Vaccines--but not as we know them: an ethical evaluation of HPV vaccination policy in Australia.

OBJECTIVE To show how systematic ethical evaluation of public health policy may reveal issues of moral significance for critical examination. METHOD Using Australia's human papillomavirus (HPV) vaccination program as an exemplar and adopting an approach outlined elsewhere, we determine whether conditions of effectiveness, proportionality, necessity and least infringement, and public justification, are met such that any breach of autonomy or justice principles associated with this intervention can be defended. CONCLUSIONS While the HPV vaccine itself may be efficacious, some aspects of the program lack sufficient moral justification and raise concerns around procedural and social justice and gender equity. IMPLICATIONS Public health interventions deploying new technologies against new targets--such as vaccines against cancer and chronic illness--require approaches crafted to their specific risk-benefit profiles that have carefully considered the ethical issues involved. Systematic ethical reflection is a useful tool for this.