The ethics of implementing human papillomavirus vaccination in developed countries

Abstract

Human papillomavirus (HPV) infection is the world's most common sexually transmitted infection. It is a prerequisite for cervical cancer, the second most common cause of death in cancer among women worldwide, and is also believed to cause other anogenital and head and neck cancers. Vaccines that protect against the most common cancer-causing HPV types have recently become available, and different countries have taken different approaches to implementing vaccination. This paper examines the ethics of alternative HPV vaccination strategies. It devotes particular attention to the major arguments for and against one strategy: voluntary, publicly funded vaccination for all adolescent boys and girls. This approach seems attractive because it would protect more people against cervical cancer and other HPV-related cancers than less inclusive alternatives, without the sacrifice of autonomy that a comparably broad compulsory programme would require. Also, the herd immunity that it would likely generate would protect those who remain unvaccinated, a major advantage from a justice perspective. However, there is a possibility that a HPV vaccination programme targeting all adolescents of both sexes is not considered sufficiently cost-effective. Also, it might pose more difficulties for achieving informed consent than comparable vaccination programmes against other diseases. Ultimately, society's choice of HPV vaccination strategy requires careful consideration not only of the values at stake but also of available and emerging scientific evidence.

School nurses’ attitudes and experiences regarding the human papillomavirus vaccination programme in Sweden: a population-based survey

“…This might have been reflected in the finding that the majority agreed that boys should also be vaccinated. Other childhood vaccinations are offered to both boys and girls, so the exclusion of boys may be viewed as an ethical dilemma, which was also noted by Malmqvist et al [22,23]. Another consideration was the attitude to the age of girls when they received the vaccination, where one-third of nurses believed that girls should be slightly older because it would have been easier to provide them with appropriate information about HPV.…”

Immunoprevention of Human Papillomavirus–Associated Malignancies

“…These regulatory and policy-making decisions profoundly affect vaccine development and uptake ((109), Reviewed in (110)). The use of CIN2/3 as the endpoint for the qualification of second generation preventive HPV vaccines will greatly increase trial sizes over the use of persistent HPV DNA detection as an endpoint, and may impede their development and drive up cost of bio-similar vaccines.…”

Vaccine herd effect

“…There is still debate about the cost-effectiveness of such expensive vaccines compared to the usual screening and promotion of condom use in resource-limited countries [57]. However, with the high efficacy of the vaccine against cervical cancer, a vaccine herd effect might be expected, especially in high endemic regions.…”