人類乳突病毒疫苗接種政策：公共衛生倫理觀點

Human Papillomavirus Vaccination Policy: a Public Health Ethics Perspective

詹明錦(Min-Chin Chan) ； 邱勝康(Shen-Kang Chiu) ； 吳建昌(Kevin Chien-Chang Wu) ； 方啟泰(Chi-Tai Fang)

《台灣公共衛生雜誌》 32卷4期 (2013/08) Pp. 309-319

https://doi.org/10.6288/TJPH2013-32-04-02

摘要

人類乳突病毒（Human papillomavirus, HPV）是子宮頸癌的主要致病因子。目前已有兩種HPV疫苗，分別為四價（HPV-6, 11, 16及18）及二價（HPV-16, 18），核准於26歲以下的青少女使用。由於定價昂貴，且長期保護力及疫苗安全性有待觀察，對HPV 疫苗接種政策出現若干不同意見。本文回顧相關文獻，並從美國Centers for Diseases Control and Prevention與Public Health Leadership Society共同制定的歷史性文獻Principles of the Ethical Practice of Public Health所揭櫫的公共衛生倫理（Public health ethics）原則來剖析「是否應強制全面接種HPV疫苗」及「是否應公費補助接種HPV疫苗」兩個議題。我們認為，在目前有限之資料下，是否強制施打，仍有商榷餘地，將來更需要進行公開透明之政策討論，取得公眾之信任，以決定HPV疫苗之強制施打是否能夠通過比例原則之考量。是否公費補助則必須考量成本效益，在最佳條件之假設下，成本效益分析顯示HPV疫苗在台灣具成本效益，因此，以公費補助低收入戶少女接種HPV疫苗，應是目前適當的做法。

關鍵字

人類乳突病毒 ； 疫苗 ； 子宮頸癌 ； 公共衛生倫理

並列摘要

Human papillomavirus (HPV) is a major factor in the etiology of cervical cancer. Two HPV vaccines, HPV4 (against HPV types 6, 11, 16, and 18) and HPV2 (against HPV 16 and 18), have been approved for adolescent girls younger than age 26. Due to concerns about the price, duration of protection, and vaccine safety, opinions differ on HPV vaccination policy. We reviewed the literature, and considered two issues from the public health ethics perspective highlighted in ”Principles of the Ethical Practice of Public Health” co-issued by the United States Centers for Diseases Control and Prevention and the Public Health Leadership Society: (1) whether or not HPV vaccination should be mandatory, and (2) whether HPV vaccination should be paid for by the government. Given the limited current information, it is still debatable whether to adopt an obligatory HPV vaccination program. In the future, it will be necessary for policy makers to engage the public in open and transparent deliberation and earn the public’s trust in seeing obligatory HPV vaccination as compatible with the principle of proportionality. In the best case scenario, analysis shows that it is cost-effective for people to voluntarily receive HPV vaccination. Currently, it is appropriate for the government to provide financial support to girls from lowincome families.

並列關鍵字

human papillomavirus ； vaccine ； cervical cancer ； public health ethics

參考文獻

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