PoPulationand Public HealtH etHics

would have to start when women are older and have wider intervals than
they currently do to offset the cost of the vaccine; there would also have to
be no need for boosters. 13 A vaccination program that targets girls at high
risk for cervical cancer may be more economically efficient, but this poses
the risk of (re)stigmatizing marginalized groups as potentially diseased and
as posing a health risk to the general population. As well, targeted efforts
may not be welcomed by groups who, historically, have been marginalized
and pathologized by public health initiatives.
Scenario shift
In light of the recent regulatory approval of the use of this vaccine for men in
Canada (2010), the Ontario Ministry of Health and Long-Term Care announces
that the school-based vaccination program has been expanded to include boys
in Grade 8. This causes the Ministry to change its risk-communication strategy
away from the “cancer vaccine” one to an “stI vaccine” strategy. Because
of the laws in Canada allowing direct-to-consumer advertising of vaccines,
the manufacturer is allowed to expand its marketing to parents and boys.
The advertising campaign is pervasive and parents of young girls become
increasingly aware that this vaccine prevents the spread of an stI which may
have implications on the uptake of the vaccine or other possible outcomes.
Concerns about the financial viability of reproductive health services and
screening programs arise given the additional costs to the system of adding
males to the Grade 8 vaccination program.
Questions for discussion
1 Is it ever ethical to knowingly amplify the perception of risk in order
to increase compliance with a public health measure? If so, is this
the case for a school-based vaccination program aimed at children
in Grade 8? Does it make a difference if it is done with the aim of
increasing access for disadvantaged groups?
2 Is it ethical to spend significant public financial and personnel resources
on a public health program that is targeted at the population
as whole, but where a minority of disadvantaged people are the main
benefactors? Does the prevalence and lethality of a disease make a
moral difference, i.e, is there a risk-severity threshold that is required
to justify such a program? Is this the most ethical and/or efficient
way to reduce health inequities at the population level?
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