A proposed ethical framework for vaccine mandates: competing values and the case of HPV

Kennedy Inst Ethics J. 2008 Jun;18(2):111-24. doi: 10.1353/ken.0.0011.


Debates over vaccine mandates raise intense emotions, as reflected in the current controversy over whether to mandate the vaccine against human papilloma virus (HPV), the virus that can cause cervical cancer. Public health ethics so far has failed to facilitate meaningful dialogue between the opposing sides. When stripped of its emotional charge, the debate can be framed as a contest between competing ethical values. This framework can be conceptualized graphically as a conflict between autonomy on the one hand, which militates against government intrusion, and beneficence, utilitarianism, justice, and nonmaleficence on the other, which may lend support to intervention. When applied to the HPV vaccine, this framework would support a mandate based on utilitarianism, if certain conditions are met and if herd immunity is a realistic objective.

MeSH terms

  • Alphapapillomavirus / immunology
  • Beneficence
  • Ethical Theory*
  • Female
  • Humans
  • Immunity, Herd*
  • Papillomavirus Infections / immunology
  • Papillomavirus Infections / prevention & control
  • Papillomavirus Vaccines / administration & dosage*
  • Personal Autonomy
  • Social Justice
  • Social Values*
  • Tumor Virus Infections / immunology
  • Tumor Virus Infections / prevention & control
  • Uterine Cervical Neoplasms / prevention & control*
  • Uterine Cervical Neoplasms / virology
  • Vaccination / ethics*


  • Papillomavirus Vaccines