Abstract
BackgroundThe first vaccine to prevent human papillomavirus (HPV) and cervical cancer has been licensed, and in future, vaccination may be routinely offered to 10–14 year old girls. HPV is a sexually transmitted virus and some parents may refuse consent for vaccination. Under-16s in the UK have a right to confidential sexual health care without parental consent. We investigated parents' views on making available HPV vaccination to adolescent minors at sexual health clinics without parental consent.MethodsThis was a semi-qualitative analysis of views of parents of 11–12 year old school children collected as part of a population-based survey of parental attitudes to HPV vaccination in Manchester. Parents were firstly asked if they agreed that a well-informed child should be able to request vaccination at a sexual health clinic without parental consent, and secondly, to provide a reason for this answer. Ethical perspectives on adolescent autonomy provided the framework for descriptive analysis.Results307 parents answered the question, and of these, 244 (80%) explained their views. Parents with views consistent with support for adolescent autonomy (n = 99) wanted to encourage responsible behaviour, protect children from ill-informed or bigoted parents, and respected confidentiality and individual rights. In contrast, 97 parents insisted on being involved in decision-making. They emphasised adult responsibility for a child's health and guidance, erosion of parental rights, and respect for cultural and moral values. Other parents (n = 48) wanted clearer legal definitions governing parental rights and responsibilities or hoped for joint decision-making. Parents resistant to adolescent autonomy would be less likely to consent to future HPV vaccination, (67%) than parents supporting this principle (89%; p < 0.001).ConclusionIn the UK, the principle of adolescent autonomy is recognised and logically should include the right to HPV vaccination, but this may concern parents who would otherwise approve vaccination.
Highlights
The first vaccine to prevent human papillomavirus (HPV) and cervical cancer has been licensed, and in future, vaccination may be routinely offered to 10–14 year old girls
In this paper we report a semi-qualitative analysis of their responses, using an ethical framework to explore parents' views on HPV vaccination in the context of adolescent autonomy
Parents who had concerns about sexual health clinics were less likely than those with favourable views to agree to future HPV vaccination, even with parental consent (67% versus 89%; chi square: p < 0.001)
Summary
The first vaccine to prevent human papillomavirus (HPV) and cervical cancer has been licensed, and in future, vaccination may be routinely offered to 10–14 year old girls. The first vaccine to prevent cervical cancer was recently approved for use in the European Union (Gardasil®, Merck &Co, Inc.)[1] This brings closer the possibility of routine vaccination against human papillomavirus (HPV) to prevent pre-cancerous cervical lesions and invasive disease [2]. This quadrivalent vaccine, which is highly effective against HPV types 6/11 (low risk) and HPV types 16/ 18 (high risk), could have a significant public health impact in reducing HPV prevalence, persistent HPV infection, cervical neoplasia and genital warts [3]. School vaccination programmes would be feasible in the UK but acceptability by the public of routine vaccination against a sexually transmitted infection (STI) is still uncertain and parental consent for vaccination would be necessary
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