Essay: Human papillomavirus (HPV) vaccine – ethics, values

According to the CDC (2016), Human papillomavirus (HPV) disease stands out as among the most common sexually transmitted diseases in both male and females. HPV infections are known by some symptoms including genital warts, however, more imperatively for urology specialists, cervical and penile carcinomas and intermittent genital condylomata in both genders. The frequency of HPV-related carcinomas has amplified in cervical, oropharyngeal, vulvar, penile, and butt-centric malignancies. Powerful antibodies have been accessible for very nearly ten years, yet across the board, reception of immunization organization has been dangerous for numerous reasons. Numerous nations (more than 100) have embraced immunization programs for females, and an expanding number of nations are extending the signs to incorporate men between the ages of 9 to 26. There still is by all accounts contention encompassing these all inclusive inoculation programs and some moral and pragmatic concerns in regards to the issuing of immunization for infections that are connected with sexual contact in both genders, particularly for children in the adolescent age.
The deliberation over the Human Papillomavirus (HPV) vaccine epitomizes a conflict of two of the most questionable arguments in healthcare in America, obligatory vaccination, and teenage sexuality. This vaccine is a major public health breakthrough/milestone. This discussion is very much politicized because several state governments have tried to make the vaccine mandatory for school admission for all girls. The argument is broken down into ethical and economic issues. Concerns that arise are about the ethics of a vaccine for sexually transmitted infection, and how parental rights play a role in respect to mandatory vaccination. Throughout this piece, one will get an understanding of what the vaccine is, what cervical cancer is, and the values are in conflict regarding this issue. In addition, it will elaborate on ethical leadership stance.
What is Gardasil?
According to Colgrove, J. (2006) the development of Gardasil, Merck’s HPV vaccine, is currently an important part of public health. The vaccine safeguards contra four strains of HPV, the greater common sexually transmitted disease in the U.S. Two of those strains cause most cases of cervical cancer. There are over 100 types of HPV. Types 16 and 18 because 70% of cervical cancer while Types 6 and 11 cause 90% of genital warts. There are About 6 million HPV infections per year, which is 15% of the population. Half of HPV infections are in 15-25 year olds. HPV is the most common sexually transmitted STI. The virus may infect many parts of the body.
FDA (2014) noted that some of the common side effects of Gardasil include ‘injection site reactions (pain, swelling, redness, bruising, or itching), fever, headache, dizziness, tiredness, nausea, vomiting, diarrhea, sleep problems (insomnia), runny or stuffy nose, sore throat, cough, tooth pain, or joint or muscle pain’. Also ‘infrequently, temporary symptoms such as fainting/dizziness/lightheadedness, vision changes, numbness/tingling, or seizure-like movements have happened after vaccine injections’. Fever and headache as well may occur.
According to the CDC (2016), in the United States there are at least 9, 700 or more diagnosed cases of cervical cancer. There is nearly 3,700 deaths per year are which result from cervical cancer and there are 500,000 precancerous cervical lesions identified per year. The age of diagnosis is usually 47 years old. The NIH (2016), defined cervix as the lower, narrow end of the uterus. The uterus is actually the organ in which a fetus develops. The main types of cervical cancer are squamous cell carcinoma and adenocarcinoma. Squamous cell carcinoma begins in the thin, flat cells that line the cervix. Adenocarcinoma begins in cervical cells that make mucus and other fluids.
Most cervical cancer cases have been caused by long-lasting infections with certain types of human papillomavirus (HPV). Having vaccines that protect against infection with these types of HPV can more likely reduce the risk of cervical cancer. Prevention is always the best starting point but sometimes it is not always possible. It is recommended for women to have their yearly pap test to check for possible abnormal cells within the cervix and also be able to check for cells that may become cervical cancer. These cells can be treated before cancer forms. While cervical cancer can be cured if it is caught and treated in the early stages but prevention should be the focus in order to avoid this.
According to McLemore, M. R. (2006) Gardasil has proven to be 100% successful in preventing HPV infections from types 6, 11, 16 and 18. HPV has the possibility to prevent at the very least 70% of cervical cancer if the insusceptibility deliberated by the vaccine continues. Throughout the study there is not enough follow-up data to determine how long the defenses will last & if additional vaccine is needed overtime. The vaccine is considered safe; however, there are reports of subsequent redness, pain and swelling after injection. Safety during pregnancy is still undergoing review and not yet recommended. Studies have also not deemed the vaccine safe for lactating mothers. Studies show the median age of females being sexually active by the age of 15. The vaccine is most effective when done before any exposure. Because of this, the suggested age of vaccination is set very low to ensure that all girls are vaccinated before sexual unveiling.
Ethics
Lancet (2007) noted that there is common agreement of widespread vaccination against HPV has sound supporting evidence. The worldwide, HPV infection has been noted to be accountable for half a million cases of cancer and more than 250,000 deaths every year. In developing countries which unfortunately don’t have the resources in order to adequately be able to promote prevention, end up having higher incidence. The current global range of vaccination is greater than 120,000,000 people worldwide that are being vaccinated since the vaccination was first introduced in 2006. While the vaccine does have some minor side effects, we cant take away the fact that the vaccine is nearly 100% effective in intercepting pre-cancerous lesions that the HPV subypes cause. It has not been reported that any death which may have occurred after the administration of this vaccine has been linked to the vaccine.
This situation forces parents to have this sensitive conversation at an early age. The ethics of this is surrounded by arguments of exposing children to sex at such a young age. One can assume that by providing a vaccination to a child at the ages of 11 or 12 for a sexually transmitted infection is giving kids a green light to take part in sexual behaviors. This is just a concern and there is no evidence presented to support the notion. Adolescents are generally not aware of HPV or STIs and it has not influenced their preference of whether or not to engage in sex. Take a minute to think, how much parental domination is really lost as a result of mandatory vaccination? Not much really when one weighs the pros and cons. With HPV preventing a terrible disease, that terminates the life of women in their prime. To add, during precancerous lesions, most women go through several procedures. Some may agree that HPV and its benefits fall under the key technology to prevent serious/detrimental diseases where possible in efforts to reduce pain and suffering in the long run.
This becomes more of a public health concern where we should think about the effects as a nation and not individually since pertains to consequences like cervical cancer. While some parents may refuse the vaccine for religious beliefs, there are not too many situations where the government would impede on parent-child relationship, but not interfering would lead to extreme health concerns. Just like any new product on the market, the cost for bringing a new product comes with a high cost. In order to start and maintain a successful programs, it requires to showcase products vias commercial that are both safe and effective. It will also require on going research to continue the cycle of new viable products. It would be beneficial to recommend HPV vaccinations to both parents and patients. While the physician can recommend the vaccine, it is up to the parents and patient to make the decision. The physicians are responsible for mentioning the financial concerns, the benefits as well as the cons as with most other interventions, the parents look to the clinician for the ultimate recommendation to vaccinations.
Some may argue that only having females vaccinated can cause a friction of stereotype, and make it seem as if sexual health is primarily a woman’s responsibility. This can be viewed to some as men are neglecting their role and responsibilities when it comes to sex. Even though cervical cancer is really a woman’s disease, men also can play a role in the spread of the virus, and have the ability to be excosed to as well as experience HPV-related problems. In an effort to shed light on this issue, sex education should be provided to bring awareness to both male and females regarding sexual health.
Furthermore, controversy has resulted over whether if boys should receive the vaccine to protect them from other diseases caused by HPV. This would also decrease the sexual transmission of HPV to girls who will later be chance cervical cancer. It is an oversight, however to view the contrasting stance on HPV-vaccine, as evidence of conflict between science and religion. The vaccine is accessible and affordable. Efforts have been pushed to have Medicaid programs & the encouragement of private health plans to cover the cost of the vaccination.
Another important ethical concern is that the vaccine only prevents 70% of cervical cancer, which means that Pap smear tests are still necessary. This also suggests that women who have had the vaccination will unfortunately feel secure and go without the recommended screening. Healthcare professionals when administrating the vaccine will need to continuously address cervical cancer risks during visits. In this case, one would think about the double costs of having to afford the vaccination as well as the Pap smear test.
The Vaccination should not be mandatory because there are people who only have one sexual partner and have less of a chance of contracting an STI. Whereas, there are people with multiple partners who should consider the idea of the HPV vaccine. Education plays a key factor in the development of the female body. This will help the individual to make a more educated decision about their partners. With that said, the female would be encouraged to have timely checkups/ pap testing done in order to properly protect themselves from any future complications. There should be Sex Education classes implemented which includes an extensive curriculum on the importance of Pap Smear Testing and having regular checkups. In junior/high school, there should b e classes that cover more than just condoms and birds and the bee talk. This would be a great opportunity to go over the importance of the HPV Vaccination as well as how to protect one’s body.
What values are in conflict?
One of the main values that most are concerned about is the economics of the HPV vaccination. The vaccine costs $360 for the three recommended doses. This price is almost impossibly high for most families. This also leads to the uneasiness that such price for the vaccine will upsurge the health inequality of cervical cancer by creating more problems financially. The matter brings to light the need for the vaccine to be included in and mandated in insurance coverage. The fact remains that there will still be people who are uninsured or who simply cannot afford the vaccine.
Important to note is that HPV is not cost effective when using this expensive vaccine in addition to continuing cervical cancer screening (Pap Smear). It is hard to comprehend why the government is rushing to out a mandatory vaccination campaign when the frequency and mortality rates of cervical cancer have been consistently declining over the past decades due to the introduction of Pap testing. Another way to look at this controversy is to note that with the HPV vaccination there will still be Pap testing. Follow-up with pap testing will also protect the female from being infected.
Separating the truth from all the myths about HPV vaccination is critical. The most popular myth is that the vaccination is gender specific. The idea that the vaccination is only for girls is a fictitious claim. The center for diseases control and vaccination has recommended vaccination for both males and females that fall between the ages of nine to twenty-six. The vaccine provides a cover against almost seventy percent of cervical cancers. In males, the immunization provides protection against almost all the HPV-linked genital cancers and also against ninety percent of all genital warts in men and women. There is also another myth that says that the vaccine is there only for people that are sexually active. However, the vaccination is recommended for people who are sexually active and also those who are not (Schwartz & Kempner, 2010). The thinking is that those who are not active at the moment will become active with time. The immunization taken stays within the body, and it is able to produce antibodies once there is a detection of infection. In fact, the vaccine works best for children who have not become sexually active yet. Scientific studies show that the bodies of young people have the ability to produce more antibodies for fighting diseases in response to vaccines. The other falsehood is that only people with multiple partners are at the risk of being infected with HPV. The truth is that even a single partner can transmit in a single sexual intercourse.
Currently, there is no HPV plague.
Even though the vaccine does have its benefits it does not really have full protection. The Gardasil vaccine does not protect women from all HPV types which are associated with cervical cancer or genital warts. However it helps protect against two types of HPV, which account for approximately 70% of cases of cervical cancer which account for about 90% of cases of genital warts. Women should still continue getting their regular pap tests in order to help protect them from sexually transmitted infections. The main target populations are girls between the ages of 9-13 years old prior to onset of sexual activity.
Mandating the HPV Vaccine poses a false sense of security. As previously noted, this vaccine does not offer protection against sexually transmitted diseases. The propability of mandating this vaccine, could lead to women feeling more secure when it comes to their sexual precaution and become less concern with engaging in unsafe sex or not getting routinely pap tests. Even after vaccination, pap tests remain essential and practicing safe sex is very important. It is highly recommended to assess the impact of vaccination on the regularity of pap test practices among vaccinated women, as well as their practices with sexual partners.
While using ccondoms consistently and properly during sex, (vaginal, orally or anally) does decrease the chances of contracting HPV or passing it on to a partner, it does not eliminate the risk of contracting HPV infection as well as passing it down to a partner. A condom can only protect the area it covers so it could be possible to become infected by any uncovered warts.
Another concern that the HPV presents is that it is very recent (still very new). There is not sufficient information regarding its ling term effects and how effective it is. If the vaccine protection goes further than 6 years or if any form of booster shots will be needed is still unknown.
There should also be more information available to the public. There are still many people who are unaware of what HPV is. It is important to note that high-risk types of genital HPV can cause cancer of the cervix, vagina, vulva, anus, penis, and throat. The type of cancer HPV causes most often is cervical cancer. While most HPV infections can go away by themselves and do not cause cancer. However, abnormal cells can develop when high-risk types of HPV do not go away. So if most HPV infections go away on their own or can be detected during a Pap test screening then what is the need to pay $360 for this vaccination?
In summary, the controversy surrounding cervical cancer vaccination and Gardasil is an intriguing debate, which leaves me extremely conflicted. It is important to understand the pros and cons of being vaccinated. Today we live in a world where monogamy is not what it once was before. Before, it was ideal that people had one sex partner and were less at risk at contracting STIs. After reviewing the multiple arguments for and against mandatory HPV vaccination, my concluding thoughts are that the HPV vaccine should not be mandated for all children. This is should be a choice that parents can make and not forced into. With proper informal education on the topic, parents will make the right decision for their circumstance.
The HPV is effective at preventing the multiple sequelae of HPV infection in both males and females, it is cost-effective, and it does not increase risky sexual behaviors. Despite its lack of contagiousness in the school setting, the best method for ensuring that children receive the HPV vaccine would be by school mandate, which will increase the percentage receiving the vaccine and make the vaccine more accessible to those of low income. Currently, no states have passed any legislation mandating HPV vaccination for school admission, although 29 states are presently considering school-mandated HPV vaccination bills. A major issue for me is that if one were so protected by the vaccine then there would be no need continuing screening via Pap smears. This brought up cost issues and that most cannot afford both. So if a Pap smear is needed and this test prescreens cancerous lesions then what is the need for a vaccination? Parents will be giving up their rights and exposing 12 or even 9 year olds to conversations about sex. Further, if parents are able to discuss sexual morals and safe sexual behavior with their children before any the child has made the decision to become sexually active this too will also prevent or warn children from contracting an STI through sexual intercourse. The HPV vaccine is a great public health milestone and has its pros but also poses setbacks and side effects. The HPV mainly singles out girls/females, which is unfair.
Benefits of HPV Vaccine Administration
The human papillomavirus (HPV) is the most common sexually transmitted contamination in both females and males. The statistics of the number of infections per year show that something must be done to reduce the rate of prevalence. Most of the infections are subclinical and asymptomatic in nature. However, certain infections are viral serotypes. As such, they are responsible for causing penile and cervical carcinomas along with oropharyngeal, vaginal, vulvar and anogenital carcinomas (Barry, 2011). The documentation of HPV viruses shows that there are more than one hundred and fifty types. About forty of those types are transmitted by sexual contact. The normal immune system of human beings clears all of the potential threats from the asymptomatic infections. The quadrivalent vaccine is used to mitigate the effects of the wart-causing and oncogenic virus types. The Gardasil vaccine is used to prevent HPV types 6, 11, 16 and 18.
The viruses cause cancers that are very devastating implications on the mortality and morbidity of people. It should be of concern that the incidences of primary cases appear to be increasing by the day. About fifty percent of the penile tumors recorded are induced by the HPV infection and types 16, 18 and 16 have been pointed out as the dominant causes with the percentages of 31, 7 and 7 respectively (Barry, 2011). Viral types 18 and 16 can be prevented by prophylactic vaccines, and that will reduce the incidence of squamous cell carcinomas by thirty percent. Viral types 6 and 11 are mostly responsible for causing genital warts in males and females. Although Pap testing has been widely adopted, still seventy percent of the cases of cervical cancer are associated with HPV 16 and HPV 18 viral types. In males, the oropharyngeal cancer is highly linked to HPV 16.
Anal cancers are likewise extremely connected with HPV 16 and 18 viral sorts. Two successful antibodies for the oncogenic HPV viral serotypes have been accessible for just about 10 years after the underlying authoritative endorsement in June 2006. In 2011, the CDC broadened the signs for all-inclusive use in male patients from ages 9-26 with extra regimens for find up dosing relying upon age (Barry, 2011). In the USA, state-sanctioned immunization programs have expanded the number of youngsters immunized. However, some states do not order general immunization of school-age kids for HPV. It is only the District of Columbia and Virginia that require children to receive HPV immunization to go to class. Other states have agreed with the training programs, and another eight have decided to subsidize immunization. The rest, which is twenty-nine states, do not have specific directions in regards to the antibody, yet numerous qualified ward youngsters can acquire the immunizations through linkage with Medicaid or other state funded insurance schemes.
Regardless of these incentives that incorporate financial covers for the immunization, just around 37.6% of female patients and 13.9% of male patients who begin the vaccine arrangements finish entire the recommended amount of dosage inside the 6-month time according to research (Selin, 2010). For females, the danger of cancer of the cervix and the potential to prevent the disease motivated the need for adopting a broad-based program to push for vaccination. The expansion in male genital sores, penile disease, and in addition oropharyngeal and anogenital malignancies should expand the net for this immunization to both genders up to the age of 26. There likewise archived advantages to male patients with respect to a diminishing in sexually transmitted injuries from female sexual accomplices who have been immunized (Barry, 2011). There is proof of populace effect of HPV antibodies with direct decreases in HPV-related pathology in the immunized gatherings. In particular, there is a national tally that is broadly illustrative on overview of reduction by half in viral prevalence from the pre-antibody years 2003 to 2006 to the post-immunization time of 2007-2010. Numerous reviews too have detailed the sharp decrease in the analysis of genital warts within the said time frame. Initial data from Australia demonstrates that group immunity might be an additional advantage from the antibody program. The perfect time to start the immunization arrangement in both genders is before the time of beginning sexual contact. In principle, this immunization might stop the spread of genital warts in both genders notwithstanding it may also help in preventing other forms of cancer.
For a few parents, this displays an ethical quandary. The advantages of preventing the disease are simpler to legitimize. For others, the antibody is viewed as a potential door to empowering sexual contact at early ages or advancing higher hazard sexual practices and, subsequently, frames the premise of a contention to dishearten the main intention of the immunization. For female patients, the contention that the immunization will counteract cervical malignancy shows up much more powerful than the counterargument of advancing prior sexual movement and higher hazard sexual practices. The most continuous parental explanations behind not immunizing high school children were compressed in the audit by Darden et al. it also expressed that the main reasons were that the young children with either not sexually active or the fact that they lack information on the antibody (Shwartz & Kempner, 2015). On the other hand, the rate of acceptance in the male parents is very high.
Currently, scientific investigations and clinical trials are being carried out to extend the antibody to incorporate action against a greater amount of the oncogenic viral subtypes for malignancies attacking the oropharyngeal and anogenital areas. Merck has a 9-valent immunization (V503) including five extra disease making subtypes increment action against these sorts of growth. The sales of Gardasil immunization have expanded in the course of recent years. This gauge serves as a proxy for aggregate antibody dosages created by the pharmaceutical organization (Crook & Baur, 2013). The number of patients immunized (either with a solitary start measurements or finish arrangement) is hard to extrapolate. The present information with respect to assessed HPV inoculation scope among pre-adult young men and women who are aged 13-17 show the elements of expansion in the completed immunization arrangements from 5.9% in 2007 to 37.6% in 2013 for young women and 1.3% to 13.9% in young men from 2011 to 2013.
The Advisory Committee on Immunization Practices (ACIP), working together with other expert affiliations, suggests the schedule for administering the vaccines. In spite of the annual proposals, there is no national body set to oversee the actualization of those suggestions (Krishnan, 2010). In the US, school immunization prerequisites are by and large chosen by every state governing body. The CDC has a mandate over government Vaccines for Children (VFC) in each of the 50 states and gives vaccination, and some state Medicaid programs similarly cover the underinsured and uninsured youngsters. Many states seem to embrace the organization of the immunization, yet neither of them displays an all-inclusive consistency nor do they provide adequate funding allocation to the immunization programs.
Regardless of the protests, the general medical advantages of the antibody and cost adequacy have been approved in different reviews. For female patients, the cervical malignancy counteractive action with immunization administration is better than the cervical tumor screening programs utilizing Papanicolaou spreads alone. In an efficient survey of 29 studies by Seto and associates evaluated that the expansion of young men to the immunization programs, for the most part, surpasses customary cost-viability edges ($50,000 per QALY). They presumed that reviews reliably demonstrate that the HPV immunizations can substantially affect the study of disease transmission of HPV infection. The reservations on Gardasil vaccinations will subside with time as empirical evidence unravels on how it has prevented the spread of cervical cancer.