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The Ethical Case for Mandating HPV Vaccination

Published online by Cambridge University Press:  01 January 2021

Michelle J. Bayefsky
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Extract

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.

Type
Independent Articles
Information
Journal of Law, Medicine & Ethics , Volume 46 , Issue 2: Law and the Opioid Crisis: An Inter-Disciplinary Examination , Summer 2018 , pp. 501 - 510
Copyright
Copyright © American Society of Law, Medicine and Ethics 2018

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References

Keim-Malpass, J., Mitchell, E.M., De Guzman, P. B., Stoler, M.H., and Kennedy, C., “Legislative Activity Related to the Human Papillomavirus (HPV) Vaccine in the United States (2006-2015): A Need for Evidence-Based Policy,” Risk Management and Healthcare Policy 10 (2017): 29-32.Google Scholar
Udesky, L., “Push to Mandate HPV Vaccine Triggers Backlash in USA,” Lancet 396, no. 9566 (2007): 979-980; L.O. Gostin and C.D. DeAngelis, “Mandatory HPV Vaccination: Public Health vs Private Wealth,” JAMA 279, no. 17 (2007): 1921-1923; J. Colgrove, “The Ethics and Politics of Compulsory HPV Vaccination,” N. Engl. J. Med. 355, no. 23, (2006): 2389-2391; B. Lemke, “Why Mandatory Vaccination of Males against HPV Is Unconstitutional: Offering a New Approach To an Old Problem,” Boston University Public Interest Law Journal 261, no. 19 (2010): 261-81; G. Haber, R. M. Malow and G.D. Zimet, “The HPV Vaccine Mandate Controversy,” Journal of Pediatric and Adolescent Gynecology 20, no. 6 (2007): 325-331.Google Scholar
Field, R.I. and Caplan, A.L., “A Proposed Ethical Framework for Vaccine Mandates: Competing Values and the Case of HPV,” Kennedy Institute of Ethics Journal 18, no. 2 (2008): 111-124.Google Scholar
Law, S., “Human Papillomavirus Vaccination, Private Choice, and Public Health” U.C. Davis Law Review 41, no. 5 (2008): 1731-1772.Google Scholar
Cancer Stat Facts: Cervix Uteri Cancer, National Cancer Institute, available at <https://seer.cancer.gov/statfacts/html/cervix.html> (last visited May 16, 2018).+(last+visited+May+16,+2018).>Google Scholar
Id.Google Scholar
HPV and Cancer, National Cancer Institute, available at <https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-fact-sheet> (last visited May 16, 2018).+(last+visited+May+16,+2018).>Google Scholar
Human Papillomavirus: HPV Information for Clinicians, Centers for Disease Control and Prevention, available at <https://www.cdc.gov/hpv/hcp/need-to-know.pdf> (last visited May 16, 2018).+(last+visited+May+16,+2018).>Google Scholar
Human Papillomavirus (HPV) Treatment and Care, Centers for Disease Control and Prevention, available at <https://www.cdc.gov/std/hpv/treatment.htm> (last visited May 16, 2018).+(last+visited+May+16,+2018).>Google Scholar
Safaeian, M., Solomon, D., and Castle, P.E., “Cervical Cancer Prevention – Cervical Screening: Science in Evolution,” Obstetrics and Gynecology Clinics of North America 34, no. 4 (2007): 739-760, ix.CrossRefGoogle Scholar
See Human Papillomavirus: HPV Information for Clinicians, supra note 8.Google Scholar
Viens, L.J., Henley, S.J., Watson, M., et al., “Human Papillomavirus – Associated Cancers — United States, 2008-2012,” Centers for Disease Control and Prevention, available at <https://www.cdc.gov/mmwr/volumes/65/wr/mm6526a1.htm?s_cid=govD_CancerNewsJuly21_14> (last visited May 16, 2018).+(last+visited+May+16,+2018).>Google Scholar
Meites, E., Kempe, A., and Markowitz, L.E., “Use of a 2-Dose Schedule for Human Papillomavirus Vaccination — Updated Recommendations of the Advisory Committee on Immunization Practices Human Papillomavirus (HPV),” Centers for Disease Control and Prevention, available at <https://www.cdc.gov/mmwr/volumes/65/wr/mm6549a5.htm> (last visited May 16, 2018).+(last+visited+May+16,+2018).>Google Scholar
See Gostin and DeAngelis, supra note 2, at 1922; Javitt, G., Berkowitz, D. and Gostin, L.O., “Assessing Mandatory HPV Vaccination: Who Should Call the Shots?” Journal of Law, Medicine and Ethics 36, no. 2 (2008): 384-95.Google Scholar
Vaccine Safety, Centers for Disease Control and Prevention, available at <https://www.cdc.gov/vaccinesafety/vaccines/hpv-vaccine.html> (last visited May 16, 2018).+(last+visited+May+16,+2018).>Google Scholar
Human Papillomavirus Vaccination: Recommendations of the Advisory Committee on Immunization Practices (ACIP), Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention, available at <https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6305a1.htm> (last visited May 16, 2018).+(last+visited+May+16,+2018).>Google Scholar
Use of 9-Valent Human Papillomavirus (HPV) Vaccine: Updated HPV Vaccination Recommendations of the Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention, available at <https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6411a3.htm#Tab2> (last visited May 16, 2018).+(last+visited+May+16,+2018).>Google Scholar
Markowitz, L.E., Hariri, S., Lin, C., et al., “Reduction in Human Papillomavirus (HPV) Prevalence Among Young Women Following HPV Vaccine Introduction in the United States, National Health and Nutrition Examination Surveys, 2003-2010,” Journal of Infectious Diseases 208, no. 3 (2013): 385-393.CrossRefGoogle Scholar
HPV Vaccine Information for Young Women, Centers for Disease Control and Prevention, available at <https://www.cdc.gov/std/hpv/stdfact-hpv-vaccine-young-women.htm> (last visited May 16, 2018).+(last+visited+May+16,+2018).>Google Scholar
See Udesky, supra note 2, at 980.Google Scholar
Roden, R. and Wu, T.C., “How will HPV Vaccines Affect Cervical Cancer?” Nature Reviews Cancer 6, no. 10 (2006): 753-763.Google Scholar
Recommendations on the Use of Quadrivalent Human Papillomavirus Vaccine in Males — Advisory Committee on Immunization Practices (ACIP), 2011, Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention, available at <https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6050a3.htm?s_cid=mm6050a3_w> (last visited May 16, 2018).+(last+visited+May+16,+2018).>Google Scholar
HPV Vaccine Implementation Guidance, American Academy of Pediatrics, available at <https://www.aap.org/en-us/Documents/immunization_hpvimplementationguidance.pdf> (last visited May 16, 2018).+(last+visited+May+16,+2018).>Google Scholar
Reagan-Steiner, S., Yankey, D., Jeyarajah, J., et al., “National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2015,” Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention, available at <https://www.cdc.gov/mmwr/volumes/65/wr/mm6533a4.htm> (last visited May 18, 2018).+(last+visited+May+18,+2018).>Google Scholar
State Mandates on Immunization and Vaccine-Preventable Diseases, Immunization Action Coalition, available at <http://www.immunize.org/laws/> (last visited May 16, 2018).+(last+visited+May+16,+2018).>Google Scholar
Middleman, A.B., “New Adolescent Vaccination Recommendations and How to Make Them ‘Stick,’” Current Opinions in Pediatrics 19, no. 4 (2007): 411-416; A.F. Dempsey and D. Mendez, “Examining Future Adolescent Human Papilloma-virus Vaccine Uptake, With and Without a School Mandate,” Journal of Adolescent Health 47, no. 3 (2010): 242-248; M.L. Smith, K.L. Wilson, J.C. Pulczinski, et al., “Support for HPV Vaccination Mandates for Both Females and Males,” American Journal of Health Behavior, 38, no. 6 (2014): 831-838; D. J. Opel, D. S. Diekema and E. K. Marcuse, “A Critique of Criteria for Evaluating Vaccines for Inclusion in Mandatory School Immunization Programs,” Pediatrics 122, no. 2 (2008): e504-510.CrossRefGoogle Scholar
Verweij, M. and Dawson, A., “Ethical Principles for Collective Immunisation Programmes,” Vaccine 22, no. 23-24 (2004): 3122-3126; D.S. Diekema, “Responding to Parental Refusals of Immunization of Children,” Pediatrics 115, no. 5 (2005): 1428-1431.Google Scholar
Kodish, E., “Informed Consent for Pediatric Research: Is it Really Possible?” The Journal of Pediatrics 142, no. 2 (2003): 89-90; See Diekema, supra note 27, at 246.Google Scholar
Balog, J.E., “The Moral Justification for a Compulsory Human Papillomavirus Vaccination Program,” American Journal of Public Health 99, no. 4 (2009): 616-622.Google Scholar
Colgrove, J., Abiola, S. and Mello, M.M., “HPV Vaccination Mandates — Lawmaking Amid Political and Scientific Controversy” N. Engl. J. Med. 363, no. 8 (2010): 785-791; See Udesky, supra note 2, at 979; See Gostin and DeAngelis, supra note 2, at 1922; R.K. Zimmerman, “Ethical Analysis of HPV Vaccine Policy Options,” Vaccine 24, no. 22 (2006): 4812-4820.Google Scholar
Bedford, K., “Rhode Island Mandate for HPV Vaccine Sparks Protests – and Interest from Massachusetts Officials,” The Boston Globe, September 8, 2015, available at <http://www.bostonglobe.com/metro/2015/09/07/rhode-island-mandate-for-hpv-vaccine-sparks-protests-and-interest-from-massachusetts-officials/ZKmTZNPVTVKibPgqsUAgYK/story.html> (last visited May 17, 2018); J. Benson, “Informed Parents, Doctors And Lawmakers Fight Mandatory HPV Vacci-nation Law In Rhode Island,” Natural News, September 18, 2015, available at <http://www.naturalnews.com/051227_Rhode_Island_HPV_vaccine_parental_rights.html> (last visited May 17, 2018).+(last+visited+May+17,+2018);+J.+Benson,+“Informed+Parents,+Doctors+And+Lawmakers+Fight+Mandatory+HPV+Vacci-nation+Law+In+Rhode+Island,”+Natural+News,+September+18,+2015,+available+at++(last+visited+May+17,+2018).>Google Scholar
See Balog, supra note 29, at 618.Google Scholar
Gostin, L.O., “Law, Ethics, and Public Health in the Vaccination Debates: Politics of the Measles Outbreak,” JAMA 313, no. 11 (2015): 1099-1100.Google Scholar
See Bedford, supra note 31.Google Scholar
American Teens’ Sexual and Reproductive Health, Guttmacher Institute, available at <https://www.guttmacher.org/fact-sheet/american-teens-sexual-and-reproductive-health> (last visited May 17, 2018).+(last+visited+May+17,+2018).>Google Scholar
Mollborn, S. and Everett, B., “Correlates and Consequences of Parent-Teen Incongruence in Reports of Teens’ Sexual Experience,” Journal of Sex Research 47, no. 4 (2010): 314-329; L. O’Donnell, A. Stueve, and R. Duran, et al., “Parenting Practices, Parents’ Underestimation of Daughters’ Risks, and Alcohol and Sexual Behaviors of Urban Girls,” Journal of Adolescent Health 42, no. 5 (2008): 496-502; B.F. Stanton, X. Li, J. Galbraith, et al. “Parental Underestimates of Adolescent Risk Behavior: A Randomized, Controlled Trial of a Parental Monitoring Intervention,” Journal of Adolescent Health 26, no. 1 (2000): 18-26.Google Scholar
See Benson, supra note 30.Google Scholar
Jena, A.B., Goldman, D.P., and Seabury, S.A., “Incidence of Sexually Transmitted Infections After Human Papillomavirus Vaccination Among Adolescent Females,” JAMA Internal Medicine 175, no. 4 (2015): 617-623.Google Scholar
Beckett, M. K., Elliot, M. N., Martino, S., et al., “Timing of Parent and Child Communication About Sexuality Relative to Children’s Sexual Behaviors,” Pediatrics 135, no. 1 (2010):33-41; K. S. Miller, M. L. Levin, D. J. Whitaker, et al., “Patterns of Condom Use Among Adolescents: The Impact of Mother-Adolescent Communication,” American Journal of Public Health 88, no. 10 (1998): 1542-1544.Google Scholar
Stanger-Hall, K.F. and Hall, D.W., “Abstinence-Only Education and Teen Pregnancy Rates: Why We Need Comprehensive Sex Education in the U.S.,” PLoS One 6, no. 10 (2011): e24658.Google Scholar
See Colgrove, supra note 2, at 2390.Google Scholar
Sher, E.J., “Choosing for Children: Adjudicating Medical Care Disputes Between Parents and the State,” New York University Law Review 58, no. 1 (1983): 157-206; Diekema, supra note 27, at 245.Google Scholar
See Diekema, supra note 27, at 248.Google Scholar
See Law, supra note 4, at 1767; Arani, S., “State Intervention in Cases of Obesity-Related Medical Neglect,” Boston University Law Review 82 (2002): 875-894; D. S. Diekema, “Parental Refusals of Medical Treatment: The Harm Principle as Threshold for State Intervention,” Theoretical Medicine and Bioethics 25, no. 4 (2004): 243-264.Google Scholar
Woolley, S., “Children of Jehovah’s Witnesses and adolescent Jehovah’s Witnesses: What are Their Rights?” Archives of Disease in Childhood 90, no. 7 (2005): 715-719.Google Scholar
See Haber et al., supra note 2.Google Scholar
See Law, supra note 4, at 1767.Google Scholar
See Arani, supra note 41, at 885.Google Scholar
See Diekema, supra note 27, at 253.Google Scholar
Jacobson v. Massachusetts, 197 U.S. 11 (1905).Google Scholar
Drolet, M., Benard, E., Boily, M.C., et al., “Population-Level Impact and Herd Effects Following Human Papillomavirus Vaccination Programmes: A Systematic Review and Meta-Analysis,” Lancet Infectious Disease 15, no. 5 (2015): 565-580.Google Scholar
Jennings, B., “Relational Liberty Revisited: Membership, Solidarity and a Public Health Ethics of Place,” Public Health Ethics 8, no. 1 (2015): 7-17.Google Scholar
Id.Google Scholar
See Lemke, supra note 2, at 261.Google Scholar
Hughess, J.P., Garnett, G.P., and Koutsky, L., “The Theoretical Population Level Impact of a Prophylactic Human Papillomavirus Vaccine,” Epidemiology 13, no. 6 (2002): 631-639; E.H. Elbasha and E.J. Dasbach, “Impact of Vaccinating Boys and Men against HPV in the United States,” Vaccine 28, no. 42 (2010): 6858-67.CrossRefGoogle Scholar
See Gostin and DeAngelis, supra note 2, at 1922.Google Scholar
Beavis, A.L., Gravitt, P.E. and Rositch, A.F., “Hysterectomy-Corrected Cervical Cancer Mortality Rates Reveal a Larger Racial Disparity in the United States,” Cancer 123, no. 6 (2017): 1044-1050.Google Scholar
Downs, L.S., Smith, J.S., and Scarinci, I., et al., “The Disparity of Cervical Cancer in Diverse Populations,” Gynecologic Oncology 109, no. 2 Suppl (2008): S22-30.Google Scholar
Robin, T.P., Amini, A., and Schefter, T. E., et al., “Disparities in Standard of care Treatment and Associated Survival Decrement in Patients with Locally Advanced Cervical Cancer,” Gynecologic Oncology 143, no. 2 (2016): 319-325.Google Scholar
See Downs, et al., supra note 55, at S22.Google Scholar
See Balog, supra note 29, at 619.Google Scholar
See Human Papillomavirus: HPV Information for Clinicians, supra note 8.Google Scholar
Gelman, A., Nikolajski, C., and Schwarz, E.B., et al., “Racial Disparities in Awareness of the Human Papillomavirus,” Journal of Women’s Health 20, no. 8 (2011): 1165-1173.Google Scholar
Ford, J.L., “Racial and Ethnic Disparities in Human Papillomavirus Awareness and Vaccination Among Young Adult Women,” Public Health Nursing 28, no. 6 (2011): 485-493.Google Scholar
See Reagan-Steiner, et al., supra note 24.Google Scholar
Zucht v. King, 260 U.S. 174 (1922).Google Scholar
See Gostin and DeAngelis, supra note 2, at 1922.Google Scholar
See Javitt, et al., supra note 14; see Benson, supra note 30.Google Scholar
See Opel, et al., supra note 26, at e508.Google Scholar
Id.Google Scholar
Smith, P.J., Chu, S.Y., and Barker, L.E., “Children Who Have Received No Vaccines: Who Are They and Where Do They Live?” Pediatrics 114, no. 1 (2004): 187-195; D. Khalili and A.L. Caplan, “Off the Grid: Vaccinations Among Home-schooled Children,” Journal of Law, Medicine & Ethics 35, no. 3 (2007): 471-477.Google Scholar
Redford, J., Battle, D., and Bielick, S., Homeschooling in the United States: 2012, National Center for Education Statistics (Nov. 2016).Google Scholar
LeFever, L.E., “Religious Exemptions from School Immunization: A Sincere Belief or a Legal Loophole?” Penn State Law Review 110 (2006): 1047-1067.Google Scholar
Sun, L.H., “Anti-vaccine Activists Spark a State’s Worst Measles Outbreak in Decades,” The Washington Post, May 5, 2017, available at <https://www.washingtonpost.com/national/health-science/anti-vaccine-activists-spark-a-states-worst-measles-outbreak-in-decades/2017/05/04/a1fac952-2f39-11e7-9dec-764dc781686f_story.html?utm_term=.fbd44ae92ad5> (last visited May 18, 2018).+(last+visited+May+18,+2018).>Google Scholar
See Gostin and DeAngelis, supra note 2, at 1922.Google Scholar
See Javitt et al., supra note 14.Google Scholar
Immunization and Communicable Disease Testing in Pre-school, School, Colleges or Universities, 216 30 R.I. Code R. § 05-3 (2014); Exemption from Certification, D.C. Code § 38-506 (2007).Google Scholar
“Vaccination Coverage Rates,” State of Rhode Island Department of Health, available at <http://www.health.ri.gov/data/vaccination/> (last visited May 18, 2018); “Child Vaccination Across America,” American Academy of Pediatrics, available at <https://immunizations.aap.org/> (last visited May 18, 2018); “Progress on HPV Vaccination Rates in the District of Columbia,” American Academy of Pediatrics, available at <http://aapdc.org/progress-on-hpv-vaccination-rates-in-the-district-of-columbia/> (last visited May 18, 2018).+(last+visited+May+18,+2018);+“Child+Vaccination+Across+America,”+American+Academy+of+Pediatrics,+available+at++(last+visited+May+18,+2018);+“Progress+on+HPV+Vaccination+Rates+in+the+District+of+Columbia,”+American+Academy+of+Pediatrics,+available+at++(last+visited+May+18,+2018).>Google Scholar
Exemptions from Immunization Requirements, 12 VA. Admin. Code § 5-110-80 (2016).Google Scholar
Kueter, C.P., “Study Seeks to Understand Why Virginia Girls Aren’t Getting HPV Vaccine,” UVAToday, February 3, 2015, available at <https://news.virginia.edu/content/study-seeks-understand-why-virginia-girls-aren-t-getting-hpv-vaccine> (last visited May 18, 2018).+(last+visited+May+18,+2018).>Google Scholar
See Lemke, supra note 2, at 266.Google Scholar