Assessing Mandatory HPV Vaccination: Who Should Call the Shots?
Gail Javitt, Deena Berkowitz, and Lawrence O. Gostin, 36 J.L. Med. & Ethics 384 (2008)
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In this paper, we review the scientific evidence supporting Gardasil’s approval and the legislative actions in the states that followed. We then argue that mandatory HPV vaccination at this time is both unwarranted and unwise. While the emergence of an HPV vaccine reflects a potentially significant public health advance, the vaccine raises several concerns. First, the long-term safety and effectiveness of the vaccine are unclear, and serious adverse events reported shortly after the vaccine’s approval raise questions about its short-term safety as well. In light of unanswered safety questions, the vaccine should be rolled out slowly, with risks carefully balanced against benefits in individual cases. Second, the legal and ethical justifications that have historically supported state-mandated vaccination do not support mandating HPV vaccine. Specifically, HPV does not threaten an imminent and significant risk to the health of others.*385 Mandating HPV would therefore constitute an expansion of the state’s authority to interfere with individual and parental autonomy. Engaging in such expansion in the absence of robust public discussion runs the risk of creating a public backlash that may undermine the goal of widespread HPV vaccine coverage and lead to public distrust of established childhood vaccine programs for other diseases. Third, the current sex-based HPV vaccination mandates present constitutional concerns because they require only girls to be vaccinated. Such concerns could lead to costly and protracted legal challenges. Finally, vaccination mandates will place economic burdens on federal and state governments and individual practitioners that may have a negative impact on the provision of other health services. In light of these potentially adverse public health, economic, and societal consequences, we believe that it is premature for states to add HPV to the list of state-mandated vaccines.
