Thursday, April 12, 2007

HPV Vaccine is a Centrist Issue

I have two teenage daughters. This summer, they will get the Human Papillomavirus vaccine. They are good girls, and I expect they will stay that way. Still, I don't know what will happen in the future, including the whole sexual history of their future (and now entirely hypothetical) husbands. The idea that there is a vaccine to prevent cancer and other lesser horribles seems like a wholly good thing to me. I am as grateful for the existence of the HPV vaccine as I am for the polio vaccine. If they ever invent a male version of the HPV vaccine, my son will get it, too.

So why is this an issue? Some people want to make the vaccine mandatory. Others opposed giving it at all. That is exactly the situation that begs for a centrist solution.

The argument for making it mandatory is the same as the argument for other mandatory vaccinations. This is a contagious disease that we can prevent, so let's prevent it. The vaccination cost is much smaller than the treatment cost. The whole society would be better off if we could wipe out this virus by giving it no hosts to live in.

I do think it would a good thing if all people who could benefit from the vaccine get vaccinated. I will leave it to the doctors to specify that population. Right now the CDC is saying girls and women from 11 to 26 should be vaccinated. I am not sure why they set that upper bound, but I will assume there is a good medical reason.

The argument against using the vaccine at all is that making sex safer encourages extramarital sex. This negative argument is advanced by pro-family Christians, but it is based on fear – if kids fear sex, they won't have any. I am a pro-family Christian, but I am against fear mongering. As I have argued before, fighting the culture of fear is the gruntled centrist issue. I try to dissuade people from extra-marital sex because it isn't good for their marriages and for the culture of marriage – not because it might kill them. We should try to prevent disease even if the people who get it in some way deserve it. Moreover, the sex diseases can easily spread to people who really don't deserve it.

Still, HPV, though very widespread, is not quite as contagious as, say, the polio virus. If some people opted out it would be a loss, but it wouldn't defeat the purpose of mass vaccination. They might opt out on moral grounds, or on sheer civil liberty grounds, both of which, I think, a free society should accommodate whenever possible.

So where does this leave us? I favor state-mandated vaccination of all girls, with the state paying the bill for poor people. If some people want to opt out, they should be permitted to. The rest of us can try to persuade them not to – as I am trying to do now – but that is a freedom that a free country can allow. Besides, a few years later, those "opted out" girls can make their own decision to get vaccinated if they want to.

21 comments:

Stuart Gordon said...

Gruntled:

Maybe I am teeno-sexo-phobic, but I do have another, conscious reason for being resistant to these shots as mandatory. It is the sexualization of our culture.

My sons are 7 and 9 now, and I resent how I must filter so much of their lives from this sexualized culture. Simply to take them to the mall or to have on the Today show is to have to guard against pre-pubescent boys being exposed to sexualized images and discussions that degrade humans and cheapen the wonders of sexual relationships.

Surely, teenagers are another story. Yet I also resent the prevailing assumption that teenagers will be slaves to their sexual desires. I'm not naive; I understand from personal experience those temptations. But a mandatory vaccine is another way of saying, "this problem is as common as the measles. Go ahead and admit it, nearly EVERYONE needs to get this in order to prevent cervical cancer."

I resent, first of all, that it may be true. But then, I realize that as high as the numbers of sexually active teens are, it is not nearly everyone. And I resent my children living in a day and time when adults are more focused on their children avoiding an early death (is there a little fear-mongering on that side of the issue?) than promoting joyful, covenant lives.

Gruntled said...

I agree with the substance of your comment about the sexualized world and the cheapening of sex. As I understand it, though, HPV is more common than measles -- hence the need for a vaccine.

halifax said...

I would say that it is a highly questionable activity for a government to be mandating vaccinations for diseases which are contracted almost solely through voluntary activity. First, the vaccines themselves are not completely innocuous. They necessarily involve the introduction of dangerous stuff into one's body. Second, the vaccines aren't completely effective. Third, and most importantly, the vaccine counters diseases which are the result of voluntary activity. A government which mandates such vaccinations is a government which believes that its citizens cannot be trusted to make their own choices. There are, of course, public health situations in which a government might be right to overrule the private inclinations of individuals (i.e. in the case of involuntarily transmitted epidemic causing diseases), however, I don't believe that this is one of the those cases. (I'm not too fond of seat belt laws, either.)

Stuart Gordon said...

Gruntled:

The site says that the American Cancer Society estimates 10,500 cases of invasive cervical cancer each year. The overwhelming majority of cases of HPV go undetected and without symptoms.

Are you serious? A nationwide, mandatory vaccination program to prevent 10,500 illnesses, some of which are likely due to other causes?

D-rew said...

HPV is more prevalent than measles because we have a vaccine for measles, amazing how that works. Also, HPV vaccine does not only prevent 70% of cervical cancers, but also other diseases caused by the virus, cervical cancer is just it's bread and butter.


The vaccine's efficacy is near 100% for its claims, as good as any vaccine or medicine can claim.

About 10,000 people a year are diagnosed, and 4,000 a year die from cervical cancer. Using simple math approximately 7,000 of the cases could be prevented, saving more than 2,500 lives a year.

Almost every single other vaccination the CDC recommends for children has a lower incidence and/or death rate than HPV.

Hep B is an STD whose vaccine is reccomended by the CDC for children. It actually has a lower incidence, and a much lower death rate than HPV.


The sexing of society is irrelevant to this disease, which doesn't care whether or not you are married to be transmitted. The government shouldn't base its policies on, "Some kids aren't going to have sex!" Fact is some to most will, and this vaccine could save their lives.

However, I agree with Dr. Weston's assesment, mandating it, but making it easy to get out of for those silly enough not to get it for their kids.

D-rew said...

I should have specified that almost all vaccines that are recommended by the CDC have a lower incidence in the US.

Neva said...
This comment has been removed by the author.
Neva said...

hmmm must've hit the wrong button!!

I believe the reason they "cap" the age is the maturity of the uterus...as the uterus matures....it becomes "tougher" and the virus has a harder time invading the uterine tissues....

Freelance Writer-Mother-Wife-Veteran said...

Vaccines are not what they are made out to be.

Please see this op-ed and I've written quite a bit about the toxic chemicals in vaccines, the fact that they can and do cause health problems and that this is nothinig more than a marketing campaign geared toward women dealing in fear.

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/03/12/EDGC7N734I1.DTL&hw=MaryAnna+Clemons&sn=001&sc=1000

Don't jump on their band wagon -- do some research. At one point there were reports that the shots were causing infertility -- I have not been able to research this further, but wouldn't that be something to explain to your children as adults, "Sorry, they said you needed this vaccine and I didn't bother to question that, you can always adopt from women who didn't get the vaccine."

Something worth considering.

Gruntled said...

Your article doesn't actually say anything about toxic chemicals in this vaccine. The CDC site has this Q & A:
"Does this vaccine contain thimerosal or mercury?
No. There is no thimerosal or mercury in the HPV vaccine. It is made up of proteins from the outer coat of the virus (HPV). There is no infectious material in this vaccine."

rdbush said...

After listening to this debate become more and more heated in my workplace and waffling on it myself, here are my thoughts:

1) I am getting the HPV vaccine because I can. I am 22 and unmarried. I’m not promiscuous and I hope that my future husband will not be. This decision will not change the value I place on intimacy, but if I happen to be exposed to HPV by some unfortunate event in the unforeseeable twisty turns of life, then I will be prepared. It’s a win-win that my insurance covers.

2) What if I couldn't get it? That is, what if I didn't have insurance, financial stability, access to health care, or even the basic information about sex and the diseases it can spread? Worse, what if I'm also a 13 year old girl in a low income, unstable family who is constantly receiving sexual pressure from older men, boys, etc? In this hypothetical case, it would be nice to think that the state could help prevent HPV and perhaps cervical cancer from being added to my long list of worldly woes.

Sure maybe you could stand back, let a preventable virus ravage those it will and hope that abstinence education makes a small dent, but in my opinion that’s social Darwinism. Those with the knowledge and money would benefit and those without would stay in place or be eliminated.

The thing is, I’m not likely to get HPV, but the young girl in the hypothetical is very much at risk. It’s great that some parents keep overt sexuality from entering their children’s lives as Mr. Gordon does, but that may not be the case in many families of lesser means and education.

In short, I think the state has a responsibility to protect children of all education and income levels by mandating the vaccine. Families who want to use fear tactics to help ensure that their kids never screw up or marry people who screwed up could always opt out.

Gruntled said...

I hadn't thought of making it difficult to get the vaccine as a kind of social Darwinism, but I think you are right.

D-rew said...

Freelance writer, your op-ed is the worst kind of misuse of statistics and anti-corporate/anti-medicine fear mongering. You act as though any of the many strains of HPV that the vaccine doesn't cover can cause cancer, most are asymtomatic. You also speak as though the other things you mention that can cause cervical cancer (smoking birth control, and such) have equal chances as the two strains of HPV that the vaccine guards against. As I stated earlier it will prevent a whopping 70% of cervical cancer cases. My favorite is that "nurses, health departments, and hospitals" are in on the conspiracy to make you sick.

Stuart Gordon said...

I shouldn't spend too much time extending this discussion, but let me make some closing observations.

1. I'm intrigued how "fear tactics" are ascribed to other folk in this conversation. I don't doubt that many people do this, but it's not a fair assumption about all who have probelms with this proposal. It's nearly an ad hominem argument.
One might just as fairly ascribe "scare tactics" to those who declare that a young person is likely to get cervical cancer and die without getting this vaccine, given the miniscule odds reported on the link.
2. Likewise, the "Social Darwinism" remark is an extremely inflammatory one. I'm aware of turn-of-the-century cases in which Spencer's ideas were propagated, and am myself outraged by them. But the context in which we discuss the subject is this: Gruntled is suggesting that the state mandate an invasive procedure for all people. That is not a neutral circumstance. To suggest "Social Darwinism" is to link a notion of natural causes (inferior breeding) to clearly unnatural causes (medical treatments). It is to link a notion of innate inferiority to a notion of medical risk. While I applaud the sentiment in protecting the poor and powerless, I will not swallow the assumptions that those who have problems with state-mandated vaccinations for sexually-transmitted diseases that result in 10,000 cases out of a population of 300 million are "fear-mongers" and "Social Darwinists."
3. If you want to have the vaccination, do so. If you want to make the vaccination available at public health clinics, fine. But please understand that you have fellow citizens who are not raving lunatics, who are not "silly," who see an angle on this proposal that troubles them.

St. Casserole said...

I agree with your decision to have your girls receive the virus. It's a public health concern: a way to prevent disease.

We intend to follow suit.

Political Realm said...

Stuart, how great do the numbers need to be before you're willing to accept it as a serious problem? 100,00? 1,000,000? Why not tackle it before it becomes even more widespread? Also, the numbers of HPV have declined because of increased awareness (pap tests, vaccines, etc). But 10,000/year does add up over time.

I'm not suggesting it should be mandatory, but why actively oppose a possible solution to a disease? The issue should be more about personal health than sex.

Stuart Gordon said...

Political Realm:

It's the mandatory part I'm questioning; I'm not actively opposing a possible solution.

I'm not motivated to research the numbers on various diseases for which there are mandatory vaccinations, but I don't know of other vaccinations that, as Halifax said, are intended for diseases that result from voluntary activity. I have no objection to vaccinations to prevent communicable diseases. I object to intrusive, state-mandated vaccinations that assume sexual infidelity on the part of all citizens.

D-rew said...

The Hep B vaccine is one that treats a disease that is transmitted from a voluntary activity.

What if there were a vaccine for HIV Stewart?

Would you then play the numbers game or the principle game?

D-rew said...

Oops, I misspelled your name. I should have said Stuart, sorry.

Stuart Gordon said...

D-rew:

Once again, I'm contesting making it mandatory. I'm not contesting making it available. Why is this so silly?

I remember ad campaigns in the late 80's and 90's that said, "Anyone can get AIDS." (Scare tactics if ever there were such things.) Well, yes and no. We know what the risk factors are.

I am not playing a numbers game. That I cited the relatively low incidence of cervical cancer may be what you focus on; my purpose was to ask why there is an assumption that every teenage girl in America should be mandated to take this vaccine. In fact, millions of Americans are not at risk of HPV. If you want your daughter to take the vaccine, by all means get her the vaccine. You cover your bases, you insure that the odds are with you.

What is going on here? Are parents of daughters afraid that promiscuous boys will infect their daughters and kill them?

D-rew said...

Summarizing and closing,
1st:
Not all sexual activities are voluntary. A 'cheap shot' on behalf of my argument, but nonetheless sadly true.

2nd:
I think it 'silly' to believe your kids are above mistakes, and 'silly' to assume that they will even share your morals. Also, I've heard that the earlier you get it the more effective it is (I don't have time to research it because my computer time is running low)

3rd:
I think it should be mandatory for the same reason any other vaccines are mandatory. HPV presents a serious but preventable health risk to our society, we can save lives. Traditionally a major way to eradicate health risks are vaccines and education. The education is being taken care of.

4th:
You should be able to 'get out' of any vaccine that doesn't pose monumental health risks, its a free country. You are the one who should be responsible for justifying it though.