In this essay, I will argue that the Ontario HPV vaccination program is ethically inappropriate and ineffective as a public health initiative aimed at combating cervical cancer. HPV vaccination in regards to cervical cancer reduction pales in comparison to other vaccination programs such as those that fight infectious diseases like polio, measles, smallpox, pertussis, and TB among others. As such, pro-vaccination arguments such as harm to others, harms and benefits, as well as best interests do not offer sufficient justification for the HPV vaccination initiative. Moreover, the critical consideration of issues such as social justice, adolescent sexuality, paternalism, and gender justice reveals that the program is inappropriate.
Before formulating vaccination policies, governmental agencies need to assess the epidemiological characteristics of the disease, the harms and benefits of a program, as well as the ethical and legal implications of a vaccination initiative on issues such as social and gender justice (Dawson 152; Canadian Institutes of Health Research- Institutes of Population and Public Health111 & 112).
Harm to Self and Others
Vaccination has a potential to protect an individual as well as others from the harmful effects of an infectious disease. This argument gives legitimacy to vaccination initiatives that may seem to interfere with an individual’s freedom and the right to self-determination (Dawson 144; Thompson 17). The mortality rate due to cervical cancer is about 1.1% in Canada. This translates to approximately 140 female deaths in Ontario. In Ontario, other forms of cancer such as breast and lung cancer lead to an estimated 1951 and 2782 female deaths respectively. The HPV program in Ontario involves the vaccination of Grade 8 girls against four strains of the virus (CIHR-IPPH 103; Thompson 13). Two of the targeted strains (16 and 18) are responsible for about two-thirds of all cervical cancer cases. The vaccination program, therefore, aims at preventing the 70% of cervical cancer cases caused by the above strains. Apart from being expensive, the vaccine does not confer immunity against other strains (approximately 100) of HPV that account for 30% cervical carcinoma cases.
It is worth noting that the Gardasil vaccine is most effective when it is given prior to the initiation of sexual activity, and its immunological protection lasts for five years (Thompsons 13; CIHR-IPPH 105). Therefore, there is a need for boosters even it is still unclear when and how many are necessary to maintain protection. There is also an unknown risk that mass vaccination against a few strains might raise the likelihood of other strains becoming dominant (CIHR-IPPH 105).
The risk communication campaigns for the program tend to equate HPV to cervical cancer erroneously. This strategy is misleading because it gives cervical cancer a ‘public health crisis’ status that calls for the eradication of HPV. However, eradication is not the end goal of the program because it does not strive for herd immunity through a population-based model. This program does not eliminate the need for other preventive measures such as pap smear screening.
Critical examination of the public health benefits of the program regarding individual and public benefits shows that the program is a weak initiative. The benefits offered by the program fail to give a justifiable reason for the Ontario government to take a paternalistic stance to HPV vaccination. Also, the ‘best interest’ argument is not justifiable in this case because the vaccine offers partial and unsustainable benefits in cervical cancer protection.
Social Justice
A need-based approach towards the HPV vaccination program calls for a focus on girls in economically challenged environments. Also portraying the vaccination strategy as an STI prevention initiative that includes boys would amplify the social injustices to the at-risk population because this approach implies sexual promiscuity and irresponsibility. This perspective has a high likelihood of enhancing stigmatization to the participants (CIHR-IPPH 111). Apparently, a distributive justice model appears to promote disparity thus compromising social justice. It, therefore, seems ethically appropriate and economical to address marginalization, socio-economic inequality, as well as other social determinants of health in combating cervical cancer. Such an approach would promote both social and distributive justice.
Gender Justice
Epidemiological statistics show that women suffer the consequences of HPV infection more than men do (CIHR-IPPH 112). Care should be taken to avoid shifting the responsibility of the health problems associated with HPV to one gender. Risk communication strategies that term the HPV vaccination project as anti-STI or anti-cancer may, in one way or another, assign responsibility to a particular group. The public may perceive cervical cancer as a result of women’s sexual irresponsibility despite the health issues that men suffer due to HPV. Consequently, the program may be viewed as a response to promiscuity that puts women at a higher risk. Vaccinating both genders while communicating the high risks that HPV poses to women may paint men as disease vectors. One is left to wonder, do the HPV vaccination campaigns propagate gender injustices?
Considering the limited benefits that the HPV vaccination offers to the Ontario citizen and the legal and ethical implication of the program both parts of the initiative (girls only and the boys and girls phase) possess insufficient justification for its implementation.
Works Cited
Canadian Institutes of Health Research – Institute of Population and Public Health. Population and Public Health Ethics: Cases from Research, Policy, and Practice. Toronto, ON: University of Toronto Joint Centre for Bioethics, 2012. Print
Dawson, Angus. Public Health Ethics. Cambridge: Cambridge University Press, 2011. Print
Thompson, Alison. “Human Papilloma Virus, Vaccination, and Social Justice: An Analysis of a Canadian School-Based Vaccine Program.” Public Health Ethics. Vol 6. No.1 (2013): 11-20.
