Recent developments in childhood immunisation programmes present unique challenges – the number of vaccines on offer continue to increase, while at the same time the risk–beneﬁt
ratios of some vaccines become increasingly narrow. In this setting, it is increasingly difﬁcult to balance competing demands– public health imperatives for high uptake of immunisation,
requirements for valid consent and respect for personal choice. But there is no option but to address these challenges as consent remains the cornerstone of respect for autonomy in health care and is one of the foundations upon which public trust in immu-nisation is maintained.