Summary of Facts
On Friday, March 2, 2007, Governor Timothy Kaine stated his intention to sign state legislation making it mandatory that all sixth-grade females be administered the HPV (human papillomavirus) vaccine, Gardasil, before entering high school. Governor Kaine expressed some uncertainty about mandating the HPV vaccination, but he felt more relieved after he studied the bill closer. He stated on Saturday, March 3, 2007, that people will get vaccination information regarding the health benefits and concerns, which will give them the ability to make their own decision. The bill is broad and parents will not have to acknowledge their reason if they choose to opt-out of the requirement (Craig, 2007).
Virginia will become the second state to mandate the HPV vaccine; an immunization against a virus that causes cervical cancer. The bill would not go into effect until the 2008-2009 school year, which supporters say would give officials ample time to study the side effects (Craig, 2007).
Lawmakers in other states have been not so willing to approve a bill requiring vaccination against the human papillomavirus even though it was overwhelmingly approved by Virginia’s legislature. An example is the legislators in Texas are discussing whether or not to overturn Governor Rick Perry’s executive order requiring the administration of the HPV vaccine in sixth-grade females (States are Divided, 2007).
In June, 2006, the Food and Drug Administration (FDA) approved the Merck vaccine, Gardasil, which was developed by two pharmaceutical companies, Merck & Co., Inc (White House Station, NJ) and GlaxoSmithKline (United Kingdom). As of April 2007, the GlaxoSmithKline vaccine, Cervarix, was not yet approved by the FDA (Vamos, Mcdermott, & Daley, 2008).
The safety and effectiveness of Gardasil has been clinically evidenced with tests on more than 11,000 females worldwide and found to be 100% effective in preventing the two types of HPV (16 & 18) responsible for 70% of cervical cancers, and the two types of HPV (6 &11) responsible for 90% of genital warts. The vaccine is administered in a series of 3 doses over a 6-month time period; ideally prior to the onset of sexual activity (Vamos, Mcdermott, & Daley, 2008).
- Should such a new vaccination be made mandatory without first studying its long-term effectiveness and possible adverse side effects?
- Who should be responsible for the cost of the mandated vaccination, Gardasil?
- Are the rights of the parents and the children being violated by politicians?
- Will the vaccination of Gardasil lead to more sexual promiscuity amongst teenagers?
- Should males also be vaccinated since they are carriers of HPV?
As a parent of 3 children, making vaccination choices has always been difficult; weighing the benefits versus risks and potential side effects. I did, however, choose to vaccinate them against the highly contagious diseases such as measles, mumps, tuberculosis, polio, diphtheria, tetanus, and pertussis. These are mandated child-hood vaccines due to their highly contagious nature and especially where people congregate in large numbers (Vamos, Mcdermott, & Daley, 2008). I do not believe that there has been enough long-term clinical evidence as to the safety, long-term effectiveness, and short-term and long-term adverse side effects to mandate the HPV vaccine, Gardasil.
Barbara Loe Fisher, cofounder of the National Vaccine Information Center points out several unknowns regarding the HPV vaccine: First, of the 25,000 patients in the clinical trial, only 1,184 were preteen girls, which is a narrow base of testing in which to mandate the vaccine. Secondly, it is scientifically unknown, due to the lack of time, if, how often, and at what age booster immunizations are required. Currently, it appears to be effective for only 5 years. Thirdly, there has not been a determination of all possible HPV vaccine side effects; since FDA approval of Gardasil in 2006, at least 82 adverse side effects have been noted to include nausea, fever, rashes, and fainting spells (Vamos, Mcdermott, & Daley, 2008).
I feel it is imperative, since the vaccine is mandated by legislature, that all families should not have pay out of pocket if they are economically deprived, uninsured, or underinsured. Grant money should be made available to those families. Women who are uninsured are most vulnerable to contracting cervical cancer due to not having a healthcare provider, transportation to regular healthcare visits, or the time to take off work (Vamos, Mcdermott, & Daley, 2008).
I believe that the rights of parents and children are being infringed upon by politicians. Decisions about the vaccination should be made between parents, family physicians, and children without the government being involved (Go Slow, 2007).
I think that the HPV vaccination could lead to more sexual promiscuity due to a lack of understanding what it can and cannot prevent. Adolescents may be under the false impression that this vaccine will protect them against other sexually transmitted infections such as HIV/AIDS, and those with less lethal potential (Vamos, Mcdermott, & Daley, 2008).
Adolescent boys are carriers of HPV. If it is mandatory for females to be vaccinated then males should also be vaccinated to help prevent the spread of infection.
HPV is a sexually transmitted virus known to cause approximately 7,000 cases of cervical cancer a year. It is estimated that 7.5 million girls and women between the ages of 14 and 24 have been infected with the virus (Craig, 2007). Gardasil was approved in 2006 and is effective in preventing the types of HPV responsible for 70% of cervical cancers and 90% of genital warts (Vamos, Mcdermott, & Daley, 2008). So far the efficacy of Gardasil has proven to be remarkable (Go Slow, 2007).
Questions remain by some lawmakers and members of the public as to the safety and effectiveness of the vaccine, parents’ rights, and the states’ ability to pay for every girl to receive the $360, three-shot cycle. Legislators in some states have amended their proposals to allow for exemptions due to public concern (States are Divided, 2007).
When it comes to a matter of public health risk, sometimes the government does need to step in and make mandatory changes. Although HPV is not inherently a public health risk, it is extremely important to have debate, public disclosure and independent medical expertise before mandating anything when public health is concerned (Go Slow, 2007).
National data on adolescent sexual behaviors (grades 9 through 12) suggest that sexual activity, the number of girls ever having sex, and the number of sexual partners decreased in the decade prior to a 2002 report; moreover, the use of condoms increased among sexually active persons. During societal debates concerning whether access and availability of birth control, emergency contraception, and abortion actually increase sexual activity in adolescents, there was actually a decrease in sexual risk-taking behavior. Research has found that making condoms available in schools and increasing the availability of the morning-after pill are not associated with younger sexual debut or an increase in sexual frequency (Vamos, Mcdermott, & Daley, 2008).
There are other questions and unknowns regarding the impact the HPV vaccine would have on males. There could be short-term or long-term implications related to fertility or pregnancy intention (Vamos, Mcdermott, & Daley, 2008).
Ethical Analysis #1: Utilitarian Viewpoint
I believe a utilitarian would respond favorably and support Virginia Governor Timothy Kaine’s signed state legislation mandating the HPV vaccination, Gardasil, for school enrollment in female children and teenagers. Their assessment of the situation would be done by asking several questions. One question that would be raised by a utilitarian is how many teenage girls and woman have been affected by the human papillomavirus. They would look at how this virus is transmitted, which is through unprotected sexual intercourse, and realize that this morally wrong act is bringing about more pain and suffering than happiness for the greater good. In the pursuit of maximal net happiness, utilitarianism requires us to set aside and sacrifice our own interests and the interests of our family and loved ones for the “greater good” (Brannigan, 2005).
The long-term safety and adverse side effects of Gardasil have not been studied over a long period of time, but no deaths or serious side effects have been reported. The vaccination has been proven to be 100% effective in preventing the two types of HPV responsible for 70% of cervical cancers and 90% of genital warts. I feel that this data would be favorable from a utilitarian’s perspective. A utilitarian would take into account how much pain and suffering has been caused by the human papillomavirus versus the benefits that could result from the vaccination. Utility requires calculation and reasoning of likely, probable, improbable, and less likely consequences, benefits, and greater good for the greatest number of people (Brannigan, 2005). Although consequences cannot be predicted with absolute certainty, especially long term, they would use moral reasoning and common sense to decide what would bring about the best outcome overall.
I do not think it would matter much to a utilitarian if the government was involved in mandating such a vaccination. They would probably not think the rights of parents and children are being infringed upon. This would be a weakness. They would just see the overall picture of reducing the virus transmission and the risk of cervical cancer by getting a few shots prior to the onset of sexual activity, and this would benefit the population, generally speaking.
Ethical Analysis #2: Duty Ethics Viewpoint
Kant and other duty-based ethicists, who base universal ethics solely on reason, would respond to mandating the HPV vaccine in several ways. According to a duty ethicist, any act done out of a sense of a duty is done with a good will, and duty and good will are contiguous with one another. Therefore, acting out of duty and good will means that we act according to a principle and the results and/or consequences are not ethically relevant (Brannigan, 2005).
From the human perspective, they would ask themselves if unprotected sexual intercourse between teenagers and young adults is morally justifiable. The answer would be “no” because the people performing these morally wrong acts are acting out of desire and not duty or good will. Kant might see this morally wrong act as a way of using another human being as a means to some other end referred to as the dignity imperative. He felt that for a human to have dignity they must be held responsible by some form of punishment for their unethical behavior (Argosy, 2009). Duty ethics do not take much in the way of human emotions such as sympathy, empathy and happiness into consideration, and may see contracting the human papillomavirus as a form of punishment for one’s unethical behavior.
From a government’s standpoint, it is their duty to protect the public from any inherent public health risk. Governor Timothy Kaine and other legislators must have used reason and felt it was their duty when making the decision regarding mandating the administration of the HPV vaccine to all sixth-grade females before entering high school. Did they make their decision based solely off of reason? It does not appear that way to me since the bill will include an opt-out clause and parents will not have to acknowledge their reason for choosing not to have their child vaccinated (Craig, 2007).
Ethical Analysis #3: Social Contract Viewpoint
Thomas Hobbes interpreted human behavior based off egoism; the moral duty of a human being to look out for their own interests and do what is best for him/her. Hobbes also notes that although humans are born selfish, they are also born with reason; enough reason to realize that it is in his/her best interest to cooperate and conform to a peaceful and secure society where humans can thrive in by sacrificing some freedom and autonomy (Argosy, 2009).
Based upon this theory, the question would be raised if a social contract is necessary to mandate the HPV vaccination to avoid living in the hypothetical “State of Nature.” Another question would be if humans will use their rationality and come to the determination that they need to submit to a higher power in order to live in a civil society, which is overall in their best interest.
I think Hobbes would be in agreement with a higher power getting involved to form a social contract in an attempt to prevent and/or eliminate the spread of HPV. He would ask what will happen to society if nothing is done to prevent the spread of HPV and cervical cancer because humans will continue to seek to fulfill their natural-born desires of sexual gratification. Obviously, laws forbidding premarital sex, not having unprotected sex, and only having one sexual partner cannot be enacted or enforced.
Governors such as Timothy Kaine of Virginia recognize that it is in the best interest of the society and probably feel some sort of political obligation to sign into legislation the mandatory vaccination, Gardasil. Even though this vaccination is mandatory for sixth-grade females upon entering high school, a parent can opt out of vaccinating their child against HPV as they see fit. Without this option I believe there would have been a huge public debate due to the differences in cultural, moral, and religious beliefs.
I believe the utilitarian analysis is the superior response to the ethical issue of Virginia Governor Timothy Kaine signing into legislation a bill mandating the HPV vaccine, Gardasil. Utilitarianism requires us to weigh the benefits versus harm and choose which course of action will produce the least amount of suffering.
HPV causes approximately 7,000 cases of cervical cancer a year. It is estimated that 7.5 million girls and women between the ages of 14 and 24 have been infected with the virus (Craig, 2007). This is a pretty significant number. Gardasil was approved in 2006 and is effective in preventing the types of HPV responsible for 70% of cervical cancers and 90% of genital warts (Vamos, Mcdermott, & Daley, 2008). Since FDA approval of Gardasil in 2006, at least 82 adverse side effects have been noted to include nausea, fever, rashes, and fainting spells (Vamos, Mcdermott, & Daley, 2008).
I think a utilitarian would calculate the number of people who have been affected and how many people could benefit from the vaccination, also taking into account the number of potential adverse side effects. Based on the clinical research, it would appear from a utilitarian perspective that more benefits could come from mandating the vaccination than harm. The weakness of using this ethical approach is no one is able to predict with absolute certainty the long-term consequences of this vaccine because of the short period of time it has been studied.
Argosy University. (2009). Ethics Across Cultures. Retrieved July 30, 2009 from http://myeclassonline.com/ec/crs/default.learn?CourseID=3442671&CPURL=myeclassonline.com&Survey=1&47=5458713&ClientNodeID=405078&coursenav=0&bhcp=1
Brannigan, M., (2005). Ethics across cultures. (1/e). McGraw-Hill.
Craig, T. (2007, March 3). Kaine says he’ll sign bill making shots mandatory. The Washington Post. Retrieved June 12, 2009, from http://www.washingtonpost.com/wp-dyn/content/article/2007/03/02/AR2007030200117.html
Go Slow on Immunization; Mandating HPV Vaccine Not Something to Rush Into. (Sept 13, 2007). The Post-Standard (Syracuse, NY), p.A15. Retrieved May 21, 2009, from Custom Newspapers via Gale: http://find.galegroup.com/ips/start.do?prodId=IPS
States Are Divided on Vaccinations for HPV; Requirements approved so far in Texas, Virginia, as other measures falter. (human papillomavirus). (March 9, 2007). Education Week, 26, 27. p.18. Retrieved June 12, 2009, from Academic OneFile via Gale:
Vamos, C., Mcdermott, R., & Daley, E. (2008, June). The HPV vaccine: framing the arguments for and against mandatory vaccination of all middle school girls. Journal of School Health, 78(6), 302-309. Retrieved June 10, 2009, doi:10.1111/j.1746-1561.2008.00