The ethics of implementing human papillomavirus vaccination in developed countries
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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.
KeywordsEthics 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.
- Beauchamp, T.L., and J. Childress. 2009. Principles of biomedical ethics, 6th ed. Oxford: Oxford University Press.Google Scholar
- Brown, D.R., S. Kjaer, K. Sigurdsson, et al. 2009. The impact of quadrivalent human papillomavirus (HPV; Types 6, 11, 16, 18) L1 virus-like particle vaccine on infection and disease due to oncogenic nonvaccine HPV types in generally HPV-naïve women aged 16–26 years. Journal of Infectious Diseases 199: 926–935.CrossRefPubMedGoogle Scholar
- Collins, S., S. Mazloomzadeh, H. Winter, P. Bloomfield, A. Bailey, L.S. Young, and C.B. Woodman. 2002. High incidence of cervical human papillomavirus infection in women during their first sexual relationship. BJOG: An International Journal of Obstetrics and Gynaecology 109: 96–98.CrossRefGoogle Scholar
- EMA (European Medicines Agency). 2009. Human medicines—Cervarix. Available: http://www.emea.europa.eu/humandocs/Humans/EPAR/cervarix/cervarix.htm. Accessed 23 Aug 2010.
- EMA (European Medicines Agency). 2010. Gardasil. Available: http://www.emea.europa.eu/humandocs/Humans/EPAR/gardasil/gardasil.htm. Accessed 23 Aug 2010.
- Faden, R.R., and T.L. Beauchamp. 1986. A history and theory of informed consent. New York: Oxford University Press.Google Scholar
- French, K.M., R. Barnabas, M. Lehtinen, O. Kontula, E. Pukkala, J. Dillner, and G.P. Garnett. 2007. Strategies for the introduction of human papillomavirus vaccination: Modelling the optimum age- and sex-specific pattern of vaccination in Finland. British Journal of Cancer 96: 514–518.CrossRefPubMedGoogle Scholar
- FUTURE II Study Group. 2007. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. New England Journal of Medicine 365: 1915–1927.Google Scholar
- Kjaer, S., C. Munk, J.F. Winther, H.O. Jorgensen, C.J. Meijer, and A.J. van den Brule. 2005. Acquisition and persistence of human papillomavirus infection in younger men: A prospective follow-up study among Danish men. Cancer Epidemiology, Biomarkers and Prevention 6: 1528–1533.CrossRefGoogle Scholar
- Lehtinen, M., K. French, J. Dillner, J. Paavonen, and G. Garnett. 2008. Sound implementation of HPV vaccination. Future Medicine (Therapy) 5: 289–294.Google Scholar
- Näsman, A., P. Attner, L. Hammarstedt, J. Du, M. Eriksson, G. Giraud, S. Ahrlund-Richter, L. Marklund, M. Romanitan, D. Lindquist, T. Ramqvist, J. Lindholm, P. Sparén, W. Ye, H. Dahlstrand, E. Munck-Wikland, and T. Dalianis. 2009. Incidence of human papillomavirus (HPV) positive tonsillar carcinoma in Stockholm, Sweden: An epidemic of viral-induced carcinoma? International Journal of Cancer 125: 362–366.CrossRefGoogle Scholar
- Paavonen, J., and the HPV PATRICIA Study Group. 2009. Efficacy of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine against cervical infection and precancer caused by oncogenic HPV types (PATRICIA): Final analysis of a double-blind, randomised study in young women. Lancet 374: 310–314.CrossRefGoogle Scholar
- Rawls, J. 1971. A theory of justice. Cambridge, Mass: Belknap.Google Scholar
- Ross, L.F. 2002. Adolescent autonomy in health care? APA Newsletter: Philosophy and Medicine 2: 193–200.Google Scholar
- WHO (World Health Organization). 2010. Viral cancer. Human papillomavirus. Available: http://www.who.int/vaccine_research/diseases/viral_cancers/en/index3.html. Accessed 04 Feb 2010.
- Woodhall, S., M. Lehtinen, T. Verho, H. Huhtala, M. Hokkanen, and E. Kosunen. 2007. Anticipated acceptance of HPV vaccination at the baseline of implementation: A survey of parental and adolescent knowledge and attitudes in Finland. Journal of Adolescent Health 40: 466–469.CrossRefPubMedGoogle Scholar
- Zimmerman, R.K. 2006. Ethical analysis of HPV vaccine policy options. Vaccine 24: 4112–4120.Google Scholar