Oral

More than 30 strains of human papilloma virus (HPV) are sexually transmitted (ca. 6.2 million new US cases annually, most of which resolve spontaneously). Approximately 10 strains rarely may lead to cervical cancer (ca. 9700 annually; 3700 deaths) or mother-infant infection during delivery. There are also rare associations with penile and anal cancers while either sex may develop genital warts. In June 2006 the Advisory Committee on Immunization Practices (ACIP) recommended the first HPV vaccine, subsequently FDA licensed for adolescent girls and women aged 9-26. (There is no vaccine for males.) Licensing was followed by an aggressive manufacturer multi-state marketing campaign with smiling female images, adorning also the CDC fact page. The vaccine targets 4 HPV strains accounting for 70% of cervical cancer and 90% of genital warts. It is preventive of new infection without treating prior infection or sequelae. (Cervical cancers not preventable by the vaccine include those from other HPV strains.) The 3-shot series is over a 6-month period, retailing at ca. $360 per patient. (Certain children are eligible for federal or state program coverage.) Vaccination regulation lies in the domain of states’ powers and reflects divergent approaches even within states: Texas governor Rick Perry’s executive order mandating vaccination of all girls entering 6th grade was blocked by the Texas legislature which adopted an opt-in policy after protest from parental-rights and other groups. The HPV controversy provides an ongoing laboratory for examining the confluence of public health interests, ethics and politics; value conflicts and market concerns.

Session Objectives: • Provide background on HPV and the newly available vaccine. • Identify stakeholders and their ethical claims in decision-making regarding HPV vaccination. • Describe the ethical and public health arguments for and against HPV vaccination of adolescent girls. • Analyze the strengths and limitations of compulsory vaccination regulation both historically and regarding HPV.

CE Credits: CME, Health Education (CHES), Nursing