Here is an opinion piece about the new human papillomavirus (HPV) vaccine in yesterday's NYT. The vaccine, Merck's Gardasil, is fully effective against the virus that causes most cases of cervical cancer. Expected to cost between $300 and $500 for a series of three shots, use of the vaccine is expected to draw fire from the right wing as yet another practice that encourages premarital sex. (Some on the right have so far said only that they oppose mandatory vaccination for school entry, but support widespread availability of the vaccine.)
Here's the rub: the vaccine is more effective when it's given between the ages of 10 to 15 than between the ages of 16 and 23; so to maximize its usefulness, experts are recommending vaccination be completed before a person (male or female) becomes sexually active. . . which means vaccinating children against an STD.
If we can prevent cervical cancer by use of this vaccine, is it ethical to decide not to do so--because of concerns about promoting teenage sex? Will Medicaid pay for the vaccine, or will only those who can afford it be protected from cervical cancer? Stay tuned.
Nancy Berlinger has a piece on the Hastings Center's Bioethics Forum here, and Katha Pollitt has a great (year-old) piece on this issue here.
Wednesday, May 24, 2006
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2 comments:
For a while now I've been following the approval process for Gardasil and the conversations surrounding objections to the vaccine based on the "sex-provocater" argument; as such, while I was heartened to hear of the overall support for its approval, I was not suprised to hear followup arguments that parents should be able to withold the vaccine from their children. Unfortunately, I wasn't any less dismayed to hear the withholding argument; it's the same kind of argument that's been used to discourage education about safe sex practices. It's so dismayed me that I've been reluctant to even address the ethical implications of withholding HPV vaccines; but arzhang, you've quite clearly explicated my thoughts about it-- so thank you. :)
I just wanted to also mention that the relevance of age groups at the time of vaccination is not only related to the issue of needing to get to girls before they become sexually active (which WILL happen no matter how much abstinence is stressed- that's biology folks!), but also to the fact that it is not yet clear how long the vaccination will last, due to the fact that not enough time has passed since testing of the vaccinations began to determine that. (I believe the running estimate now is about 10 years.) Unfortunately, the ethical perspectives of vaccination cannot be circumvented by the idea of vaccination at a young age (with measles and mumps vaccinations for example) when a child's lack of understanding of STDs would likely prevent any possible influence on future sexual behavior, as it is likely that a vaccination administered at the age of 5 would no longer be effective by the onset of sexual activity. So the target group of 10-15 is crucial.
I whole heartedly agree with both of you. I support mandatory vaccination, because, just like measles, mumps, and rubella, HPV is a contagious disease that, until vaccination is standard practice, will continue it's rampant spread. If you look at the statistics you'll find that ~70% of the human race has contracted one of the HPV strains. But, because it's sexually transmitted, it's one of those taboo topics for conservative folks. Well, I say too bad, because it's for the greater good and, to my knowledge, there are no serious adverse events associated with this vaccine, so the only thing these conservatives have to baulk at is their contrived association with increased sexual activity. ugh!
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