Yale Institute for Global Health, New Haven, CT, USA.
Hubert Department of Global Health, Rollins School of Public Health and Center for Ethics, Emory University, Atlanta, GA, USA.
Hum Vaccin Immunother. 2022 Dec 31;18(1):1917231. doi: 10.1080/21645515.2021.1917231. Epub 2021 May 19.
There is a high burden of human papillomavirus (HPV) associated cancers in low- and middle-income countries (LMICs). Reducing the recommended dosing schedule from two doses to one makes the vaccine schedule logistically simpler and lowers the cost. This could make the distribution of the current vaccine supply more equitable and lead to the protection of more people. However, the clinical trials studying the efficacy of a single-dose schedule have not yet delivered final results. Against this background, the question is whether a single-dose HPV vaccine recommendation is appropriate now, and if so, what are the ethical considerations of such a recommendation? We developed three ethical recommendations: (1) adopt a holistic view of evidence to justify policy decisions; (2) prioritize the reduction in global disparities in decision-making at all levels; and (3) be transparent in the reporting of how key stakeholder interests have shaped the collection and interpretation of the evidence, and ultimate decisions. The complex discussion regarding the HPV single-dose vaccine schedule highlights the need for in-depth engagement globally to improve our understanding of country-specific contexts, and how those contexts influence decisions regarding the HPV vaccine single-dose recommendation.
在中低收入国家（LMICs），与人类乳头瘤病毒（HPV）相关的癌症负担很高。将推荐的两剂接种方案减少至一剂，可以使疫苗接种计划在后勤上更加简单，并降低成本。这可能使当前疫苗供应的分配更加公平，并保护更多的人。然而，研究单剂方案疗效的临床试验尚未得出最终结果。在此背景下，问题是现在是否适合推荐单剂 HPV 疫苗，如果是，这种推荐的伦理考虑因素是什么？我们制定了三项伦理建议：（1）采用整体证据观来证明政策决策的合理性；（2）优先在各级决策中减少全球差距；（3）在报告中透明地说明关键利益相关者的利益如何影响证据的收集和解释以及最终决策。关于 HPV 单剂疫苗接种方案的复杂讨论突出表明，需要在全球范围内进行深入参与，以加深我们对特定国家/地区背景的理解，以及这些背景如何影响 HPV 疫苗单剂推荐的决策。
