Vaccines to Promote and Protect Sexual Health: Policy Challenges and Opportunities

"...[D]ecisions to use vaccinations are not without controversy, and the introduction of vaccines targeting sexually transmitted infections (STIs) is particularly contentious."

In this paper, the authors investigate the underlying policy challenges and opportunities for rolling out sexually transmitted infection (STI) vaccines by looking in detail at the experience of delivering human papillomavirus (HPV) vaccine globally. The paper explores "the lessons that can be learnt, including policy and human rights dimensions, for future STI vaccine introduction and scale up." [Footnotes have been removed by the editor.]

Focusing STI vaccine policy towards vaccinating young age groups "may offer an opportunity to 'catalyze a life course approach' to promoting and protecting sexual health". In order to address challenges, the authors offer policy options for vaccine programmes and consider how these may be modified for this particular age group and for infections transmitted through sexual exposure. Citing HPV vaccine as an example: "In the specific case of HPV vaccine, dilemmas around decision making on delivery of vaccines, including the capacity of adolescents to make informed decisions around vaccine acceptance, have added to an already heady mix of mandatory versus voluntary vaccine policies, perceptions of profiteering, and concerns about vaccine safety and efficacy."

One policy strategy is to demonstrate the benefits of STI vaccines from a human rights perspective. A communication and delivery strategy could be "ensuring that vaccine delivery is not a stand-alone effort, but supported by engaging young people with comprehensive and appropriate information, including on sexuality." The document recommends not making the vaccines mandatory, but taking a different approach: "Our review suggests that policies which support the roll-out of vaccines to address STIs globally will be largely a battle of ideas.... HPV vaccination meets the standard criteria for policy uptake including epidemiological burden, safety and cost-effectiveness of the intervention.... However, such criteria may not be sufficient to ensure policy uptake - importantly, HPV vaccine was framed as a 'cancer vaccine' in some settings, and this may have assisted its widespread policy uptake. Thus, the first policy opportunity for other STI vaccines is to identify similar associative and compelling frames - for example, highlighting the role that chlamydia vaccines could play in preventing infertility, or how syphilis vaccines could contribute to significant reductions in the risk of adverse outcomes of pregnancy."

In considering age of consent, "human rights standards call for the establishment of supportive policies so that children, parents and health workers have adequate rights-based guidance on consent, assent and confidentiality, in order to ensure that adolescents are not deprived of any sexual and reproductive health information or services...Such an approach may provide an opportunity for others to become involved in STI vaccine policy promotion - for example, those institutions (such as The United Nations Educational, Scientific and Cultural Organization - UNESCO) that work on issues of comprehensive sexuality education." However, where the age of consent is 18 years old, "laws and policies should reflect the recognition of the status of people under 18 years of age as rights holders, in accordance with their evolving capacity, age and maturity and their best interest."

While government, public health, and commercial interests play a role, "parents, civil society groups and those representing religious viewpoints, have all at some time or another vocalized and acted to promote their interests in relation to vaccine policy....Thus, introduction of STI vaccines provides a third policy opportunity - to ensure that all concerned stakeholders have access to adequate information for informed decision-making around the vaccine."

"The final policy opportunity lies in working to embed STI vaccines (including HPV vaccine) within more comprehensive packages of health interventions promoted within various international policy-making fora"... including the post-2015 development agenda, negotiations on ICPD+20 (International Conference on Population and Development, which focuses on sexual and reproductive health), and deliberations on the content of a proposed Framework Convention on Global Health.

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