The most common sexually transmitted infection (STI) is human papillomavirus (HPV) (CDC, 2013). Over half of sexually activity people will become infected with HPV at some point in their lifetime (National Cancer Institute, 2012). HPV can fall into two categories: low-risk HPV and high-risk HPV (National Cancer Institute, 2012). Low-risk HPV, also known as HPV types 6 and 11, cause about 90% of genital warts (National Cancer Institute, 2012). High-risk HPV, also known as HPV types 16 and 18, causes about 70% of cervical cancer (National Cancer Institute, 2012).
There are two HPV vaccines available for females (Cervarix and Gardasil) that protect against cervical cancer (CDC, 2013). The CDC Advisory Committee on Immunization Practices advises the vaccine be given to girls 11-12 years old and can be given as young as 9 years old (Armstrong, 2010). Since the Food and Drug Administration approved Cervarix and Gardasil, state legislators have being working to pass laws to require HPV vaccination for young girls before they enter school (Javitt, Berkowitz, & Gostin, 2008).
Case Study 6.3 Summary
In a state with high rates of cervical cancer and a low rate of HPV vaccination, a public health director has some decisions to make (Shi & Johnson, 2014). The state health department was given two options to help increase HPV vaccination rates: 1) require HPV vaccination for entrance into school for girls 11-12 years old, or 2) provide the HPV vaccine at a reduced cost for individuals who are at high risk for HPV (Shi & Johnson, 2014). It is the responsibility of the public health director to determine which option is the most ethical decision (Shi & Johnson, 2014).
Traditionally, mandatory vaccines for entrance into school have been for diseases that can spread by casual contact, which is not the case with HPV (Shi & Johnson, 2014). Since HPV is spread through sexual activity, many people believe requiring the vaccine unethical (Shi & Johnson, 2014). Recent studies have shown that groups who are at the highest risk for cervical cancer are the ones who have the lowest uptake of the HPV vaccine (Shi & Johnson, 2014). Required vaccines for school entry have been successful at making sure children are vaccinated before they enter school, regardless of their race, socioeconomic status, ethnicity, and geographic location (Shi & Johnson, 2014).
What considerations might count against mandatory HPV vaccination for all girls aged 11-12?
There are many ethical and legal issues that count against a mandatory HPV vaccination for all girls aged 11-12 years old. First, the long-term safety and effectiveness of the vaccination is unknown (Javitt et al., 2008). Clinical trials conducted on the HPV vaccine concluded no short-term adverse effects, but as more girls and young women begin to get the vaccine some adverse effects may appear (Javitt et al., 2008). The extent immunity of the HPV vaccine is also unclear. Studies have shown the vaccine to be...