Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.
Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health and Robert H. McKinney School of Law, Indianapolis, IN.
J Pediatr. 2021 Apr;231:24-30. doi: 10.1016/j.jpeds.2021.01.026. Epub 2021 Jan 20.
We address ethical, legal, and practical issues related to adolescent self-consent for human papillomavirus (HPV) vaccination. HPV vaccination coverage continues to lag well behind the national goal of 80% series completion. Structural and behavioral interventions have improved vaccination rates, but attitudinal, behavioral, and access barriers remain. A potential approach for increasing access and improving vaccination coverage would be to permit adolescents to consent to HPV vaccination for themselves. We argue that adolescent self-consent is ethical, but that there are legal hurdles to be overcome in many states. In jurisdictions where self-consent is legal, there can still be barriers due to lack of awareness of the policy among healthcare providers and adolescents. Other barriers to implementation of self-consent include resistance from antivaccine and parent rights activists, reluctance of providers to agree to vaccinate even when self-consent is legally supported, and threats to confidentiality. Confidentiality can be undermined when an adolescent's self-consented HPV vaccination appears in an explanation of benefits communication sent to a parent or if a parent accesses an adolescent's vaccination record via state immunization information systems. In the context of the COVID-19 pandemic, which has led to a substantial drop in HPV vaccination, there may be even more reason to consider self-consent. The atmosphere of uncertainty and distrust surrounding future COVID-19 vaccines underscores the need for any vaccine policy change to be pursued with clear communication and consistent with ethical principles.
我们探讨了与青少年自行同意接种人乳头瘤病毒（HPV）疫苗相关的伦理、法律和实际问题。HPV 疫苗接种覆盖率仍远低于全国 80% 系列完成目标。结构和行为干预措施提高了疫苗接种率，但态度、行为和准入障碍仍然存在。增加准入和改善疫苗接种覆盖率的一种潜在方法是允许青少年自行同意接种 HPV 疫苗。我们认为，青少年自行同意是合乎道德的，但在许多州，法律上存在障碍。在自行同意合法的司法管辖区，由于医疗保健提供者和青少年对该政策缺乏认识，仍然存在障碍。自行同意实施的其他障碍包括来自反疫苗和父母权利活动家的抵制、提供者即使在法律支持自行同意的情况下也不愿同意接种疫苗，以及对保密性的威胁。当青少年自行同意的 HPV 疫苗接种出现在发送给家长的福利说明中，或者当家长通过州免疫信息系统访问青少年的疫苗接种记录时，保密性可能会受到损害。在 COVID-19 大流行导致 HPV 疫苗接种大幅下降的背景下，可能更有理由考虑自行同意。围绕未来 COVID-19 疫苗的不确定性和不信任气氛突显出，任何疫苗政策的改变都需要明确沟通，并符合伦理原则。
