Public health vaccination programs have been responsible for a significant portion of the control, and in some cases elimination, of serious epidemic infectious diseases. Recommended vaccines for infants and young children are widely used and often the most effective public health measure in areas with limited health budgets. Mandatory vaccination programs have been in place for school entry and military personnel for many years. During Operations Desert Shield/Storm, numerous concerns were raised about the use of anthrax vaccine and botulinum antitoxin in British and United States military forces, and the impact of their use continues today. More recently, with the concern about the possibility of terrorist use of infectious or toxic aerosols as weapons against populations, ethical issues related to use of vaccines to protect public health have again received publicity. The success of these public health vaccination programs depends not only on the widespread use of effective vaccines, but the attitudes, concerns, and acceptance of those at risk who should receive them. This paper will discuss the ethical issues underlying deliberations and decisions on the use and acceptance of public health vaccination programs.