STATES OF CANCER IMMUNITY: THE ETHICAL DIMENSIONS OF HPV VACCINATION POLICIES

Human Papillomavirus (HPV) is a sexually transmitted virus, recognized to be the necessary, yet not sufficient, cause of cervical cancer. Vaccines for individual administration targeting HPV are available today. In this dissertation I undertake a normative analysis of existing HPV vaccination programmes and evaluate how current policy alternatives put in balance competing moral concerns at stake. To this aim, I explore the ethical dimension of the different policy models, with respect to issues of respect for individual choice, expected coverage rates, and population health goals.
My goal is thus to show how the different policies - ranging from a hotly contested mandatory model to prima facie more justifiable voluntary approaches – fare with respect to the interests of individuals targeted by HPV vaccination campaigns. Differently from standard approaches in public health ethics, however, I show that concerns for individual choice in HPV contexts cannot be severed by equally important concerns for social justice. In particular, I show that an insistence on the least restrictive alternative alone leaves out of focus important concerns for social justice and the need to avoid the worsening of existing inequalities. Moreover, I argue that standard approaches in public health ethics should be widened to consider the legitimate interests of specific social groups, namely those belonging to socio-economically disadvantaged strata of society, and fair consideration of the health interests of minority groups.
In this dissertation I therefore present a rationale for adopting a capability-based approach to HPV immunization in order to cope with the most pressing ethical issues at stake in this field.