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Abstract
Despite the great promise offered by human papillomavirus (HPV) vaccines to reduce disease burden and promote socioeconomic and gender equality, their implementation into national programmes has been slow. The vaccination of adolescents against a disease that may have serious consequences much later in life requires special consideration to the principles and processes of informed consent. Accumulating experiences from implementations in many countries indicate a need to examine ethical considerations related to adolescent vaccination. However, frameworks that integrate legal, development- and rights-based considerations in adolescent vaccination policies, while taking into account practical realities of HPV vaccination programmes, are currently lacking. We argue that principles of autonomy, social justice and gender equality have impacts on adolescent immunization that go beyond mere acceptance of vaccination and place greater demands on what constitutes meaningful informed consent, with implications for the provision of age- and context-appropriate information, vaccine financing and gender-based vaccination policies. Independent of cost-effectiveness considerations, we find a strong case to support universal HPV vaccination of girls that is free at the point of use and, where feasible, to extend vaccination to boys under the same financing schemes. ABBREVIATIONS HPV: Human papillomavirus; STI: Sexually transmitted infections; WHO: World Health Organization.
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Affiliation(s)
- Neisha Sundaram
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine , London, UK.,Saw Swee Hock School of Public Health, Tahir Foundation Building, National University of Singapore , Singapore, Singapore
| | - Teck Chuan Voo
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore , Singapore, Singapore
| | - Clarence C Tam
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine , London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine , London, UK
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O'Neill J, Newall F, Antolovich G, Lima S, Danchin MH. Adolescent immunisation in young people with disabilities in Australia. Med J Aust 2019; 211:199-200.e1. [PMID: 31342525 DOI: 10.5694/mja2.50293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jenny O'Neill
- University of Melbourne, Melbourne, VIC.,Royal Children's Hospital, Melbourne, VIC
| | | | - Giuliana Antolovich
- Royal Children's Hospital, Melbourne, VIC.,Murdoch Children's Research Institute, Melbourne, VIC
| | - Sally Lima
- University of Melbourne, Melbourne, VIC.,Bendigo Health, Bendigo, VIC
| | - Margie H Danchin
- Royal Children's Hospital, Melbourne, VIC.,Murdoch Children's Research Institute, Melbourne, VIC
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O’Neill J, Newall F, Antolovich G, Lima S, Danchin M. Vaccination in people with disability: a review. Hum Vaccin Immunother 2019; 16:7-15. [PMID: 31287773 PMCID: PMC7012164 DOI: 10.1080/21645515.2019.1640556] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 06/03/2019] [Accepted: 06/27/2019] [Indexed: 10/26/2022] Open
Abstract
People with disabilities are vulnerable to complications from vaccine-preventable diseases, and every effort should be made to ensure equitable access to immunization for this population. This paper aims to summarize the research on immunizations in people with disabilities, in order to ensure a comprehensive understanding of knowledge in this area and direct further research. The literature is weighted towards coverage data that is difficult to synthesize because of the different definitions of disability, and the variety of settings, vaccinations and age groups across the studies. In-depth qualitative data and data from a variety of health-care providers and people with disability is notably lacking. This is vital to redress in order to develop effective immunization interventions in this population.
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Affiliation(s)
- Jenny O’Neill
- Department of Neurodevelopment and Disability, The Royal Children’s Hospital, Melbourne, Australia
- The Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Developmental Disability and Rehabilitation Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Fiona Newall
- The Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Department of Haematology, The Royal Children’s Hospital, Melbourne, Australia
- Nursing Research, The Royal Children’s Hospital, Melbourne, Australia
- Clinical Haematology Research Group, Murdoch Children’s Research Institute, Australia
- The Department of Nursing, The University of Melbourne, Melbourne, Australia
| | - Giuliana Antolovich
- Department of Neurodevelopment and Disability, The Royal Children’s Hospital, Melbourne, Australia
- Developmental Disability and Rehabilitation Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Sally Lima
- Nursing Research, The Royal Children’s Hospital, Melbourne, Australia
- The Department of Nursing, The University of Melbourne, Melbourne, Australia
- Clinical Learning and Development Unit, Bendigo Health, Victoria, Australia
| | - Margie Danchin
- The Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Department of General Medicine, The Royal Children’s Hospital, Melbourne, Australia
- Vaccine and Immunisation Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
- The School of Population Health, The University of Melbourne, Melbourne, Australia
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Malagón T, Laurie C, Franco EL. Human papillomavirus vaccination and the role of herd effects in future cancer control planning: a review. Expert Rev Vaccines 2018; 17:395-409. [PMID: 29715059 DOI: 10.1080/14760584.2018.1471986] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Vaccine herd effects are the indirect protection that vaccinated persons provide to those who remain susceptible to infection, due to the reduced transmission of infections. Herd effects have been an important part of the discourse on how to best implement human papillomavirus (HPV) vaccines and prevent HPV-related diseases. AREAS COVERED In this paper, we review the theory of HPV vaccine herd effects derived from mathematical models, give an account of observed HPV vaccine herd effects worldwide, and examine the implications of vaccine herd effects for future cervical cancer screening efforts. EXPERT COMMENTARY HPV vaccine herd effects improve the cost-effectiveness of vaccinating preadolescent girls, but contribute to making gender-neutral vaccination less economically efficient. Vaccination coverage and sexual mixing patterns by age are strong determinants of herd effects. Many countries worldwide are starting to observe reductions in HPV-related outcomes likely attributable to herd effects, most notably declining anogenital warts in young men, and declining HPV-16/18 infection prevalence in young unvaccinated women. Policy makers making recommendations for cervical cancer screening will have to consider HPV vaccination coverage and herd effects, as these will affect the positive predictive value of screening and the risk of cervical cancer in unvaccinated women.
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Affiliation(s)
- Talía Malagón
- a Division of Cancer Epidemiology, Faculty of Medicine , McGill University , Montréal , Canada
| | - Cassandra Laurie
- a Division of Cancer Epidemiology, Faculty of Medicine , McGill University , Montréal , Canada
| | - Eduardo L Franco
- a Division of Cancer Epidemiology, Faculty of Medicine , McGill University , Montréal , Canada
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Komparic A. An Ethical Justification for Expanding the Notion of Effectiveness in Vaccine Post-Market Monitoring: Insights from the HPV Vaccine in Canada. Public Health Ethics 2016; 9:78-91. [PMID: 26955399 PMCID: PMC4778494 DOI: 10.1093/phe/phu049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Health regulators must carefully monitor the real-world safety and effectiveness of marketed vaccines through post-market monitoring in order to protect the public's health and promote those vaccines that best achieve public health goals. Yet, despite the fact that vaccines used in collective immunization programmes should be assessed in the context of a public health response, post-market effectiveness monitoring is often limited to assessing immunogenicity or limited programmatic features, rather than assessing effectiveness across populations. We argue that post-market monitoring ought to be expanded in two ways to reflect a 'public health notion of post-market effectiveness', which incorporates normative public health considerations: (i) effectiveness monitoring should yield higher quality data and grant special attention to underrepresented and vulnerable populations; and (ii) the scope of effectiveness should be expanded to include a consideration of the various social factors that maximize (and minimize) a vaccine's effectiveness at the population level, paying particular attention to how immunization programmes impact related health gradients. We use the case of the human papillomavirus vaccine in Canada to elucidate how expanding post-market effectiveness monitoring is necessary to close the gap between clinical practice and public health, and to ensure that vaccines are effective in a morally relevant sense.
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Barbaro B, Brotherton JM. Assessing HPV vaccine coverage in Australia by geography and socioeconomic status: are we protecting those most at risk? Aust N Z J Public Health 2014; 38:419-23. [DOI: 10.1111/1753-6405.12218] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 10/01/2013] [Accepted: 01/01/2013] [Indexed: 11/29/2022] Open
Affiliation(s)
- Bianca Barbaro
- Public Health Information Development Unit; University of Adelaide; South Australia
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Spencer AM, Roberts SA, Brabin L, Patnick J, Verma A. Sociodemographic factors predicting mother's cervical screening and daughter's HPV vaccination uptake. J Epidemiol Community Health 2014; 68:571-7. [PMID: 24567443 DOI: 10.1136/jech-2013-202629] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Achieving high human papillomavirus (HPV) vaccine coverage may reduce inequalities in cervical cancer prevention by mitigating the inequalities seen in the cervical screening programme. This paper assesses whether the same sociodemographic factors are associated with both cervical screening and HPV vaccination. METHODS Girls' HPV vaccination records were linked by address to cervical screening records for their mothers in the North West of England. Index of Multiple Deprivation scores (2010) and census ethnicity data (2001) were used to investigate the association between deprivation and ethnic composition of area of residence with HPV vaccination and cervical screening uptake, along with potential differences between Primary Care Trusts (PCTs), which were responsible for vaccine delivery. RESULTS Deprivation was not associated with routine (12-13-year-olds) vaccination initiation, but girls living in the most deprived quintile were significantly less likely to complete the three vaccine doses (OR 0.75; 95% CI 0.63 to 0.88). Mother-daughter pairs failing to engage in either screening or vaccination were also more likely to live in deprived areas (routine vaccination OR for most deprived quintile: 2.35; 95% CI 2.00 to 2.77). There were differences between PCTs after controlling for demographic effects (OR 1.35; 95% CI 1.23 to 1.52). CONCLUSIONS Ensuring completion of the vaccine schedule is critical for organisations responsible for vaccine delivery in order to reduce cancer risk among girls living in deprived areas. There remains a small minority of mothers and daughters from disadvantaged backgrounds who do not participate in either cervical screening or HPV vaccination.
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Affiliation(s)
- Angela M Spencer
- Manchester Urban Collaboration on Health, Institute of Population Health, Manchester Academic Health Sciences Centre, University of Manchester, , Manchester, UK
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Fisher H, Audrey S, Mytton JA, Hickman M, Trotter C. Examining inequalities in the uptake of the school-based HPV vaccination programme in England: a retrospective cohort study. J Public Health (Oxf) 2013; 36:36-45. [PMID: 23620542 DOI: 10.1093/pubmed/fdt042] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although uptake of Human Papillomavirus (HPV) vaccine is high in the United Kingdom, it is unknown whether the programme has been delivered equitably by ethnicity or deprivation. This study aimed to investigate factors associated with HPV vaccine initiation and completion within the routine HPV vaccination programme in the South West of England. METHODS Data were retrieved for young women eligible for routine vaccination from 2008/09 to 2010/11 from three Primary Care Trusts (PCTs)/local authorities. Multivariable logistic regression models were developed to examine factors associated with uptake of HPV vaccination. RESULTS Of 14 282 eligible young women, 12 658 (88.6%) initiated, of whom 11 725 (92.6%) completed the course. Initiation varied by programme year (86.5-89.6%) and PCTs/local authorities (84.8-91.6%). There was strong evidence for an overall difference of initiation by ethnicity (P < 0.001), but not deprivation quintile (P = 0.48). Young women educated in non-mainstream educational settings were less likely to initiate and, if initiated, less likely to complete (both P < 0.001). CONCLUSIONS HPV vaccination uptake did not vary markedly by social deprivation. However, associations with ethnicity and substantially lower uptake in non-mainstream educational settings were observed. Research to identify reasons for low vaccine uptake in these population groups is required.
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Affiliation(s)
- Harriet Fisher
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
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Thompson A. Human Papilloma Virus, Vaccination and Social Justice: An Analysis of a Canadian School-Based Vaccine Program. Public Health Ethics 2013. [DOI: 10.1093/phe/pht010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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