1
|
Reiss DR, Karako-Eyal N. Informed Consent to Vaccination: Theoretical, Legal, and Empirical Insights. AMERICAN JOURNAL OF LAW & MEDICINE 2019; 45:357-419. [PMID: 31973669 DOI: 10.1177/0098858819892745] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Informed consent matters - so does protecting people from infectious diseases. This paper examines what the appropriate informed consent process for vaccines should look like and how the process is conceptualized by law and health authorities. Drawing on the extensive theoretical and empirical literature on informed consent and vaccination, this article sets out what an ideal informed consent process for vaccination would consist of, highlighting the need for autonomous decisions. To be autonomous, decisions need to be based on full, accessible information and reached without coercion. We suggest that the information provided must address the nature of the procedure - including benefits to the child, benefits to society, and risks. Parents should have their concerns and misconceptions addressed. The information needs to be accessible and include an opportunity to ask questions. Based on this ideal model we examined in detail the legal framework surrounding informed consent to vaccination and the process as conceptualized by health authorities in two countries, Israel and the United States, to assess whether they meet the requirements. These two countries are similar in some of their values, for example, the importance of individual autonomy, and face similar problems related to vaccine hesitancy. At the same time, there are meaningful differences in their vaccine policies and the current structures of their informed consent processes, allowing for a meaningful comparison. We found neither country met our ideal informed consent process, and suggested improvements both to the materials and to the processes used to obtain informed consent.
Collapse
Affiliation(s)
| | - Nili Karako-Eyal
- Senior Lecturer, School of Law, the College of Management, Academic Studies, Israel
| |
Collapse
|
2
|
Siu JYM, Fung TKF, Leung LHM. Social and cultural construction processes involved in HPV vaccine hesitancy among Chinese women: a qualitative study. Int J Equity Health 2019; 18:147. [PMID: 31533722 PMCID: PMC6751778 DOI: 10.1186/s12939-019-1052-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/11/2019] [Indexed: 11/15/2022] Open
Abstract
Background HPV vaccine is a prophylactic vaccine to prevent HPV infections. Recommended by the World Health Organization, this vaccine is clinically proven to be one of the most effective preventive measures against the prevalence of cervical cancer and other HPV-associated cancers and chronic genital conditions. However, its uptake rate among women in Hong Kong is insignificant—only approximately 2.9% adolescent girls and 9.7% female university students received HPV vaccination in 2014. With the notion of Critical Medical Anthropology, we aimed to identify if different influential factors, ranging from individual, societal, and cultural, are involved in the decision-making process of whether to receive HPV vaccination. Methods We adopted a qualitative approach and conducted in-depth individual semistructured interviews with 40 women in Hong Kong between May and August 2017. Results We noted that the following factors intertwined to influence the decision-making process: perceptions of HPV and HPV vaccine; perceived worthiness of HPV vaccines, which was in turn influenced by vaccine cost, marriage plans, and experiences of sexual activities; history of experiencing gynecological conditions, stigma associated with HPV vaccination, acquisition of information on HPV vaccines, distrust on HPV vaccines, and absence of preventive care in the healthcare practice. Conclusions HPV vaccination is promoted in a manner that is “feminized” and “moralized” under the patriarchal value system, further imposing the burden of disease on women, and leading to health inequality of women in pursuing the vaccination as a preventive health behaviour as a result. We believe that this ultimately results in an incomplete understanding of HPV, consequently influencing the decision-making process. The “mixed-economy” medical system adopting capitalist logic also molds a weak doctor–patient relationship, leading to distrust in private practice medical system, which affects the accessibility of information regarding HPV vaccination for participants to make the decision.
Collapse
Affiliation(s)
- Judy Yuen-Man Siu
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
| | - Timothy K F Fung
- Department of Communication Studies, School of Communication, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Leo Ho-Man Leung
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| |
Collapse
|
3
|
Loke AY, Kwan ML, Wong YT, Wong AKY. The Uptake of Human Papillomavirus Vaccination and Its Associated Factors Among Adolescents: A Systematic Review. J Prim Care Community Health 2017; 8:349-362. [PMID: 29161946 PMCID: PMC5932744 DOI: 10.1177/2150131917742299] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: The purpose of this review was to explore the uptake of the human papillomavirus (HPV) vaccination, its associated factors, and the facilitators of and barriers to HPV vaccination among adolescents. Methods: A comprehensive literature search was conducted through 5 electronic databases, including PubMed, CINAHL, Cochrane Library, Medline, and PsycInfo from January 2006 to March 2015 for studies examining the uptake, awareness, knowledge, acceptability, and intention of adolescents with regard to HPV vaccination. Results: Twenty-eight studies were identified and included. The HPV vaccination uptake rate (at least 1 dose) varied significantly among countries, ranging from 2.4% to 94.4%. Scotland achieved the highest uptake of all the studies included in this review, while Hong Kong had the lowest, at 2.4% to 9.1%. This review also showed that adolescents had limited awareness and knowledge of HPV infections and vaccines, even 10 years after the vaccine had become available. Conclusions: It is recommended that barriers to the uptake of the vaccine should be addressed, and that school-based sexual health education of HPV infection and vaccine promotion should be reinforced.
Collapse
Affiliation(s)
- Alice Yuen Loke
- 1 The Hong Kong Polytechnic University, Kowloon, Hung Hom, Hong Kong SAR
| | - Miu Ling Kwan
- 1 The Hong Kong Polytechnic University, Kowloon, Hung Hom, Hong Kong SAR.,2 Tuen Mun Hospital, Hospital Authority, Hong Kong SAR
| | - Yuen-Ting Wong
- 1 The Hong Kong Polytechnic University, Kowloon, Hung Hom, Hong Kong SAR
| | - Alice Kar Yan Wong
- 1 The Hong Kong Polytechnic University, Kowloon, Hung Hom, Hong Kong SAR
| |
Collapse
|
4
|
Daley EM, Vamos CA, Thompson EL, Zimet GD, Rosberger Z, Merrell L, Kline NS. The feminization of HPV: How science, politics, economics and gender norms shaped U.S. HPV vaccine implementation. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2017; 3:142-148. [PMID: 28720448 PMCID: PMC5883212 DOI: 10.1016/j.pvr.2017.04.004] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 03/10/2017] [Accepted: 04/19/2017] [Indexed: 12/14/2022]
Abstract
Human papillomavirus (HPV) can cause a number of anogenital cancers (i.e., cervical, penile, anal, vaginal, vulvar) and genital warts. A decade ago, the HPV vaccine was approved, and has been shown to be a public health achievement that can reduce the morbidity and mortality for HPV-associated diseases. Yet, the mistaken over-identification of HPV as a female-specific disease has resulted in the feminization of HPV and HPV vaccines. In this critical review, we trace the evolution of the intersection of science, politics, economics and gender norms during the original HPV vaccine approval, marketing era, and implementation. Given the focus on cervical cancer screening, women were identified as bearing the burden of HPV infection and its related illnesses, and the group responsible for prevention. We also describe the consequences of the feminization of HPV, which has resulted primarily in reduced protection from HPV-related illnesses for males. We propose a multilevel approach to normalizing HPV vaccines as an important aspect of overall health for both genders. This process must engage multiple stakeholders, including providers, parents, patients, professional organizations, public health agencies, policymakers, researchers, and community-based organizations.
Collapse
Affiliation(s)
- Ellen M Daley
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA.
| | - Cheryl A Vamos
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA.
| | - Erika L Thompson
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA.
| | - Gregory D Zimet
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Zeev Rosberger
- Lady Davis Institute for Medical Research, Jewish General Hospital & Departments of Oncology, Psychiatry and Psychology, McGill University, Montreal, QC, Canada.
| | - Laura Merrell
- Department of Health Sciences, James Madison University, Harrisonburg, VA, USA.
| | - Nolan S Kline
- Department of Anthropology, Rollins College, Winter Park, FL, USA.
| |
Collapse
|
5
|
Young AM, Crosby RA, Jagger KS, Casquejo E, Pinote L, Ybañez P, Casquejo L, Estorgio D, Pinote L. Influences on HPV vaccine acceptance among men in the Philippines. JOURNAL OF MENS HEALTH 2011. [DOI: 10.1016/j.jomh.2011.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
6
|
Shuman AG, Wolf GT. Human papillomavirus status in head and neck cancer: the ethics of disclosure. Cancer 2010; 116:4221-6. [PMID: 20544838 DOI: 10.1002/cncr.25210] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Human papillomavirus (HPV) is an emerging causative factor for squamous carcinoma of the oropharynx and perhaps other head and neck cancers. There is a great deal of uncertainty regarding the clinical significance and implications of HPV status in this patient population. As a result, there is no established protocol for informing patients of the potential link between viral infection and their cancer. This paper discusses some of the ethical issues involved with informing head and neck cancer patients of their HPV status, recognizing the dilemma posed by unresolved clinical questions and the need to respect the autonomy of patients by disclosing relevant information.
Collapse
Affiliation(s)
- Andrew G Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.
| | | |
Collapse
|
7
|
Benítez-Bribiesca L. Ethical dilemmas and great expectations for human papilloma virus vaccination. Arch Med Res 2009; 40:499-502. [PMID: 19853191 DOI: 10.1016/j.arcmed.2009.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Accepted: 05/26/2009] [Indexed: 11/15/2022]
Abstract
When the first preventive HPV vaccine became available in 2006, it drew both enthusiasm and multiple ethical problems. In the case of HPV vaccination, there is a clear conflict between the scientific data that claim a definitive advantage for preventing HPV infection in the exposed population and the ethical and moral issues resulting from a compulsory program. Despite the evident success of routine and compulsory vaccination in young women, there is increasing concern about safety, efficacy, and equity of the vaccine and to close the knowledge "gaps" about HPV infection and consequent health outcomes. Some of these fears are expressed particularly in conservative groups that link these arguments to those of religious and moral issues contending that HPV vaccination is an indirect license for liberal sexual activity in youths, resulting in promiscuity and/or less participation in cervical cancer screening. It has been well demonstrated that HPV infection can lead to harm through the induction of premalignant and cancerous lesions. Therefore, any proven method for preventing infection, such as HPV vaccines, should be used in persons at risk. These policies, however, should be strictly linked to cervical cancer screening programs.
Collapse
Affiliation(s)
- Luis Benítez-Bribiesca
- Oncology Research Unit, Oncology Hospital, Centro Medico Nacional Siglo XXI, Mexico, D.F., Mexico.
| |
Collapse
|
8
|
Tsui J, Saraiya M, Thompson T, Dey A, Richardson L. Cervical cancer screening among foreign-born women by birthplace and duration in the United States. J Womens Health (Larchmt) 2008; 16:1447-57. [PMID: 18062760 DOI: 10.1089/jwh.2006.0279] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Mortality rates for cervical cancer have increased among foreign-born women in the United States in the last two decades. Previous research indicates that rates of Pap testing are lower among foreign-born women than in U.S.-born women. This study identifies screening rates among foreign-born women by birthplace and duration in the United States. METHODS We used data from 4 years (1998, 1999, 2000, 2003) of the National Health Interview Survey (NHIS) to estimate Pap testing rates by birthplace (Mexico, Central America, Caribbean, South America, Europe, Russia, Africa, Middle East, India, Asia, and Southeast Asia) and percent of lifetime spent in the United States for women aged>or=18 years (n=70,775). Rates were age standardized to the 2000 U.S. population. RESULTS After adjusting for demographic characteristics and health indicators, we found that 18.6% (95% CI 16.7, 20.6) of recent immigrants (<25% of lifetime in the United States) and 9.9% (95% CI 9.0, 10.8) of established immigrants (>or=25% of lifetime in the United States)never received a Pap test in their lifetime compared with 5.8% (95% CI 5.5, 6.1) of U.S.-born women. Adjusted prevalence of never receiving a Pap test was highest among women from Asia, Southeast Asia, and India (19.6%), South America (12.7%), Mexico (11.2%), Caribbean (11.0%), Europe (9.9%), and Central America (9.2%). CONCLUSIONS Significant differences exist in rates of screening for cervical cancer between foreign-born groups by birthplace and by duration in the United States. Nationally and locally funded screening programs may benefit from these findings in developing screening strategies for foreign-born women.
Collapse
Affiliation(s)
- Jennifer Tsui
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | | | | | | | | |
Collapse
|
9
|
Abstract
Cancer of the uterine cervix is the second largest cause of cancer deaths in women, and its toll is greatest in populations that lack screening programmes to detect precursor lesions. Persistent infection with 'high risk' genotypes of human papillomavirus (HPV) is necessary, although not sufficient, to cause cervical carcinoma. Therefore, HPV vaccination provides an opportunity to profoundly affect cervical cancer incidence worldwide. A recently licensed HPV subunit vaccine protects women from a high proportion of precursor lesions of cervical carcinoma and most genital warts. Here we examine the ramifications and remaining questions that surround preventive HPV vaccines.
Collapse
Affiliation(s)
- Richard Roden
- Department of Pathology, The Johns Hopkins University, Baltimore, Maryland 21231, USA.
| | | |
Collapse
|
10
|
Sherris J, Friedman A, Wittet S, Davies P, Steben M, Saraiya M. Chapter 25: Education, training, and communication for HPV vaccines. Vaccine 2006; 24 Suppl 3:S3/210-8. [PMID: 16950009 DOI: 10.1016/j.vaccine.2006.05.124] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Accepted: 05/31/2006] [Indexed: 11/16/2022]
Abstract
As human papillomavirus (HPV) vaccines come to market, they will face education and training challenges similar to those of other new vaccines, along with HPV-specific issues. Recent studies document stark knowledge gaps about HPV at all levels--among policy makers, healthcare providers, parents, and teens--in both the industrialized and developing worlds. Pharmaceutical companies, public health advocates, medical trainers, and health educators need to understand their diverse audiences and respond appropriately to the needs of each. They also must use research-based communication strategies and materials to most effectively, and accurately, convey the need for an HPV vaccine and to manage expectations about how the vaccine can, and cannot, protect women and men.
Collapse
Affiliation(s)
- Jacqueline Sherris
- Program for Appropriate Technology in Health, 1455 NW Leary Way, Seattle, WA 98107, USA.
| | | | | | | | | | | |
Collapse
|