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Vaksiner mot humant papillomavirus (HPV). Etiske aspekter ved innføring av profylaktiske HPVvaksiner

Hofmann, Bjørn
Peer reviewed, Research report
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Report; systematic review (229.1Kb)
URI
http://hdl.handle.net/11250/2378507
Date
2008-09
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  • Rapporter og andre publikasjoner fra Kunnskapssenteret [694]
Original version
Rapport fra Kunnskapssenteret 22/2008  
Abstract
KEY MESSAGES: Ethical challenges with implementing prophylactic vaccines against human

papilloma virus (HPV)

Background: About 300 women get cervix cancer and about 100 die from cervix

cancer every year in Norway. Cervic cancer is primarily caused by continuous infection

with human papilloma virus (HPV), and over 120 strains of HPV have been

identified. About 14 of these are are oncogenic. HPV-16 and HPV-18 can be found in

about 70% of of the women with cervix cancer. Most HPV infections will cease by

themselves, but where the infections persist, there is an increased risk for cellular

changes. There exist vaccines against HPV 16/18, but there is yet no evicence that

the vaccine is effective against cervical cancer. This has incited fierce debates on

whether to introduce the HPV vaccine in national or statewide vaccination programs.

This report aims at highlighting and discussing the moral aspects that are

relevant for the decisionmaking process with regards to HPV vaccine.

Method: The report uses a method developed for addressing ethical issues in health

technology assessments (HTAs) that discusses central moral questions related to

health interventions. The aim is not to give unequivocal answers to the questions,

but rather to elucidate arguments and aspects that are important for decision makers

and stake holders.

Results: The potential utility of HPV 16/18 vaccination is considerable, but morally

challenging, as the real impact of HPV vaccination on cervical cancer is not known,

and the vaccine is costly. Vaccination is an intervention towards healthy people, calling

for special attention, especially as there is conciderable uncertainty about its effects

and side effects. It is challenging to assess future utility of potential prophylactic

interventions against the utility of health interventions today. HPV vaccine of

children is also challenging with respect to informed consent. Informing the public

and potential persons to receive the vaccine appears to be a considerable challenge.

Conclusion: HPV vaccination can potentially save 40 women from getting cervix

cancer every year and 13 from dying, but there is no evidence for this, and vaccination

is costly. That raises a series of morally challenging issues that are important to

address when deciding whether to implement the vaccine or not (and how to implement

it).
Publisher
Norwegian Knowledge Centre for the Health Services
Series
Rapport fra Kunnsskapssenteret
22/2008
Report from NOKC
22/2008

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