Preventing sin: the ethics of vaccines against smoking.

Advances in immunotherapy are paving the way toward vaccines that target unhealthy behaviors, such as a vaccine that blocks the action of nicotine, reducing the pleasure caused by smoking. Such a tool could prove to be an effective tool for preventing children from taking up smoking. Would it be permissible? The alarming rates of smoking, obesity, and substance abuse pose an enormous challenge for parents and public health officials: how do we prevent children and adolescents from adopting unhealthy behaviors? Legal age limits, high taxes on nicotine products, and advertising restrictions are the primary methods used to discourage tobacco abuse by minors, but dismal statistics show that these methods are woefully inadequate. About 85 percent of current smokers in the United States began smoking before the age of twentyone,1 and 23 percent of high school students are current tobacco users.2 Most school-based programs, as well as media and community interventions, appear to have limited effectiveness in preventing smoking and reducing prevalence rates among children and adolescents.3 There is therefore a clear need to develop additional strategies. One new option that may soon be available is the use of nicotine vaccines. Immunological therapies to help smokers stop smoking have shown promise in phase I and II trials; similar therapies could combat smoking addiction before it starts.4 Nicotine vaccines are distinctive because they confer protection not against infection—the normal target for vaccines—but against enticing pleasures that lead to unhealthy behaviors. As a result, using them preventively in children would be likely to arouse some novel ethical concerns that should be addressed before the vaccines become commonly available and their off-label use as a preventive measure becomes a real option. In this paper, we consider whether it would be ethical for parents to vaccinate their children against smoking if a nicotine vaccine were to be proven effective as a preventive intervention for children or adolescents. We begin by explaining the current state of nicotine vaccine science and suggesting some likely ethical concerns about allowing parents to have their children receive a vaccine. We then present a preliminary argument for making Disclaimer The opinions expressed are the authors’ own. They do not reflect any position or policy of the National Institutes of Health, U.S. Public Health Service, or Department of Health and Human Services. HHS Public Access Author manuscript Hastings Cent Rep. Author manuscript; available in PMC 2016 January 08. Published in final edited form as: Hastings Cent Rep. 2013 ; 43(3): 23–33. doi:10.1002/hast.159. A uhor M anscript