Vaccination policies and the ethics of risking: A scoping review of the bioethics literature

Managing the perceived or actual risks of vaccine policy remains a challenge for public health. Vaccines are among the most significant public health achievements; however, current public and political discourse focuses on the risk of harm they purportedly produce. While the vaccine-related bioethics literature often centres on risk, it has largely overlooked the growing normative scholarship on ethical risk imposition and just distribution. We undertook an analytic scoping review to understand how risk is applied in the bioethics literature, primarily to take stock of where we stand as a bioethics community to advance discussions on ethical vaccination policy. Sixty-two papers were included. Most of the literature adopts an agent-relative rather than agent-neutral account of risk, prioritising duties and rights related to avoiding harm, respecting autonomy and ensuring fairness over simplistic consequentialist reasoning. While individual papers often convey risk as flowing in a single direction - falling into either agent-centred or patient-centred perspectives - the literature as a whole reveals risk to be multidirectional. We are simultaneously both vector and victim, and with regard to risk imposition and distribution, also, morally, both agent and patient. Recognising this is critical for clearer ethical reasoning and more effective discourse and policymaking.