Ethics of HPV vaccine policy options in Vaccine
The May 29 issue of Vaccine includes a paper that we have been expecting since first seeing a draft online back in March: "Ethical analysis of HPV vaccine policy options" written by Richard K. Zimmerman (Vol. 24, p.4812-4820 -- free abstract, subscription required for full text). Zimmerman is an Associate Professor at the University of Pittsburgh School of Medicine and a former ACIP member. (The bio on his website is out-of-date.)
Kudos to the editors at Vaccine for recognizing the importance of discussions at the intersection of ethics and policy, specifically regarding HPV vaccines. As a glance at any of its table of contents will attest, a paper on ethics is a rarity in the science-focused publication. Unfortunately, the paper doesn't quite live up to our hopes or even its own title. It reads more as a (simplified) primer to the major ethical theories than a useful discussion of the ethics of HPV vaccine policy. (See the two full paragraphs on the criticisms of utilitarianism with nary a mention of HPV therein.)
After brief examinations of HPV vaccination through the lenses of utilitarianism, the doctrine of double effect, and principlism (oddly, Kantian deontology is excluded), the paper concludes in this way:
Kudos to the editors at Vaccine for recognizing the importance of discussions at the intersection of ethics and policy, specifically regarding HPV vaccines. As a glance at any of its table of contents will attest, a paper on ethics is a rarity in the science-focused publication. Unfortunately, the paper doesn't quite live up to our hopes or even its own title. It reads more as a (simplified) primer to the major ethical theories than a useful discussion of the ethics of HPV vaccine policy. (See the two full paragraphs on the criticisms of utilitarianism with nary a mention of HPV therein.)
After brief examinations of HPV vaccination through the lenses of utilitarianism, the doctrine of double effect, and principlism (oddly, Kantian deontology is excluded), the paper concludes in this way:
"Given concerns for autonomy, justice, as not all persons are at risk, and non-maleficence, HPV vaccine should not be mandated for school or college entry."Accepting the paper's ethical arguments would make it difficult to support mandating any vaccine, particularly new products with unclear risk profiles. (To be fair, Zimmerman doesn't take his argument that far, though there have been papers that do.) The most noteworthy omission from the paper is a discussion of the risks of vaccination compared to the risks of doing nothing (both the risk of infection and the consequences thereof, to individuals as well as populations). Criticisms aside, Zimmerman's offering is a laudable contribution to what should be a robust dialogue of the ethics of vaccination policy.
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