Vaccine against HPV – Ethical and social aspects

Cervical cancer is caused by the human papillomavirus (HPV). Today, there are more than 100 different variants of HPV; of these, HPV types 16 and 18 are the most common oncogene virus types, which cause approximately 70% of all cases of cervical cancer. This cancer affects about 450 women annually in Sweden. HPV is even related to vaginal and anal cancer and to known cancers in the vulva, penis and pharynx.

Recently, two very effective vaccines against HPV have been registered. The National Board of Health and Welfare has recommended that the new vaccine should be included in the general vaccination program for children and youths in Sweden. The vaccine is very expensive and the recommendation was preceded by an intense debate on its cost effectiveness. The new HPV vaccine raises many questions from both ethical and gender perspectives, e.g., how youths and their parents should be informed; what effects the vaccine would have on youngster’s sexual habits; and how boys might be informed on HPV as the vaccine will only be given to girls.


The purposes of this PhD project was:

  • To survey youth’s knowledge on sexually transmitted infections and their consequences, together with their views on the use of condoms, with special focus upon HPV and the new vaccine against it.
  • Through an explorative interview study, using focus group method, examine how midwives and school nurses view their task of informing youths and their parents on the vaccine against HPV.
  • With these results as a base, carry out a targeted intervention, with the aim of increasing youth’s knowledge of STIs in general and of HPV in particular.
  • To present constructive suggestions of clinical guidance for midwives and school nurses concerning the social and ethical aspects of the new HPV vaccine.


Gottvall M, Introduction of School-Based HPV Vaccination in Sweden: Knowledge and Attitudes among Youth, Parents, and Staff, 2013, Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, doctoral dissertation

Gottvall M, Tydén T, Larsson M, Stenhammar C & Höglund AT, Informed Consent for HPV Vaccination: A Relational Approach, Health Care Analysis 2013 E-pub ahead of print doi: 10.1007/s10728-012-0237-9

Gottvall M, Grandahl M, Höglund AT, Larsson M, Stenhammar C, Andrae B & Tydén T, Turtst versus concerns: how parents reason when they accept HPV vaccination for their young daughter, Upsala Journal of Medical Sciences 2013;118(4)263-270

Gottvall M, Tydén T, Larsson M, Stenhammar C, Höglund AT, Challenges and opportunities of a new HPV immunization program - Perceptions among Swedish school nurses, Vaccine, 2011;29(28):4576-4583.

Gottvall M, Tydén T, Höglund AT, Larsson M, Knowledge of human papillomavirus among high school students can be increased by an educational intervention, International Journal of STD & AIDS, 2010;21:558-562.

Gottvall M, Larsson M, Höglund AT, Tyden T. High HPV vaccine acceptance despite low awareness among Swedish upper secondary school students, Eur J Contracept Reprod Health Care, 2009;14:399-405

PhD Student

Maria Gottvall was a PhD student between 2008-2013. She is a registered nurse (2008). Her main area of interest is sexual and reproductive health.


  • Tanja Tydén, Professor of caring sciences, Department of Public Health and Caring Sciences
  • Anna T. Höglund, Associate Professor of Ethics
  • Margareta Larsson, Associate professor, Department of Women’s and Children’s Health


The Swedish Cancer Society (Cancerfonden)

Nursing Ethics & Ethics of Care

Nursing ethics is concerned with the moral dimensions of nursing practice while the ethics of care is a normative ethical theory. For many years CRB has developed these fields from different angles. We have used qualitative studies to describe and explore the kinds of ethical dilemmas nurses encounter in their day-to-day work and how they solve them. Other studies have investigated the role of ethical guidelines in the building of ethical competence in nursing practice and in priority setting. In this report, we provide a summary of our research.

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