Key ethical considerations to guide the adjudication of a single-dose HPV vaccine schedule

• Authors: Ruha Shadab, Yale Institute for Global Health; James Lavery, Emory University; Sarah M McFadden, Yale Institute for Global Health; Jad A Elharake, Yale Institute for Global Health; Fauzia Malik, Emory University; Saad Omer, Emory University
• Journal Title: HUMAN VACCINES & IMMUNOTHERAPEUTICS
• Volume: Volume 18, Number 1
• Publisher: TAYLOR & FRANCIS INC | 2021-05-16, Pages 1917231-1917231
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1080/21645515.2021.1917231
• Subjects: Health Sciences, Public Health; Health Sciences, Nursing; Health Sciences, Epidemiology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Biotechnology & Applied Microbiology; Immunology; HPV vaccine ethics; policy; distributive justice; single-dose schedule; IMMUNOGENICITY; REGIMENS; GIRLS

Abstract

There is a high burden of human papillomavirus (HPV) associated cancers in low- and middle-income countries (LMICs). Reducing the recommended dosing schedule from two doses to one makes the vaccine schedule logistically simpler and lowers the cost. This could make the distribution of the current vaccine supply more equitable and lead to the protection of more people. However, the clinical trials studying the efficacy of a single-dose schedule have not yet delivered final results. Against this background, the question is whether a single-dose HPV vaccine recommendation is appropriate now, and if so, what are the ethical considerations of such a recommendation? We developed three ethical recommendations: (1) adopt a holistic view of evidence to justify policy decisions; (2) prioritize the reduction in global disparities in decision-making at all levels; and (3) be transparent in the reporting of how key stakeholder interests have shaped the collection and interpretation of the evidence, and ultimate decisions. The complex discussion regarding the HPV single-dose vaccine schedule highlights the need for in-depth engagement globally to improve our understanding of country-specific contexts, and how those contexts influence decisions regarding the HPV vaccine single-dose recommendation.