This paper reflects my argument that the Ontario governments Hpv vaccination program falls

short of its potential. The program fails to address the high risk groups and fails to combine its

immunization efforts with improvements in primary health care services.

An issue such as vaccination can be approached from a multitude of angles. Especially if it is

treated as a public health issue and not just as a preventive measure. Before printing the issue as

a public health issue, we need to consider the various facets that would make any issue into a

public health issue. When assigning any issue into the public forum, we imply that the issue

affects all members of the population. Individual consideration in such issue is secondary to the

public good (Veirweij and Dawson, 2007)). So any public health issue would need to affect the

collective health of the population. But such a description fails to live up the myriad intricacies

of defining a concept. Veirweij and Dawson (2007) provide us with various ways to define what

may be included in the public health forum. Each way has its uses and pitfalls. For instance, we

might be able highlight an issue's importance of assigning it a public health issue label, but a

broad definition of public health would include so many issues in the field that the sense of

importance would be rendered ineffectual. Hence the authors insist on having clear and sufficient

conditions in order to clearly demarcate the border between an individual issue and a public

issue. The need of demarcation is stressed upon because such demarcations provide us with ways

to avoid moral and ethical conundrums. So, if we assume that the vaccination program falls into

the category of public health, then we need to approach the issue with an understanding of wider

social, political and ethical implications.

Ontario governments program has touched both economic, social (gender), political issues

related to vaccination. The introduction of the vaccination to girls of a certain age group has

reduced the potential to create a herd immunity. Herd immunity or herd protection , according to

Dawson (2011), refers to the state where approximately ninety percent of the population has

immunity to a disease. While it is true that just vaccinating girls may provide benefit to other

members of the group, the program fails to take advantage of the opportunity to make a bigger

impact. Furthermore, the vaccination program has disregarded the two high risk groups

(Thomson, 2013). Studies have shown that cervical cancer, the target disease of the vaccination,

is more prevalent in the lower income groups of the population. Considering what Thomson

(2013) calls social and biological vulnerability, it follows that this high risk group would benefit

the most from the program. Social and biological vulnerability refers to the low income groups

that are at high risk, biologically, from the disease. Even if we don't consider the ethical issue,

which demands that we first help the ones who need it the most, it makes sense from an

economic perspective as well.

While one is working on a budget, common sense would dictate that the least effort that

produces the most good must be made a priority. Such discrepancies show that the project

leaders are still thinking from an individual prospective and not considering the common good

(Dawson, 2011). The governments stance reflects that the focus is on individual benefits and

risks and due consideration has not been given to the collective good. Further evidence of

projects failure to address herd protection comes from the non inclusion of boys into the

vaccination drive (Thomson, 2013). Studies have shown that the vaccine is effective in

preventing anal cancer, but that facts seems to have been neglected in favour of other numerous
small benefits (Thomson, 2013). Similar to low income women, gay community is also a high

risk group that could have benefited from the vaccination. Thomson (2013) states that this

exclusion comes from the lack of funds available for the project. But she also argues that such

economic concerns could have been mitigated by focusing on just the high risk groups.

As can be observed from the above discussion, the Ontario government has touched the gender

inequality subject with its vaccination program. But this time, it seems that the boys are getting

the short end of the stick. Thomson (2013) also argues that the economic consideration must not

trump moral ones. In other words, the high risk groups must have access to the vaccine despite

economic strains. Also, the cost effective analysis used in the projects leaves a lot to be desired.

First, it fosters inequality by placing one gender over the other. Secondly, it does a poor job of

comparing one method of health improvement to another. As such, it cannot be trusted to

understand the success of the immunization drive. Lastly, it does not include the cost incurred by

the individual and focuses on the cost incurred by the institution. Any such scenario where the

high risk individuals are not getting proper aid is an unjust scenario.

Evidence seems to suggest that the projects approach to its target audience may not been well

considered. As it can be argued that the low income groups of the society are at most risk from

the disease, it seems worthwhile to consider whether such a technological intervention

(Thomson, 2013), referring to the vaccine, is the best way to approach the problem. While the

vaccine may be a important part of a health plan, it might be more worthwhile to address social

and economic facts that might enhance the lives of this particular group. By focusing on

vaccination only, we are intensifies the debate whether on not one should get vaccinated.
Immunization is not the only way to tackle the problem of public health. The exclusion of any

supporting projects that aim to enhance the standing of the low income group, even just to

provide more information, suggest a lack of proper planning on the part of the Ontario

Government. Thomson (2013) reminds us that over-reliance on immunization effort to counter

the problem of cervical cancer may not be the best way to resolve the problem. The emphasis

must to improve the social condition that puts the social group at disadvantage.

Such an immunization effort must also consider the part where a parent refuses to vaccinate

his/her child. Sufficient resources must be allocated to ensure that people do not act out of

ignorance. Dawson (2011) sets forth a notion that many people refuse vaccination because of

the success of previous vaccination drives. According to him, the success of vaccination has

eroded the understanding of the risk posed by such diseases. And it is because of this lack of

experience that people refuse practical aid via vaccination. While Dawson (2011) contends that

side effects and risks from vaccinations are rare, he also maintains that a system of

compensation should be considered for such events. Though one might surmise that he puts the

common good before all else, he also considers that unnecessary sacrifice of individuals

should be avoided.

While the Ontario government has not made the vaccination process compulsory, Dawson(2011)

tells us of indirect compulsions that may stem from such an issue. Such scenarios may include

instances where a school may require vaccination for enrolment or the parent may act without

sufficient knowledge. But if we consider vaccination from a public perspective, the first

consideration should be given to group safety.

Authors such as Dawson argue that the focus vaccination should be must be on the collective

good. But such social responsibilities are not always apparent to everyone. It can be argued that

the Hpv vaccination target group is mostly of minors (Thomson, 2013) and as such the decision

by vaccination fall into the hands of their parents, Dawson (2011) argues that we must act in the

best interest of the child. Dawsons (2011) best interest argument acknowledges that the

parents of a child do not always act in the best interest of the child. This might be due to many

reasons, but nevertheless, they can act in error over the issue of vaccination. In such scenarios,

where the judgement of the parents is not in the best interest of the child, other parties may, and

should, intervene (Dawson,2011). In case a child is not vaccinated the parent not only puts the

child at risk but also the immediate social group. Dawson (2011) also considers vaccination a

social responsibility, because by failing to vaccinate ones child, a parent is not inputting the

child at risk but also failing to contribute to the common good. He argues that vaccination does

not only affect the individual. And the choice to vaccinate a child affects the entire population.

Dawsons argument has strong undercurrent of utilitarianism. Common good, for him, trumps

individual deliberations. Perhaps in the field of public health such an opinion can be more

beneficial for the society and the individual.

The above discussion aims to touch upon the various aspects of the vaccination debate by

focusing on the Ontario government's Hpv vaccination program. As one may observe, the myriad

facets of the debate make it difficult for anyone to ascertain the best vaccination policy. But

analyzing the evidence and research may help one form a worthwhile policy. It remains to be

seen whether or not the governments efforts are in the right direction or not.
 References

Dawson, A. (2011). Public Health Ethics (pp. 143-152). Cambridge: Cambridge University

Press.

Thompson, A. (2013). Human Papilloma Virus, Vaccination and Social Justice: An Analysis of a

Canadian School-Based Vaccine Program. Public Health Ethics, 6(1), 11-20.

http://dx.doi.org/10.1093/phe/pht010

Verweij, Marcel & Dawson, Angus (2007). The Meaning of 'Public' in 'Public Health'. In Angus

Dawson & Marcel Verweij (eds.), _ Ethics, Prevention, and Public Health _. Clarendon Press