Informed choice and mass immunization programmes

Women’s Health Action Trust – Women’s Health Update Feb 2009 (partly funded by the Ministry of Health!)
Christy Parker looks at some of the ethical issues surrounding mass immunization programmes targeting children and young people and argues that the principles of informed choice and consent must not be compromised by population health objectives.
When extraordinarily high immunization targets, aggressive marketing campaigns, and one sided information resources are employed, they risk undermining consumers’ rights to informed choice and  informed consent…Offering practitioners financial incentives to meet high uptake targets works to undermine informed consent processes, especially when practitioners also believe that it is their “moral responsibility” to ensure children are immunized.
Once again there are unanswered questions around how long the vaccine will offer immunity. HPV vaccination programmes are also solely targeting girls and women when HPV infection is present in boys and men and is associated with other cancers and genital warts. HPV is thus a sexual health issue, not a women’s health issue and young women should not have to bear the burden for reducing the  incidence of HPV related diseases. Further we risk sending young women the message that they alone are responsible for sexual health. Gardasil is also one of the most expensive vaccines ever sold and the programme will cost hundreds of millions of dollars- prompting questions about the gains given that women still need regular cervical smears with or without the vaccine.
..Ethical issues aside, safety is a major issue if aggressive one-sided marketing campaigns and poor information resources reduce young women’s ability to make a meaningful informed choice about Gardasil. Young women must understand that they will still need to have regular cervical smears because Gardasil does not offer “lifetime protection from cervical cancer” (as parents believed with meningococcal B). Gardasil does not protect against all cancer causing types of HPV and it is unknown how long immunity will last – experience tells us the duration of immunity is likely to be shorter than first thought. If young women do not understand the limitations of Gardasil there is a major risk that they may not participate in New Zealand’s excellent cervical screening programme.

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