Tuesday, November 01, 2005

Controversy regarding the new human papilloma virus vaccine

The Instapundit has posted a link to a San Francisco Chronicle article on the the human papilloma virus (HPV) vaccine. The thrust of this particular article is that some conservative groups are opposed to making this particular vaccine mandatory in that it may encourage risky sexual behavior.

HPV is a virus that is harbored by both males and females and is responsible for rather benign and rarely hazardous venereal warts (warts appearing on the penis as well as the vagina).

Although the lesions caused by HPV are more of a nuisance than anything else, they are strongly associated with the vast majority of cervical cancer throughout the world. The vaccine is therefore being touted as an anti-cervical-cancer measure, an assertion for which there is excellent biological plausibility.

There is some controversy about making this vaccine one of the "mandatory" childhood vaccines familiar to all parents (and the kids who get stuck so frequently!) The reason I have mandatory in quotes is that in virtually all states for which I'm familiar with there are provisions for which any parent can opt their children out of all or some of the vaccines.

The question that has been raised is whether knowledge of one's immunity will promote promiscuous, unprotected sex. Leaving aside questions of efficacy and safety (which obviously cannot be ignored in any discussion of a brand new biologic agent that may be given to millions of children), this concern seems quite over the top.

Advanced cervical cancer is a deadly disease and it predominantly affects younger woman. The toll on society both in economic terms and more importantly, the awesome psychological burden is extraordinary. My experiences taking care of women with end-stage disease often with young husbands and children, have been gut-wrenching. To not wish to do everything possible to prevent these tragedies seems extraordinary.

No one tries to be more cognizant of the possibility of unintended consequences than myself. If there was data suggesting that a vaccine to prevent cervical cancer encouraged risky, sexual promiscuity among young people and that the overall costs to society were greater than the benefits, I'd be the first to propagate this perspective.

However, in this instance, I don't believe such data exists, nor is it likely to be forthcoming.

I'm not an expert on teenage promiscuity and unprotected sex nor am I possessed of any unique insight to the underlying causes of such behaviors. However, as a matter of common sense, I cannot imagine a scenario whereby a teenage girl or boy in the height of passion would base a decision to have intercourse on the abstract notion that the girl is protected against cervical cancer. I suspect that most girls and women in the world aren't even aware of the association of sexual contact with cancer.

Does anyone believe that the hepatitis B vaccine, currently given to children, will encourage intravenous drug abuse or unprotected sex (both are frequent methods for transferring the disease)?

If this vaccine is shown to be broadly effective and safe, a very good argument could be made to make its use mandatory in childhood. One of the ways a vaccine benefits the public is that in addition to preventing the disease in the vaccinated individual, widespread use promotes a phenomenon known as herd immunity.

Herd immunity arises when a large percentage of a population is vaccinated. Even the unvaccinated individuals benefit because there is less of a reservoir for the particular organism available for spread. For this reason childhood vaccination (which studies have indicated are the most effective way of achieving massive compliance) should be undertaken. Both girls and boys (who can get venereal warts and pass the virus on to girls) should be vaccinated.

Again, I have to reiterate that the above discussion is depended on the success of proving safety and efficacy of this vaccine.

Without better data to support the remote possibility that HPV immunity will be viewed by couples as an impermeable shield to ill consequences, allow the science of this vaccine and its public health implications to be evaluated and made "mandatory" if indicated. Certainly, as with other vaccines, parents can opt out if they choose for either health or moral reasons.

At the risk of sounding "small", it seems to me that the failure to want to do everything possible to reduce the incidence of this terrible disease strikes me as being at least a bit misogynous.


Anonymous Anonymous said...

I really enjoyed the hep B analogy. It made me think of it differently.Although I have always been a supporter of the HPV vaccine (most conservatives are, fyi), I could understand the concerns of those saying it would promote sexual activity. However, now I don't really believe it to be a factor.

October 28, 2007 7:50 PM  
Anonymous Anonymous said...

I thought it was hep c, that was transferred via intravenous drug use? Nonetheless...

October 28, 2007 7:52 PM  
Blogger The Medicine Man said...

Hepatitis B and C can both be transmitted by IV drug use. But there's no vaccine for hep C yet.


October 28, 2007 8:16 PM  

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