Human papillomavirus (HPV) infection is the world’s most common sexually transmitted infection. It is a prerequisite for cervical cancer, the second most common cause of death in cancer among women worldwide, and is also believed to cause other anogenital and head and neck cancers. Vaccines that protect against the most common cancer-causing HPV types have recently become available, and different countries have taken different approaches to implementing vaccination. This paper examines the ethics of alternative HPV vaccination strategies. It devotes particular (...) attention to the major arguments for and against one strategy: voluntary, publicly funded vaccination for all adolescent boys and girls. This approach seems attractive because it would protect more people against cervical cancer and other HPV-related cancers than less inclusive alternatives, without the sacrifice of autonomy that a comparably broad compulsory programme would require. Also, the herd immunity that it would likely generate would protect those who remain unvaccinated, a major advantage from a justice perspective. However, there is a possibility that a HPV vaccination programme targeting all adolescents of both sexes is not considered sufficiently cost-effective. Also, it might pose more difficulties for achieving informed consent than comparable vaccination programmes against other diseases. Ultimately, society’s choice of HPV vaccination strategy requires careful consideration not only of the values at stake but also of available and emerging scientific evidence. (shrink)

Advances in immunotherapy pave the way for vaccines that target not only infections, but also unhealthy behaviors such as smoking. A nicotine vaccine that eliminates the pleasure associated with smoking could potentially be used to prevent children from adopting this addictive and dangerous behavior. This paper offers an ethical analysis of such vaccines. We argue that it would be permissible for parents to give their child a nicotine vaccine if the following conditions are met: (1) the vaccine is expected to (...) result in a net benefit to each individual vaccinated, (2) the expected harms from the side effects of the vaccine are lower than the non-voluntary harms of smoking, and (3) there are no less manipulative methods available that are as effective at preventing smoking initiation. Finally, we show how the framework developed here could be used to analyze the ethics of other chemical interventions designed to modify children’s behavior. (shrink)

When the HPV vaccine was released over a decade ago, there was intense opposition to mandating the vaccine, including among bioethics and legal scholars. Some of the original concerns are now obsolete, while other objections continue to present an obstacle to mandating the vaccine. This essay responds to earlier critiques of mandatory HPV vaccination and offers a series of arguments in support of a vaccine mandate. The first section briefly addresses initial concerns that are no longer relevant. The second section (...) makes the ethical case for mandating HPV vaccination, based on three principles: 1) the best interests of children, 2) solidarity, and 3) health equity. The final section addresses concerns related to implementation of the vaccine, including the validity of linking vaccination to school entry. The essay concludes that we have a moral imperative to protect children from the leading cause of cervical cancer, and that mandating HPV vaccination is the best way to ensure that children of all backgrounds receive the vaccine before they have been exposed to the virus. (shrink)

As of July 1, 2008, females aged 11-26 years seeking status as permanent residents in the United States must produce documentation that they have received the human papillomavirus vaccine before the U.S. Citizenship and Immigration Services will approve their status adjustment. Immigration rights activists and public health officials have objected to this new requirement on the grounds that it is unnecessary and imposes unreasonable barriers to lawful immigration due to its expense. The Supreme Court has generally upheld mandatory vaccination requirements (...) for citizens and non-citizens and has tolerated federal immigration regulations that would be unconstitutional if applied to citizens. However, the HPV vaccination requirement may be arbitrary, unnecessary, and discriminatory as applied to green card applicants who pose no greater threat to public health than citizens who are not subject to the same requirements. Furthermore, the requirement may also impose unreasonable restraints on aliens individual liberties as well as real barriers to immigration. (shrink)

As of July 1, 2008, females aged 11-26 years seeking status as permanent residents in the United States must produce documentation that they have received the human papillomavirus vaccine before the U.S. Citizenship and Immigration Services will approve their status adjustment. Immigration rights activists and public health officials have objected to this new requirement on the grounds that it is unnecessary and imposes unreasonable barriers to lawful immigration due to its expense. The Supreme Court has generally upheld mandatory vaccination requirements (...) for citizens and non-citizens and has tolerated federal immigration regulations that would be unconstitutional if applied to citizens. However, the HPV vaccination requirement may be arbitrary, unnecessary, and discriminatory as applied to green card applicants who pose no greater threat to public health than citizens who are not subject to the same requirements. Furthermore, the requirement may also impose unreasonable restraints on aliens individual liberties as well as real barriers to immigration. (shrink)