Ethics of HPV Vaccination

This has been a topic at ScienceBlogs before.  Now, finally,
the New England Journal of Medicine is catching up.  They have
an editorial on the ethics of vaccination against Human Papilloma
Virus.  It turns out that there are many facets to this issue.
 The background is this: HPV is a major factor in the
development of cervical cancer.  About 10,000 women are
diagnosed with cervical cancer each year in the USA, and there are
about 3,700 deaths per year from the disease.  

To put that in perspective, that is more than the total number of
deaths in the terrorist attacks on 9/11.  


Previous posts on the topic include: href=""> HPV
Vaccine May Be Required in Michigan (mine);  id="a021423"
of the Day: The HPV Vaccine Edition (Mike the Mad Biologist);
and two at Aetiology:  href="">Well,
this is going to tick some people off, and  id="a020131"
cancer, vaccines, and jackalopes.

Michigan did end up passing a law requiring HPV vaccination in girls as
a requirement for attending school.  The big controversy came
from groups who argued against it, citing fear of promoting sexual
activity in teenage girls.  

 James Colgrove, Ph.D., M.P.H., writing in the New England
Journal of Medicine, acknowledges that point, but goes on to say that
it is more complicated than that...


Ethics and Politics of Compulsory HPV Vaccination

James Colgrove, Ph.D., M.P.H.

Volume 355:2389-239, December 7, 2006, Number 23

On September 12, 2006, 3 months after the Food and
Drug Administration licensed a vaccine against human papillomavirus
(HPV), Michigan lawmakers became the first in the United States to
propose that vaccination be compulsory for girls entering sixth grade.
Parents who objected would be able to opt out of the requirement under
the same provisions that apply to other vaccinations. The bill passed
the state senate by an overwhelming margin a week later and awaits
consideration by the house. Other states are likely to follow
Michigan's lead...

Moves to make the vaccine compulsory are sure to ignite a new round of
polarizing debates. Controversy over the product began before it was
licensed, when some religious conservatives expressed concern that the
availability of a vaccine against a sexually transmitted disease would
undermine abstinence-based prevention messages. Advocacy groups such as
Focus on the Family ultimately came to support availability of the
vaccine, but they remain opposed to mandating its use. In their view,
such a requirement constitutes an attempt by the secular state to force
a child to undergo an intervention that may be irreconcilable with her
family's religious values and beliefs.

It is a mistake, however, to view the contrasting stances on
HPV-vaccine mandates as solely, or even primarily, evidence of a
conflict between science and religion. A more complicated dynamic will
shape the ongoing discussion...

The gist of the argument is this: there is no denying the life-saving
potential for this vaccine.  The health issues are
sufficiently urgent that it makes sense to impose policy to maximize
the use of the vaccine.  The issue is whether it should be

The counterarguments are as follows:

  • There are already many vaccines required for children.
     This has been followed by a backlash of sorts, accompanied by
    all sorts of antivaccination rhetoric and activism.  Adding
    another mandatory vaccine could add fuel to the backlash.
  • Bioethicists tend to place high value on patient autonomy.
     Compulsory vaccination goes against this principle.
     Because HPV is not spread as casually as other disease, e.g.
    measles or pertussis, the argument for compulsory vaccination is

Dr. Colgrove does not conclude with a recommendation.  When I
frist read the editorial, I had the vague impression that he was
opposed to mandatory vaccination.  After going through it a
couple of times, I no longer have that impression.  I think he
tried to be nonjudgmental about the issue.  That is
appropriate, given the nature of the article.  

Personally, I think that compulsory vaccination is a good idea.
 Given the nature of blog posts, I am free to say that.
 I know that the schedule of compulsory vaccinations is
already pretty long.  But spread out over several years, it is
not really a burden.  The strongest argument is the
libertarian one, that there should be strict limits on what the
government can compel us to do.  However, as I pointed out,
there are many facets to this issue.  Given that the yearly
mortality from disease from HPV is greater than the loss of life from
the terrorists attacks on 9/11, and the fact that we have put up with a
significant increase in governmental intrusion because of those
attacks, it is at least congruent for us to accept a lesser intrusion
that holds a much greater likelihood of actually saving lives.


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"view, such a requirement constitutes an attempt by the secular state to force a child to undergo an intervention that may be irreconcilable with her family's religious values and beliefs."

Gotta go with Dawkins on this one. In this sense, especially, forcing religion on your child in a way that could jeopordize their health and life is in no uncertain terms child abuse.

If the sole argument you're willing to make in favor of compulsory vaccination is that there's a precedent - particularly when that precedent is quite controversial - then I think it's probably a bad idea. It makes sense to mandate vaccination against diseases which can easily spread from person to person and that would be a serious risk to large populations of children brought together in one place. HPV doesn't have those characteristics.

By Caledonian (not verified) on 09 Dec 2006 #permalink

It was not my intention to propose precedent as the only rationale for mandatory vaccination. Rather, I mention that because it is one issue that was not already mentioned in the NEJM article, or prior scienceblogs posts. No need to be redundant.

I'm really not crazy about mandatory vaccination, it seems to fly in the face of personal choice and responsibility. Certainly it would fuel more hostility against scientific medicine, something we don't need. Throughout history, parents have made choices, some good, some bad for their children, that's just the way it happens (I'm sure some people wouldn't approve when I took my son motorcycling). Extensive government second-guessing is incompatible with a free society.

On the other hand 'promoting promiscuity' is a pretty hokey argument (doseatbelts in cars encourage speeding?)

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WHAT IS WRONG WITH YOU PEOPLE? Isn't SAVING a womans life more important than whether or not the vaccine will be portrayed by society as promoting teen girl sex?

HPV causes cervical cancer. This has just been "admitted, or DISCLOSED TO WOMEN" HPV is spread to the vagina by an infected man's penis via skin-to-skin contact, i.e., engaging in unprotected sex. Thus it can spread so easily, by having unprotected sex with a male partner that has cheated on his girlfriend/wife. Realistically speaking, a woman that has unprotected sex with a male that is having unprotected sex with 1 or more other women DESCRIBES ALOST EVERY WOMAN IN AMERICA. Statistics prove this because by age 50, 80% of women will have contacted HPV.

It was not my intention to propose precedent as the only rationale for mandatory vaccination. Rather, I mention that because it is one issue that was not already mentioned in the NEJM article, or prior scienceblogs posts. No need to be redundant.

thanks for this post admin!!

It is surprising to see that so many people are interested with the idea that mandating the vaccine will promote promiscuity. I definitely do not agree with this idea. People will have sex no matter if you give them a vaccine or not. Some girls have sex at such a young age that they donât realize or have knowledge about the consequences. According to CDC, HPV is one of the most common sexually transmitted infections in the U.S. There is also no test for HPV, so it keeps getting passed around. The HPV vaccine gives 100% protections against HPV types 16 and 18; which is responsible for 70% of all cervical cancers. It also protects against HPV types 6 and 11 that causes genital warts. If the government did mandate it then more people will be likely to get the vaccine. So think about just imagine how many lives could be saved just by getting 3 doses of the HPV vaccine. When the HPV or the vaccine is brought up in conversations it is shocking to see how many people pay no attention to the severity of it. This is a big deal. That is why women are supposed to get annual pap smears, so that they can catch precancerous cells early. This could be prevented just by getting the vaccine. There is no cure for HPV. If a woman does happen to contract HPV she canât just get rid of it. She would have to wait until it shows up in her results for the pap smear. Just by getting the vaccine it could calm your nerves for the rest of your life. That doesnât mean you become superman because there are some types that the vaccine doesnât have protection over but it does protect against the most common. It still lessens your chance by a lot. Susana Wilson I have to agree with you about the society being more worried about promoting sex than worrying about saving a womanâs life. Now that the vaccine is effective for boys and men what is there reason for not getting it? If society is worried about the stigma for women about becoming promiscuous than it doesnât make sense because in society it is more accepted for men to be promiscuous than it is for a woman. One question I leave you with is if there was a vaccine for HIV would people still get it? In my opinion, that has the same meaning as getting a vaccine for HPV. The only difference is that there is a vaccine available for HPV, but many people donât take advantage of it.