Human papillomavirus vaccination: Making sense of the public controversy

Abstract

A large body of evidence supports the prevailing scientific opinion that human papillomavirus (HPV) vaccines are efficacious, safe, and cost-effective. Since first licensure in 2006, however, HPV vaccines have sparked unjustified controversy over their effectiveness, safety and risks, utility, and ethical implementation. We discuss various public criticisms relating to HPV vaccination and the weight of the evidence and counterarguments concerning each. These criticisms can be classified as follows: (1) effectiveness (lack of demonstrated efficacy against cervical cancer, lack of vaccine clinical trial data in targeted age groups, and limited HPV type protection of first-generation vaccines), (2) safety and risk (concerns regarding potential serious adverse health events linked with vaccination, effect of vaccines on prevalent infections, and potential sexual disinhibition caused by vaccination), (3) utility (disputing the added value of vaccination on the grounds of financial conflicts of interests, the low risk of cervical cancer consequent to screening, and the cost-effectiveness of vaccination), and (4) ethics (concerns regarding informed consent and self-determination in vaccination programs, the social justice of vaccine distribution, and gender equity). Most HPV vaccine controversies stem from misinformation and distrust of institutions. Public health institutions must deploy effective communication strategies to address ill-founded criticisms, enable informed consent, and foster public confidence in HPV vaccines.