A tale of two policies

This week's Editorial in the Lancet is entitled "Should HPV vaccines be mandatory for all adolescents?". Those who expect an intelligent debate on the pros and cons of this type of mandatory vaccination are bound to be frustrated, because the editors just flatly state that, of course, it should be mandatory, and then go on to ponder whether HPV vaccines should be mandatory for boys too. Newspaper articles have covered the Lancet editorial, and parents have been bringing up the key ethical issue that the Lancet ignors: should the state have the power to enforce vaccination of adolescents, even against the will of parents or those adolescents themselves? It looks as if the Lancet's editorial team lapsed back into unreconstructed paternalism.

The Lancet editorial has even managed to misrepresent a recent ruling on HPV vaccination in the Michigan Senate.

Following earlier approval by the US Food and Drug Administration of the vaccine in girls and women, the Michigan Senate passed a bill on Sept 21, ruling that all girls entering the sixth grade of school (11–12 years old) should be immunised. This is the first legislation of its kind in the USA, and a decision from which the EU member states should take heed.

What this statement omits is the fact that the Michigan ruling allows for exceptions: parents who have medical, religious or philosophical objections to having their daughter vaccinated make opt them out of vaccination. Parents are not necessarily happy being told by their government that they must put drugs by big pharmaceutical companies like Merck into their daughters, no matter how effective those drugs may be. These days, governments, medical institutions and big pharma are not, to put it lightly, regarded as worthy of blind trust by the public. (It may be worth noting that the results of Merck's HPV vaccine Gardasil was first published in ... the Lancet Oncology). This relationship of compromised trust is perhaps something that EU member states, and the Lancet, should take more heed of in HPV vaccine promotion and policy-making.