CASE STUDY: Summary: The context is a European Union country (specifically, Spain) with a national health insurance system that covers the cost of all childhood immunizations. It is 2009-2010, and a new vaccination for human papilloma virus (HPV) has been developed and is available on the market. Administration of the vaccine has been shown to reduce incidence of cervical cancer in women, since HPV is associated with over 70% of cases of cervical cancer. Current recommendations (in 2009) are for routine vaccination of females aged 11 or 12 years, and the vaccination series can be started beginning at age 9 years. Vaccination is also recommended for females aged 13 through 26 years who have not been vaccinated previously or who have not completed the 3- dose series. The country is in the throes of an economic crisis (just like the U.S. and most developed countries in 2009), and there are no budgetary increases to accommodate the new HPV vaccination requirements. Moreover, the cost of a single HPV vaccination (around 600 euros) is equivalent to the sum total of all routine childhood vaccinations already covered until adolescence. Questions/Tasks: a) Discuss this case in terms of: 1) public health ethics and 2) cost-benefit. b) What would you recommend? Provide your rationale for this recommendation. Supporting Documents: CDC HPV vaccination recommendations (patient information sheet) Public Health Leadership Society: Principles of the Ethical Practice of Public Health, 2002