Published online August 1, 2008
PEDIATRICS Vol. 122 No. 2 August 2008, pp. e504-e510 (doi:10.1542/peds.2007-3218)
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SPECIAL ARTICLE

A Critique of Criteria for Evaluating Vaccines for Inclusion in Mandatory School Immunization Programs

Douglas J. Opel, MDa,b, Douglas S. Diekema, MD, MPHa,b and Edgar K. Marcuse, MD, MPHb,c

a Treuman Katz Center for Pediatric Bioethics, Children's Hospital and Regional Medical Center, Seattle, Washington
b Department of Pediatrics
c School of Public Health and Community Medicine, University of Washington, Seattle, Washington

Several new vaccines for children and young adults have been introduced recently and now appear on the Advisory Committee on Immunization Practices’ recommended childhood and adolescent immunization schedule (meningococcal, rotavirus, human papillomavirus). As new vaccines are introduced, states face complex decisions regarding which vaccines to fund and which vaccines to require for school or child care entry. This complexity is evidenced by the current debate surrounding the human papillomavirus vaccine. We present a critique to the approach and criteria for evaluating vaccines for inclusion in mandatory school immunization programs that have been adopted by the Washington State Board of Health by illustrating how these criteria might be applied to the human papillomavirus vaccine. We conclude that these 9 criteria can help ensure a deliberate and informed approach to important public policy decisions, but we argue that several clarifications of the review process are needed along with the addition of a 10th criterion that ensures that a new vaccine mandate relates in some manner to increasing safety in the school environment.

Key Words: ethics • health policy • human papillomavirus • immunizations

Abbreviations: HPV—human papillomavirus • ACIP—Advisory Committee on Immunization Practices • IAC—immunization advisory committee • TAG—technical advisory group

Accepted Apr 2, 2008.


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