwide cohort study. Ann Intern Med. 2019;170(8):513–520.
- Omer SB, Salmon DA, Orenstein WA, deHart MP, Halsey N. Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. N Engl J Med. 2009;360:1981–1988.
- Emanuel EJ, Wendler D, Grady C. What makes clinical research ethical? JAMA. 2000;283(20):2701–2711.
- Gavi, the Vaccine Alliance. 2026–2030 Strategy. Geneva: Gavi.
- Coalition for Epidemic Preparedness Innovations (CEPI). The 100 Days Mission. Oslo: CEPI.
- World Health Assembly. WHO Pandemic Agreement. Geneva: WHO; 2025.
- African Union. Agreement Establishing the African Medicines Agency (AMA). Addis Ababa: African Union.
- World Health Organization. Ethics and Governance of Artificial Intelligence for Health. Geneva: WHO; 2021.
- Larson HJ. The State of Vaccine Confidence. Various annual reports, Vaccine Confidence Project, London School of Hygiene & Tropical Medicine.
