Adolescents' Access and Consent to the Human Papillomavirus Vaccine: A Critical Aspect for Immunization Success

The human papillomavirus (HPV) vaccine has the potential to significantly decrease the incidence of diseases caused by HPV, specifically cervical cancer. Approved by the US Food and Drug Administration since late June 2006, this vaccine is currently being marketed for clinical use in girls and women aged 9 to 26 years.1 Effective policies and guidelines about immunization should include consideration of the unique health care needs of adolescents, who represent the majority of this target population. Issues that pertain to adolescents' ability to consent for reproductive health care in an independent fashion and confidential manner already provoke challenging ethical and legal dilemmas. The HPV vaccine is likely to raise similar questions about informed consent and confidentiality, particularly when adolescents request it in addition to other sexually transmitted infection (STI) services that they can access without the consent or knowledge of their parents. The fact that the adolescent who is under 18 years of age can consent for treatment of STIs but not for prevention via this vaccine at the current time remains a subtlety that is lost on many teens, parents, and even health care providers. The answers to questions of adolescents' access to the vaccine will play a significant role in the clinical application of the HPV vaccine and a successful immunization strategy. Health care providers and policy makers must now address important issues about the integration of the HPV vaccine into clinical practice in a way that maximizes its efficacy through timely patient access and administration. Because HPV is an STI, the goal of a primary immunization strategy is to administer the vaccine before viral exposure at the onset of sexual activity. For this reason, childhood and early adolescence is a prime time to target this type of intervention. Moreover, the best antibody response to this vaccine … Address correspondence to Ellen S. Rome, MD, MPH, Section of Adolescent Medicine, Cleveland Clinic, Lerner College of Medicine at Case, 9500 Euclid Ave, A120, Cleveland, OH 44195. E-mail: romee{at}ccf.org