Intended for healthcare professionals

Rapid response to:


Uptake of first two doses of human papillomavirus vaccine by adolescent schoolgirls in Manchester: prospective cohort study

BMJ 2008; 336 doi: (Published 08 May 2008) Cite this as: BMJ 2008;336:1056

Rapid Response:

HPV vaccination: unresolved issues around consent

Brabin et al’s success in achieving an uptake of 70% for two doses of HPV vaccine is extremely encouraging [1]. However, this pilot has raised important issues that will need to be addressed before the vaccination program is rolled out nationally.

The GMC is clear that a fundamental component of seeking informed consent involves the process of providing adequate information for a patient to understand and make a decision, and that a mere signature on a form is not enough [2]. The main reasons for vaccine refusal in the pilot were insufficient information and fears of vaccine safety, evidently some parents seek more than an information sheet can provide. Hopefully a national publicity campaign will illustrate a clear rationale for vaccination, but additional opportunities for girls and their parents to ask questions are likely to depend on local provision. It remains unclear who will provide the answers to their questions: primary care is likely to be important but school-delivery of this vaccine may require further education of school nurses, possibly aided by ‘open evenings’ to discuss issues with parents.

In addition, guidance is currently ambiguous on situations where there is a disagreement between a parent and child’s decision regarding vaccination. Parental opinion is divided as to whether a girl should be able to seek the vaccine without their knowledge [3]. The principle of ‘Gillick competence’ might apply, if a girl sufficiently understands the concepts involved and wishes to make the decision for themselves [4]. However, given that the long-term effects of this vaccine are not known, is it safe for children to be vaccinated unknown by those with parental responsibility? Furthermore, would it be ethical to apply ‘Gillick competence’ in such a setting?

1. Brabin L, Roberts SA, Stretch R, Baxter D, Chambers G, Kitchener H, et al. Uptake of first two doses of human papillomavirus vaccine by adolescent schoolgirls in Manchester: prospective cohort study. BMJ 2008; doi: 10.1136/bmj.39541.534109.BE.

2. Seeking Patients’ Consent: The Ethical Considerations, General Medical Council (1998)

3. Brabin L, Roberts SA, Kitchener HC. A semi-qualitative study of attitudes to vaccinating adolescents against human papillomavirus without parental consent. BMC Public Health 2007;7:20

4. Gillick v West Norfolk and Wisbech Area Health Authority and Department of Health and Social Security [1983] 3 WLR (QBD).

Competing interests: None declared

Competing interests: No competing interests

13 May 2008
Elizabeth C.F. Brown
Academic F2 doctor
Southampton University Hospital Trust, SO16 6YD