Ethical issues regarding HPV vaccine legislation

Human papillomavirus (HPV) is the most prevalent sexually transmitted disease in the United States and caused an estimated 9700 cases and 3700 deaths from cervical cancer last year. The FDA approval of an HPV vaccine in June 2006, however, caused ethical and political controversy. Much of the political debate relates to the Advisory Committee on Immunization Practices (ACIP) recommendation to vaccinate 11-12 year girls, sparking proposed legislation in over 20 states. While the vaccine may prevent up to 70% of cervical cancer and 90% of genital warts, parents and others raise ethical claims of potential harms, e.g., that vaccination of young girls may lead to earlier initiation and increased risk-taking in adolescent sexual behavior. Opponents also raise moral challenges based on parental autonomy and religious values. Proponents argue, on utilitarian grounds, that population-wide HPV vaccination will significantly reduce cervical cancer and the health care costs related to cervical cancer screening and treatment of abnormal pap smears. This presentation will examine the ethical underpinnings of state legislation, ranging from monetary allocations and educational campaigns to mandates requiring girls to be vaccinated before entry into the sixth grade. For example, the governor of Texas issued an executive order requiring sixth grade girls to be vaccinated in order to avoid the debate in the legislature, thus highlighting ethical challenges about “who” decides and with what criteria. We also will explore the ethical claims embedded in the current political rhetoric that pits provider against parent with children caught in the middle.