The Sexual Ethics of HPV Vaccination for Boys

Abstract

Human papillomavirus (HPV) is one of the most common sexually transmitted infections. It is a leading cause of cervical cancer in women but the virus is increasingly being linked to several other cancers in men and women alike. Since the introduction of safe and effective but also expensive vaccines, many developed countries have implemented selective vaccination programs for girls. Some however argue that these programs should be expanded to include boys, since (1) HPV constitutes non-negligible health risks for boys as well and (2) protected boys will indirectly also protect girls. In this paper we approach this discussion from an ethical perspective. First, on which moral grounds can one justify not reimbursing vaccination for the male sex? We develop an ethical framework to evaluate selective vaccination programs and conclude that, in the case of HPV, efficiency needs to be balanced against non-stigmatization, non-discrimination and justice. Second, if vaccination programs were to be expanded to boys as well, do the latter then also have a moral duty to become immunized? Two arguments in favor of such a moral duty are well known in vaccination ethics: the duty not to harm others and to contribute to the public good of public health. However, we argue that these are not particularly convincing in the context of HPV. In contrast, we believe a third, more powerful but also more controversial argument is possible. In our view, the sexual mode of transmission of HPV constitutes an additional reason to believe that boys in fact may have a moral obligation to accept vaccination.

Universal HPV Vaccination – a Global Prerogative

“…51 It is also unfair for females to be expected to bear the burden of HPV prevention through vaccination, particularly when HPV is a virus that is sexually transmitted, and affects both sexes so prolifically. 15,52 With the burden of HPV-related disease in men in developed countries comparable to women, and no screening programme available in males for anal cancer or OPC, it is questionable to have a public health policy that is reliant on men being protected solely by herd immunity.…”

The male role in cervical cancer prevention and transmission: Representation of subject positions in South African press reports (1998-2014)

“…The intimacy discourse of sex as moral justification for male vaccination has been used (Luyten et al, 2014), yet this dominant construction serves as a barrier for action and excludes the realistic possibility that sex may be experienced outside of the context of emotional and romantic intimacy. The parent-consumer must engage with sexual enlightenment.…”

“…This is a case in point of Thompson's (2010) statement that a country's government can unknowingly continue to propagate paternalistic values. Furthermore, the position of the fiscal-savvy organization reinforces structural culpability because, following the argument of Luyten et al (2014), policies about HPVV, which are argued to be morally justified for both boys and girls, cannot be ethically based on cost-effectiveness. This organization's agency illustrates how biopolitics links with sex selectivity.…”

“…Luyten, Engelen and Beutels (2014) question the moral dimensions of justifying HPVV for the female sex. They argue that discrimination occurs on an individual level if public demographics are used to justify selective vaccination.…”

“…By targeting girls only, girls become stigmatized as responsible and promiscuous. Another moral argument for boys to be vaccinated appeals to sex being equated with intimacy: Luyten et al (2014) argue that boys should be vaccinated because they have sex with girls, and sexual acts symbolize intimacy. The problem with the intimacy argument is that it delegates recreational or casual sex into positions of deviance.…”