Vaccines to promote and protect sexual health: policy challenges and opportunities.

Vaccines aim to improve the well-being of everyone and are seen as a public health success story in the prevention and control of communicable infections. However, decisions to use vaccinations are not without controversy, and the introduction of vaccines targeting sexually transmitted infections (STIs) is particularly contentious. In this paper we investigate the underlying policy challenges and opportunities for rolling out STI vaccines. Looking in detail at the experience of delivering HPV vaccine, we explore the lessons that can be learnt, including policy and human rights dimensions, for future STI vaccine introduction and scale up. Policies arise from the interaction of ideas, interests and institutions. In the case of HPV vaccine, ideas have been particularly contested, although interests and institutions have impacted on policy too. A review of human rights in relation to STI vaccine policies highlights the specific needs and rights of adolescents, and the paper details concepts of consent and evolving capacity which can be used to ensure that adolescents have full access to health interventions. Policy options for vaccines include mandatory approaches - and these have been utilized in some settings for HPV vaccines. The paper argues, and outlines the rationale, against adopting mandatory STI vaccine policy approaches. The paper concludes by identifying policy opportunities for introducing new vaccines targeting STIs.