The Ethics and Politics of Compulsory HPV Vaccination

Colgrove, James

doi:10.1056/nejmp068248

Cited by 172 publications

(94 citation statements)

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“…However, some argue that society should protect innocent children who may be hurt by the choices of their parents. 24 The issue has been conceptualized as conflict between autonomy and utilitarianism. 25 Other parents place the decision in the hands of their health care provider.…”

Section: Discussionmentioning

confidence: 99%

Parental Acceptance of a Mandatory Human Papillomavirus (HPV) Vaccination Program

Ferris¹,

Horn²,

Waller³

2010

The Journal of the American Board of Family Medicine

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Objectives: The objective of this study was to determine factors that influence parent's acceptance of a mandatory school-based human papillomavirus (HPV) vaccination program.Methods: A convenience sample of 325 parents, with children aged 9 to 17 years old, completed a 53-item survey. Survey questions targeted their opinions about HPV, the HPV vaccine, and a mandatory HPV vaccination program.2 tests were used to examine relationships between survey items. Results: Characteristics of parents who believed the HPV vaccine should be mandated included limited financial resources (P ‫؍‬ .03), history of HPV-related disease (P ‫؍‬ .04), understanding their child's susceptibility (P ‫؍‬ .03), interest in HPV vaccination for their child (P ‫؍‬ .0001), and knowledge that the vaccine reduces the risk of cervical cancer (P ‫؍‬ .001). Parents of children aged 12 to 14 years old (P ‫؍‬ .02) or who knew the vaccine reduced their child's risk of developing genital warts (P ‫؍‬ .02) and cervical cancer (P ‫؍‬ .001) would be more likely to comply with a mandatory HPV vaccine program.Conclusions Although the quadrivalent human papillomavirus (HPV) vaccine has demonstrated robust efficacy and reasonable safety, suboptimal vaccination rates raise concern and questions.1-6 A survey conducted in 2007 by the Centers for Disease Control and Prevention found that approximately 25% of 13-to 17-year-old girls had received at least one dose of the HPV vaccine. 5 Moreover, far fewer 9-to 12-year-old and 18-to 26-year-old girls and women have initiated the vaccination series. The poor rate of HPV vaccine coverage for 9-to 12-year-old girls is particularly worrisome because this has been deemed the ideal age to vaccinate. 7 In comparison, coverage for school-entry vaccines during the 2007-2008 school year estimated by the Centers for Disease Control and Prevention varied between 94% (varicella) and 96% (hepatitis B).8 The differences in these vastly contrasting rates of vaccination are likely because of many factors, including cost, safety, knowledge, provider issues, access, and controversy.9 -11 However, one simple explanation is that school-entry vaccines are mandated and the HPV vaccine is not.Although discussion of mandating vaccines generates conflicting opinions, this approach has proven very beneficial from a public health perspective. School-mandated vaccination programs have increased coverage for other vaccines. [12][13][14][15] However, such an approach for the HPV vaccine has met some resistance by the medical community. 16 Further, only a minority of parents approve mandating the quadrivalent HPV vaccine. 17,18 Loss of parental autonomy, cost, insufficient data from clinical trials, and too This article was externally peer reviewed.

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Section: Discussionmentioning

confidence: 99%

Parental Acceptance of a Mandatory Human Papillomavirus (HPV) Vaccination Program

Ferris¹,

Horn²,

Waller³

2010

The Journal of the American Board of Family Medicine

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“…Furthermore, commentators speculate that the controversy may have undermined public confidence in the HPV vaccine and, more generally, in other state immunization requirements. [6][7][8] For instance, in a May 2007 editorial in the Journal of the American Medical Association, Lawrence Gostin and Catherine DeAngelis argued that "making the HPV vaccine mandatory contributes to long-standing parental concerns about the safety of school-based vaccinations. The use of compulsion, therefore, could have the unintended consequence of heightening parental and public apprehensions about childhood vaccinations."…”

Section: Background On the Issuementioning

confidence: 99%

Controversy Undermines Support For State Mandates On The Human Papillomavirus Vaccine

et al. 2010

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State actions requiring adolescent girls to receive the human papillomavirus (HPV) vaccine created controversy following the vaccine's approval in 2006. Some health professionals worried that the controversy might dampen public support for those state policies and for other school immunizations in general. We fielded an experimental Internet survey to determine how controversy affects attitudes about vaccines. We discovered that public support for the HPV vaccine mandates wanes when the public is informed that the policies are controversial. However, the experimental survey also revealed that exposure to this policy controversy did not spill over and reduce public support for immunizations in general.

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“…The interested reader is directed to excellent commentaries on the topic. 23,24 Generally speaking, the proponents of vaccination highlight the efficacy and safety of the vaccine and the public health responsibility to protect citizens from avoidable dangers, often citing the finding that other vaccines such as polio have been mandated with great success. 25 Opponents question the safety of the vaccine and length of follow-up data in clinical trials, the need for a vaccine given the availability of screening programs for premalignant lesions, as well as the potential violation of privacy, family values, and civil liberties.…”

Section: Hpv Vaccinationmentioning

confidence: 99%

Human papillomavirus status in head and neck cancer

Shuman

Wolf

2010

Cancer

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Human papillomavirus (HPV) is an emerging causative factor for squamous carcinoma of the oropharynx and perhaps other head and neck cancers. There is a great deal of uncertainty regarding the clinical significance and implications of HPV status in this patient population. As a result, there is no established protocol for informing patients of the potential link between viral infection and their cancer. This paper discusses some of the ethical issues involved with informing head and neck cancer patients of their HPV status, recognizing the dilemma posed by unresolved clinical questions and the need to respect the autonomy of patients by disclosing relevant information. Cancer 2010;116:4221-6. V C 2010 American Cancer Society.KEYWORDS: human papillomavirus, head and neck cancer, oropharynx, disclosure, patient autonomy.An increasing volume of data have linked infection with human papillomavirus (HPV), a sexually transmitted pathogen, with head and neck cancer. 1,2 HPV infection may explain the increasing incidence and changing demographics of these cancers, particularly squamous cell carcinomas of the oropharynx. 3,4 Patients with HPV-related tumors often lack the classic risk factors for these malignancies, such as a history of tobacco or alcohol abuse, and often present at younger ages. 5 Currently, there are no conclusive data suggesting that treatment modalities or other aspects of care should differ for head and neck cancer patients based on their HPV status.The issue of discussing the relationship of HPV status and the development of head and neck cancer poses a dilemma. Clinicians aspire to keep their patients duly informed, but may not know which patients might have HPVrelated infections, nor can they make further definitive statements regarding etiology or outcome based on the limited knowledge of this clinical entity. In general, we know that the association of HPV infection in a nonsmoking head and neck cancer patient is a favorable prognostic factor; however, the literature addressing HPV-related head and neck cancers is growing exponentially. This paper does not attempt to provide a comprehensive review of the topic, but will discuss the ethical issues surrounding the disclosure and discussion of HPV status among head and neck cancer patients. Ethical Tenets of Honesty and TransparencyContemporary medical ethics is based on a foundation in which patients and their healthcare providers are partners. Patients and their designated decision-makers are charged with using the expertise and recommendations of their physicians to make informed and reasoned decisions. Rather than make paternalistic judgments concerning what patients should know or must do, physicians are obligated to present all relevant and pertinent information in a way that is accurate and honest, and allow their patients to act autonomously. One model of this process involves the implementation of both informal conversational ethics and formal deliberative ethics. 6 The former process centers on the creation of a partnership between physic...

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The Ethics and Politics of Compulsory HPV Vaccination

Cited by 172 publications

References 5 publications

Parental Acceptance of a Mandatory Human Papillomavirus (HPV) Vaccination Program

Parental Acceptance of a Mandatory Human Papillomavirus (HPV) Vaccination Program

Controversy Undermines Support For State Mandates On The Human Papillomavirus Vaccine

Human papillomavirus status in head and neck cancer

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