Human papillomavirus (HPV) vaccine is a scientific and public health breakthrough in the prevention of cervical cancer. In an analysis article in this week's BMJ, Raffle argues that HPV vaccination must be part of a comprehensive, integrated system of cervical cancer prevention.1 She emphasises that public health policy should be data driven, and several outcomes of an HPV vaccination programme must be assessed, including uptake, follow-up screening, cancer incidence, and cost effectiveness.

Therefore, a successful HPV vaccination programme requires more than just a series of injections. A still broader perspective would also tackle the controversial matters of adolescent sexuality, parental control, and protection of children. HPV vaccine should be given before exposure to the virus. Ethical and political dilemmas arise because some parents may not want to consider the possibility that their daughters might initiate sexual intercourse at an early age.

Responding to individuals who decide against participation in such vaccination programmes presents a classic public health dilemma. Voluntary measures to encourage the uptake of HPV vaccine—which include government coverage of costs, practice guidelines that make it standard care, public health campaigns, and peer counselling programmes, pose no insurmountable ethical problems. However, some parents or adolescents …