Concerns over a rare but serious adverse event (intussusception) led to the market withdrawal in 1999 of the RotaShield rotavirus vaccine. The withdrawal, the rationale for which did not adequately consider the staggering burden of diarrheal disease in developing countries, arguably resulted in millions of preventable deaths from rotavirus in high burden areas. Such concerns over what constitutes an acceptable vaccine continue to surface frequently in global health, not least because of the low probability of any current or future vaccine fully satisfying the trifecta of real‐world effectiveness: high efficacy, low cost, and no safety concerns. The ESC team took a novel approach to providing guidance on this issue in a paper published in the Journal of Global Health in December 2011. We used the case of limited uptake of rotavirus vaccines in high‐burden countries to illustrate the imperative for public health decision‐makers to apply principles from public health ethics (i.e., effectiveness, necessity, and promotion of the greater good) in considering vaccine uptake.