HPV vaccine: Who chooses?

Public health experts say that most teenagers have sex by the time they finish high school. The CDC's National Survey of Family Growth, conducted in 2002, shows that 69% of 18- to 19-year-old women, and 64% of men in that age group, have had sex. Further, HPV is the most common sexually transmitted disease, with about 6.2 million new infections in the U.S. each year; most sexually active women become infected by age 50. (Fortunately, most of those infections resolve themselves. But some go on to cause cervical cancer.) A school-linked mandate for HPV vaccination would be an efficient and effective way to protect the public from widespread infection.

Dr. Richard Zimmerman, who recently wrote an ethical analysis of the vaccine's policy options for the journal Vaccine, sees things differently. As a professor of family medicine at the University of Pittsburgh who has served on the committee that advises the CDC on immunization policy, Zimmerman says that just because a school-linked mandate would work well is not reason enough to impose it.

Proponents of mandatory vaccination are invoking the philosophy of utilitarianism, the notion that decisions should be made to provide the greatest good for the greatest number of people, Zimmerman says. That philosophy, he says, can be used to justify all sorts of ethically suspect behavior. Although he plans to have his daughter vaccinated against HPV, he says he should not be coerced to do so.

"HPV is not caught by sitting next to someone in class but by sexual contact, which often is a lifestyle choice," he says. "Using school laws, which were developed to protect children from communicable diseases like smallpox and measles, to mandate vaccination against a sexually transmitted infection, is to use the ends to justify the means."

As for other vaccine mandates, such as those for measles or whooping cough, Zimmerman says that other ethical principles justify those requirements -- notably the notions of beneficence (doing good) and nonmaleficence (doing no harm), Zimmerman says. "If a person who is unvaccinated brings measles or pertussis [whooping cough] to school, their mere presence can lead to harm to other children," particularly to those children who cannot receive the vaccine for medical reasons.