Perspectives on HPV vaccination, Michigan mandate bill

Yesterday's Lexington Herald-Leader included a pair of items about HPV vaccines with comments from a host of vaccine experts (and not-quite-experts). One story, "Is Prevention Worth a Shot?," offers general advice to parents. The other is a sidebar, "Feedback about Michigan Law," with comments on the bill under consideration that would mandate vaccination for girls in sixth grade. I was asked by the Herald-Leader for comments on the ethical merits of such a mandate. From the story, here are my remarks:

"Ethically, electing to mandate a vaccine for children requires weighing the societywide benefits of vaccination versus the infringement, however minor, on the decision-making authority of parents. Among the factors that influence this ethical analysis are the risk of infection, the severity of disease without vaccination, and, very importantly, the likelihood that a vaccination program can succeed without state mandates. Unfortunately, history tells us that vaccines in the U.S. have great difficulty achieving high levels of support without the power of mandates.

"The points above are true for any vaccine, but the HPV vaccine has unique considerations that point in favor of a mandate. We know that groups with reduced access to medical care, and particularly regular Pap screenings, are more likely to develop cervical cancer than the general population. They are also more likely to die as a result of it than cervical cancer patients overall. Without a mandate, there remains a great risk that those not getting Pap screens or other care will similarly not be reached by HPV vaccination efforts. Without a mandate, we may miss exactly the same people who stand to benefit most from HPV vaccination. Ethically, this is of great concern.

"While a mandate is not a silver-bullet solution to these potential problems, it would signify the importance of HPV vaccination and very likely lead to novel strategies by local health departments and school districts to deliver the vaccine to all girls in the target age group. A mandate puts the vaccine in the best position to save the most lives, while still allowing parents with philosophical or religious objections to opt out by means of the generally straightforward exemption policies."