Friday, August 28, 2009

Should 11-year old girls be mandated to get HPV vaccine?

Is it me or is there something wrong with the logic of the Gardasil debate? In a nation that has been reluctant to allocate public resources to teaching safe sex to our high schoolers, the move toward universal vaccination of pre-adolescent girls against a sexually transmitted disease seems illogical. Is the thought that we will teach them to abstain, but if that does not work, no need to teach them anything else -- they can just go ahead and have sex with impunity, as long as they are protected against HPV by the vaccine? What about unwanted pregnancy? What about HIV and other sexually transmitted illnesses? And how can we collude with such taciturn matter-of-factness in normalizing the idea that 11 years is an OK age for a child to make her sexual debut?

The manufacturer of Gardasil, in the name of public health, is calling for the government to mandate this as yet another vaccination required for school entry. This may make sense in a third-world country, where access to Pap smears is poor and the chances of using a condom are culturally slim, but in the US this seems over-the-top. How about instead, in the name of public health, halting the confusion of conflicting messages about sexual activity?

I know that once my kids are teens I will have very little to say about how they exercise their judgment. What I can hope for is that through honest dialogue I am preparing them now for the decisions they will be making on their own. One of the lessons we emphasize is that actions have consequences. Pushing Gardasil as the solution to a culturally created problem takes personal and societal responsibilities out of the equation. Yes, we may avoid a few cases of cervical cancer and even deaths from it, but we will have forgone the opportunity to teach our children to exercise their personal choices, responsibility and common sense. Moreover, we will be promoting further the culture of "a pill for everything", a philosophy that has brought our healthcare "system" to the brink of bankruptcy and our nation to unprecedented rates of bad behavior.

In view of the recent questions about the vaccine's risk-benefit profile, caution is needed more than ever. Vaccines should be mandated for highly infectious diseases spread via casual contact, likely to cause unmitigatable and frequent morbidity and mortality, and only if their benefits outweigh their risks. Gardasil fails this entire formula: HPV is pretty hard to get, cervical cancer is nearly 100% curable if detected early, and the vaccine's risk-benefit profile is in question. It is entirely clear that HPV is not smallpox. Let's stop pushing this false panacea on our kids and get back to teaching them the valuable skills and judgment that will serve them well as good people and responsible citizens of our nation.


  1. I don't see the mandate as any permision to act sexually that is how you raise your kids or do not that makes the most difference not what the schools decide to teach. When did it become the schools responsibility? well I guess you mean it is good for schools to teach EVERYONE so that those with poor parents or lax parenting get information about what sex is and how to practice it safely, avoid unwanted kids and oh yeah wait until you're emotionally ready. Also the drug company not only has profit motive but a good public health motive to vaccinate everyone because imagine if only a portion of people got polio vaccine. IF they did they wouldnt have wiped it out ( minus a few cases worldwide) and I dont think they give that vaccine anymore right? Anyways I believe that the more people vaccinated the better population -wise or public health wise its effect so makes sense to mandate it. Just bcause it is related to a sexually transmitted disease doesn't make that logic false, just politcally messy. Finally as a RN I think your comment about condoms is a false one even if it reduces the rate of transmission I bet it doesn't prevent HPV I think any contact genital to genital would work probally other types of contact I bet too.

  2. Thanks for your comment, anonymous. I believe you missed my point -- the risk benefit of this intervention warrants extreme caution, as is likely to be the case with most vaccinations for diseases not meeting the criteria I outlined ("the cure is worse than the disease" type of thing). Overlaying the opportunity to teach responsibility for me puts the nail in its coffin.

  3. "Anonymous" have you thought of the fact that this vaccine has hardly been tested and has a wide variety of side effects that are worse than it's purported benefit? I agree with Marya "the cure is worse than the disease". The American Cancer Society states that cervical cancer is down 70% in the past 30 years and that with yearly pap test early prevention almost always leads to a cure. I feel that this vaccine is being pushed to hard (perhaps desperate times for Merck? ) without proper testing.