Medicine, Health Care and Philosophy

, Volume 14, Issue 1, pp 19–27 | Cite as

The ethics of implementing human papillomavirus vaccination in developed countries

  • Erik MalmqvistEmail author
  • Gert Helgesson
  • Johannes Lehtinen
  • Kari Natunen
  • Matti Lehtinen
Scientific Contribution


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.


Ethics Cervical cancer Herd immunity Human papillomavirus Vaccination 



This work was supported by the Swedish Cancer Society.

Conflicts of interest

ML has received grants for phase II-IV vaccination research from Merck & Co Inc. and GSK Biologicals through his employers: University of Tampere and National Institute for Health and Welfare.


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Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Erik Malmqvist
    • 1
    Email author
  • Gert Helgesson
    • 2
  • Johannes Lehtinen
    • 3
  • Kari Natunen
    • 3
  • Matti Lehtinen
    • 3
    • 4
  1. 1.Centre for Research on Meaning, Ethics and Society (CERSES)Université Paris DescartesParis Cedex 06France
  2. 2.Stockholm Centre for Healthcare Ethics, LIME, Karolinska InstitutetStockholmSweden
  3. 3.University of TampereTampereFinland
  4. 4.National Institute for Health and WelfareHelsinkiFinland

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