sunday times: comment on HPV vaccine

July 23, 2006

in Flotsam and jetsam

I recall as a child getting my tetanus shot.  I just could not wait to run out and play amongst garbage and sharp objects, with no worry my contaminated wounds would cause lockjaw. And along with that hepatitis B shot my public school also required, I could not only step on dirty needles, I could share them! I was rarin' to go.

Of course, this is bullshit.

So is the notion from conservative religious groups who oppose mandatory immunization of the recently approved human papilloma virus (HPV) vaccine because they feel it might encourage promiscuity. The vaccine is 100% effective against the two strains of HPV, 16 and 18, that cause around 70% of cervical cancers in the U.S. Cervical cancer is the second or third most common cancer in women. The vaccine is administered in three doses over six months, and is proposed for girls between the ages of 9 and 26, as it is most effective as a preventative measure.  Since HPV is a very common sexually-transmitted virus, the goal is to vaccinate girls (and eventually boys) prior to them becoming sexually active.

The stupidity of opposing vaccination on these grounds has been thoroughly discussed (e.g., here, here, and here).  Bad enough these groups have considerable influence within the U.S.  I can't help but wonder if this political pull will also extend to thwarting financial support to other countries which have high HPV rates and problems with social taboos when it comes to screening for HPV, in the same way conservatives oppose funding for condom distribution for AIDS prevention overseas.

In an editorial in the July 21 issue of Science, editor Donald Kennedy goes a step further from other opinions I've read, pointing out that a policy of voluntary vaccination places society as a whole at risk.  I leave you with his concluding words:

If there is to be significant progress in reducing the incidence of cervical cancer, the HPV vaccine should be made part of a mandatory preschool immunization package. In the present situation, in which participation is voluntary, the girl who says no to vaccination and yes to Focus on the Family's advice to elect abstinence creates two risks. One is to herself: Numerous studies have shown that abstinence often fails; and even if it succeeds, it will eventually be displaced by either marriage or romance — with a partner who may have HPV. The second risk is to society: By declining vaccination, the refusenik becomes a free rider. The objective of vaccination programs is to reduce the overall probability of infection by creating herd immunity — that is, by making a large majority of the population immune. Those who won't participate in the vaccination program are thereby spreading a small risk to the rest of society. "Freedom of choice" is an argument favored by the abstinence advocates. But that slogan ignores a serious ethical consequence: If the choice entails spreading harm to other people, can it really be called "free"?


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