Is it fair to limit access to free human papillomavirus vaccinations to only girls in public schools in South Africa?

Abstract

Gender-neutral Human Papillomavirus (HPV) vaccination programs, covering girls and boys, are necessary to combat the global rise in HPV-related cancers and escalating treatment costs. HPV vaccination is the primary preventative intervention for both men and women. In South Africa, it is freely available to adolescent girls in public schools, excluding girls in private schools and boys. This exclusion deprives them of the benefits of free HPV vaccination, potentially exposing them to a greater risk of cancer, and incurring more costs to society in the end. I apply Kantian ethics and rule utilitarianism to evaluate and argue that the current South African school-based HPV program is unfair and morally unjustified in limiting free access to HPV vaccination to only girls in public schools. I specifically examine Kant’s Formula of Humanity and the Formula of Universal Law to evaluate the ethical dimensions of the policy and show that the policy has significant shortcomings in terms of equality, autonomy, and universality from a Kantian perspective. I further demonstrate that a policy excluding certain groups based on gender and socio-economic status is not aligned with the principles of rule utilitarianism because it fails to maximise overall well-being, perpetuates inequalities, hinders optimal vaccine coverage, and neglects the potential benefits of gender-neutral vaccination. I address potential counterarguments that proponents of the current policy might present from both a Kantian and a utilitarian viewpoint. I advocate for a more just and ethical approach and recommend a revision of the HPV vaccination policy to align with Kantian and utilitarian principles. I show that both Kantian ethics and rule utilitarianism support a gender-neutral HPV vaccination strategy in the South African context. Gender- neutral coverage of HPV vaccination ensures free and equitable access to all adolescents who can benefit from it, irrespective of sex, gender, school type, or socio-economic circumstances. A gender-neutral approach to HPV vaccination is more aligned with the South African Constitution