title: The sexual ethics of HPV vaccination for boys.
abstract: Human papillomavirus (HPV) is one of the most common sexually transmitted infections. It is a leading cause of cervical cancer in women but the virus is increasingly being linked to several other cancers in men and women alike. Since the introduction of safe and effective but also expensive vaccines, many developed countries have implemented selective vaccination programs for girls. Some however argue that these programs should be expanded to include boys, since (1) HPV constitutes non-negligible health risks for boys as well and (2) protected boys will indirectly also protect girls. In this paper we approach this discussion from an ethical perspective. First, on which moral grounds can one justify not reimbursing vaccination for the male sex? We develop an ethical framework to evaluate selective vaccination programs and conclude that, in the case of HPV, efficiency needs to be balanced against non-stigmatization, non-discrimination and justice. Second, if vaccination programs were to be expanded to boys as well, do the latter then also have a moral duty to become immunized? Two arguments in favor of such a moral duty are well known in vaccination ethics: the duty not to harm others and to contribute to the public good of public health. However, we argue that these are not particularly convincing in the context of HPV. In contrast, we believe a third, more powerful but also more controversial argument is possible. In our view, the sexual mode of transmission of HPV constitutes an additional reason to believe that boys in fact may have a moral obligation to accept vaccination.
authors.affiliation: Centre for Health Economics Research and Modelling Infectious Diseases, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium, jeroen.luyten@ua.ac.be.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Luyten
authors.forename: Bart
authors.initials: B
authors.lastname: Engelen
authors.forename: Philippe
authors.initials: P
authors.lastname: Beutels
mesh_terms: D018562:Disease Transmission, Infectious / Q000517:prevention & control; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000191:economics / Q000941:ethics*; D008297:Male; D028681:Moral Obligations; D030361:Papillomavirus Infections / Q000517:prevention & control* / Q000635:transmission; D053918:Papillomavirus Vaccines; D063507:Sexism; D015229:Sexually Transmitted Diseases, Viral / Q000517:prevention & control; D014611:Vaccination / Q000941:ethics*
chemical_list: D053918:Papillomavirus Vaccines
references.citation: J Natl Cancer Inst Monogr. 2003;(31):57-65
references.pmid: 12807947
references.citation: BMC Infect Dis. 2013 Mar 18;13:140
references.pmid: 23506489
references.citation: J Adolesc Health. 2010 Apr;46(4 Suppl):S20-6
references.pmid: 20307840
references.citation: Sex Health. 2010 Sep;7(3):352-8
references.pmid: 20719227
references.citation: J Infect Dis. 2011 Aug 1;204(3):372-6
references.pmid: 21742835
references.citation: Ann Oncol. 2011 Dec;22(12):2675-2686
references.pmid: 21471563
references.citation: Lancet. 2001 May 12;357(9267):1513-8
references.pmid: 11377626
references.citation: Int J Equity Health. 2013 Feb 08;12:14
references.pmid: 23394214
references.citation: Med Health Care Philos. 2011 Feb;14(1):19-27
references.pmid: 20853152
references.citation: Lancet Infect Dis. 2007 Apr;7(4):289-96
references.pmid: 17376386
references.citation: Public Health Genomics. 2009;12(5-6):291-307
references.pmid: 19684442
references.citation: Vaccine. 2004 May 7;22(15-16):1862-7
references.pmid: 15121296
references.citation: Clin Infect Dis. 2011 Apr 1;52(7):911-6
references.pmid: 21427399
references.citation: J Med Ethics. 2012 Apr;38(4):247-9
references.pmid: 22138726
references.citation: Sex Health. 2012 Dec;9(6):527-37
references.pmid: 23380235
references.citation: Curr Infect Dis Rep. 2011 Apr;13(2):175-81
references.pmid: 21365381
references.citation: Am J Prev Med. 2004 Jan;26(1):84-8
references.pmid: 14700717
references.citation: Vaccine. 2006 May 8;24(19):4212-21
references.pmid: 16546308
references.citation: Clin Infect Dis. 2009 May 1;48(9):1250-3
references.pmid: 19292662
references.citation: Health Econ. 2001 Dec;10(8):751-74
references.pmid: 11747055
references.citation: Lancet Oncol. 2012 Aug;13(8):e333
references.pmid: 23024997
references.citation: Lancet Infect Dis. 2008 Nov;8(11):727-33
references.pmid: 18992409
references.citation: J Viral Hepat. 2007 Aug;14(8):584-91
references.pmid: 17650293
references.citation: Vaccine. 2006 Aug 31;24 Suppl 3:S3/11-25
references.pmid: 16949997
references.citation: Sex Transm Dis. 2002 Nov;29(11):725-35
references.pmid: 12438912
references.citation: Vaccine. 2011 Oct 26;29(46):8390-6
references.pmid: 21856360
references.citation: N Engl J Med. 2003 Feb 6;348(6):518-27
references.pmid: 12571259
references.citation: BMJ. 1995 Nov 4;311(7014):1215-7
references.pmid: 7488907
references.citation: Int J Cancer. 2013 Sep 15;133(6):1459-69
references.pmid: 23463194
references.citation: Vaccine. 2012 Nov 20;30 Suppl 5:F55-70
references.pmid: 23199966
references.citation: Lancet. 2013 May 18;381(9879):1688
references.pmid: 23683613
references.citation: Soc Sci Med. 2013 Jan;77:84-9
references.pmid: 23218439
references.citation: Br J Cancer. 2007 Nov 5;97(9):1322-8
references.pmid: 17923869
references.citation: Pharmacoeconomics. 2009;27(2):127-47
references.pmid: 19254046
references.citation: Proc Natl Acad Sci U S A. 2012 Jan 31;109(5):1378
references.pmid: 22307587
references.citation: Reprod Health Matters. 2008 Nov;16(32):97-103
references.pmid: 19027627
references.citation: Eur J Public Health. 2010 Aug;20(4):438-42
references.pmid: 19959614
references.citation: Vaccine. 2012 Nov 20;30 Suppl 5:F123-38
references.pmid: 23199956
references.citation: Travel Med Infect Dis. 2007 Mar;5(2):90-6
references.pmid: 17298914