Thursday, February 15, 2007

The HPV Vaccine

If someone had asked me a few months ago whether there could possibly be an objection to a vaccine that could prevent cancer in thousands of people each year, I would have confidently answered "Absolutely not."

And yet, here we are, facing debates over the morality, cost, and efficacy of an FDA approved HPV vaccine. Human papillomaviruses cause more than ten thousand cases of cervical cancers and four thousand deaths annually in the US alone. The numbers are much worse in developing countries where sex education is inadequate, screening is rare, and cancer treatments are prohibitively expensive.

The new vaccine, which is being actively (and clumsily) marketed by Merck pharmaceuticals, appears to effectively prevent certain virus strains that are responsible for two thirds of HPV-related cancer cases.

I'm sure that no one will be surprised to learn that I support HPV vaccinations. Anything that extends life and reduces suffering gets my support. The fact that it also makes sex safer only strengthens my conviction.

If you've been following the public debate, you've probably noticed that the connection to sex is one of the chief objections that some vocal opponents to the vaccine point to.

One opponent, conservative Jill Stanek, focuses on the immoral origins of HPV cases. "[Like smoking,] HPV is also the consequence of a destructive behavior, sex outside of marriage."

Besides that fact that sex outside of marriage is both widespread and healthy (if you take reasonable precautions), Jill has a pretty odd idea about how HPV is transmitted. I can't imagine that many viruses can distinguish between sex inside and outside of marriage. If your partner or husband or wife carries the virus, you may be exposed during sex.

I suppose a woman could search for a mate who claims to be a virgin, and then take him at his word. Or she could simply get the vaccine and protect herself.

But the biggest issue I see is that vaccines like the Merck HPV vaccine don't just protect the individual, they protect the community as a whole. A Stanford University study from 2004 showed that HPV-related cancers could be reduced by 64% as a result of a vaccination program targeting prepubescent girls. The benefits extend beyond vaccinated girls. Both men and unvaccinated women will be safer as a result of herd immunity, even if as few as 40% of young girls are immunized. (Of course, the greatest protection will go to the vaccinated girls.)

Abstinence-based objections to HPV vaccinations strike me as both unrealistic and antisocial. It's not just about you, Jill Stanek, it's about protecting society as a whole. Stanek points out that an HPV vaccine will not protect us from other STDs. Such reasoning is so absurd that I can't imagine where to start. Were Small Pox vaccinations a bad idea because they didn't also prevent polio?

Another, more frivolous and short sighted objection is the fact that Merck will make a bundle off of the vaccine. I don't trust the altruism of major corporations (they're set up to make money, not save the world), and I certainly think we should look closely at any drug they provide. That's why we have the FDA. But the lack of profit in vaccinations is one reason we are facing a potential crisis the next time a highly-contagious and virulent flu hits our shores. In this case, it looks as though an HPV vaccine will lead both to profits and improved societal health.

Overall, the Stanford study concludes that the additional cost of the vaccine will raise average lifetime medical expenses of people in the US by $245, or about 0.6%, while saving thousands of lives every year. How can a compassionate person possibly object?

Think of all the additional people who will be alive to hear the abstinence messages that folks like Stanek promote.


JoshR said...

Some people are so stupid it actaully causes me physical pain...

Buzz Skyline said...

I'm with you Josh.

Thanks for the comment.


You Know Me said...

It seems that there are other diseases or medical problems the treatment of which would reduce the lifetime health care cost for each of us, instead of raising it.

Examples might be ensuring that all children are provided dental care or that all children are screened for hearing deficiencies, so that children who do not hear well don't wash out of school and end of more likely to be imprisoned. (There was actually a study in a particular state, some years back, that found a higher percentage of inmates with hearing problems.)

It seems to me that Merck is financing quite an effective lobbying campaign to compel young girls to be vaccinated.