such as "Introduction", "Conclusion"..etc
Experts from the University of Pennsylvania Center for Bioethics and
Johns Hopkins Berman Institute of Bioethics review the controversy
surrounding the human papillomavirus (HPV) vaccine debate, and its
effects on ethical and public health issues in a new article.*
"The arrival of Gardasil® was a major achievement for cervical
cancer prevention efforts worldwide," says Jason Schwartz, MBE,
Researcher, Penn's Center for Bioethics and Department of History &
Sociology of Science, and lead author. "Much of the initial enthusiasm
for the vaccine was lost amid the controversy surrounding state
proposals that would require teenage girls to be vaccinated in order to
attend school. The events of the past year reveal important lessons
regarding ways to introduce new vaccines successfully and in an
ethically responsible manner."
In the months leading up to the June 2006 approval of Gardasil®,
there was unprecedented media coverage and support from even
socially-conservative groups. However, this support for the vaccine
began to slow in September 2006 following the introduction of a bill in
the Michigan state legislature that would require the vaccination of
girls attending public schools. Additional states also were quick to
propose similar legislation. In response to the legislation, numerous
groups expressed their opposition by arguing that it was either too
soon to consider an HPV requirement, or that the sexual transmission of
the virus did not warrant requiring the vaccine in schools.
The opposition grew when the governor of Texas issued an executive
order requiring HPV vaccination for all girls entering the sixth grade.
Critics of state HPV requirements called attention to how these
policies violated obligations to respect parental autonomy. However,
many critics often overlooked opt-out provisions, implying that the
proposals made vaccination compulsory.
The authors note that, "Quite apart from whether it was prudent
public health policy to implement state requirements for HPV
vaccination so soon after the vaccine's licensure, these attacks on the
state initiatives may have exacted a very real ethical price in terms
of the public's understanding of the justifications for state
vaccination requirements generally, as well as the public's
understanding of the merits of the HPV vaccine itself." Additionally,
they suggest that issues of price gouging, corporate profits, and
political motives, may have also added to the opposition.
In order to move forward with cervical cancer prevention efforts,
the authors suggest that attention be focused on assessing the
long-term safety of the vaccine, while implementing effective patient
and provider educational programs about HPV and the HPV vaccine, as
this is the model that other successful vaccination programs have
followed. "With a second HPV vaccine expected to be approved in early
2008, it is vital to understand the strategies that are most likely to
lead to the long-term success of this remarkable weapon against
cervical cancer," says Schwartz.
The authors also discuss the importance of designing and
implementing HPV vaccination programs in developing countries.
"Cervical cancer is a worldwide concern, but its impact is particularly
severe in the developing world," says Schwartz. "It would be tragic if
the negative attention created by the debate over HPV vaccine
'mandates' in the U.S. hamper efforts to make the vaccine available to
those internationally who could benefit most from it."
*The article was recently published in Clinical Pharmacology & Therapeutics.
Additional article authors are Arthur Caplan, PhD, Director, Center
for Bioethics, Penn; Ruth Faden, PhD, MPH, the Philip Franklin Wagley
Professor of Biomedical Ethics and Executive Director of The Phoebe R.
Berman Bioethics Institute, Johns Hopkins University; and Jeremy
Sugarman, MD, MPH, MA, the Harvey M. Meyerhoff Chair of Bioethics and
Medicine at the Phoebe R. Berman Bioethics Institute, Johns Hopkins
This work was supported by grants from the Burroughs Wellcome Fund
(Ethics and Vaccine Policy Initiative: Planning Conference) and the
University of Pennsylvania Provost's Interdisciplinary Seminar Fund.
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