OBJECTIVES: This study examines the existing norms regarding immunization within the communities and the ethical notions that govern the action of different health professionals and their collective synergistic or conflicting effect on governance of the programme. Design: We used descriptive and analytical qualitative methods as it suited the research question. SETTING: The data was collected from areas under 16 Primary Health Centres in Kerala and Tamil Nadu identified through three-step sampling process. PARTICIPANTS: This involved in-depth interview with stakeholders including providers, beneficiaries and other stakeholders, focus group discussions with mother of under five children and participant and non-participant observations of vaccination related activities. RESULTS: Unlike most other ethical analysis that looks at ethics of vaccination policies, the interactions of normative principles and notions are analysed in this article. Moral obligation of parents towards their children, beneficence of health care providers and the utilitarian aspirations of the state are the key normative principles involved. Our analysis points to the interplay of both synergy and conflict in ethical notions and moral values in the context of immunisation services. Paternalistic interventions like special immunisation campaigns against polio and Japanese encephalitis are a case in point: they generate conflict at the normative level and create mistrust. CONCLUSIONS: Analysis of vaccination policies and programmes need to go beyond factors that assess monitory benefits or herd immunity. Understanding the interactions normative notions that shape the social organisation of the providers and the users of vaccination is important in creating a sustainable environment for the programme.