A vaccine that protects against a virulent cancer sounds like a great advance for public health, yet the use of the vaccine Gardasil, which protects against the cervical-cancer causing human papillomavirus (HPV), has met with resistance and controversy.
Should the government mandate its use to ensure the highest level of immunity within the population? Would a mandate to vaccine adolescent girls against a sexually transmitted disease violate parental rights?
Sanford School senior Zahra Remtulla became interested in the issues surrounding the use of the HPV vaccine in the United States while taking a class in Global Health Ethics taught by Associate Professor of Public Policy Kathryn Whetten.
Cervical cancer is the second most common cause of death for women worldwide, with those who do not have access to pap tests at higher risk. In the United States, minority populations have higher rates of the cancer, especially Latinas. Remulla decided to look at local community attitudes toward the vaccine, focusing on Latina mothers in Durham.
She shaped her research to consider four ethical dilemmas raised by distribution of the HPV vaccine: whether vaccination should be mandated for school attendance; whether to vaccinate males as well as females; whether to vaccinate females under 18 without parental consent; and mandating the vaccine for immigrants.
Remtulla organized six focus groups, recruited through word of mouth, churches, local social service agencies, a health fair and an ESL tutoring program. The sessions were conducted in Spanish and held at various community locations.
"I found things that were already happening and went there," Remtulla said.
The women were asked to fill out a one-page survey, read a two-page information sheet about the HPV vaccine and then respond to a series of open-ended questions in a group discussion.
Remtulla found generally high acceptance of the vaccine among the groups, but with conservative approaches to the distribution questions. They favored vaccination for males, but thought parental consent should be respected. They disagreed with the mandate for immigrants, as a form of discrimination.
"All the women were willing to share and passionate in their views," Remtulla said.
The groups also thought that if mothers knew more about Gardasil, they would want their daughters to be vaccinated. That would make some of the ethical dilemmas explored in her thesis non-issues, Remulla said.
After graduation, Remulla plans to return home to Canada, and work in public health policy for a year before pursing a master's degree in public health.