September 21, 2011
The Washington Post editorial criticizing Michele Bachmann for her objections to requiring Human Papilloma Virus (HPV) vaccination for school attendance suggests that objection to this requirement would lead to a public health apocalypse following widespread rejection of other vaccines—those against polio, chicken pox, measles and other diseases. This claim is highly debatable, but even so, the editors’ criticism misses the point. The resistance to mandatory vaccination is not due primarily to fear of the vaccine itself, but is rather based on an objection to the erosion of parental rights by the state. The integrity of the family must be respected.
Mandatory vaccinations as a prerequisite for school attendance have traditionally been based on the reasonable desire to prevent diseases likely to be spread in the school setting. Measles, mumps, chicken pox, diphtheria, pertussis and polio are all risks among an un-vaccinated school age population.
There is, on the other hand, a precedent for vaccinating against a disease associated with risky adult behavior: the hepatitis B vaccine prevents a virus that is transmitted sexually or via contact with blood and body fluids. It is a significant risk for IV drug abusers, but it is also a risk for health care workers and emergency first-responders. This vaccine series is now initiated in newborns and is required in many school districts.
This is a reasonable precaution, mandated because teachers, emergency personnel, and students are at risk of contact with blood and other bodily fluids if an infected student becomes ill or injured. HPV, on the other hand, is only transmitted via sexual contact. There is, one assumes, no reason to expect exposure to HPV in a school setting.
In a separate Washington Post editorial, Michael Gerson argues that the public health consequences of failing to vaccinate for HPV warrant state intrusion into family health care decisions. This position is not backed up by the facts. Contrary to the hype, this vaccine does not prevent “cancer;” it prevents a sexually transmitted disease: human papillomavirus (HPV). It is true that most cases of cervical cancer are linked to an infection with HPV, but prevention of cervical cancer is a secondary, not primary, effect of the vaccine. Women who are vaccinated against HPV are still advised to get regular pap smears to screen for cervical cancer.
Although HPV is the most prevalent sexually transmitted disease; the vaccine only protects against a small fraction of the subtypes of HPV. Also, most cases of HPV infection, including those caused by the cancer-causing subtypes, are cleared by the body naturally without medical intervention. Regular screening for cervical cancer by pap smear catches most cancers when they are easily treated. Currently, most deaths from cervical cancer occur in women who have not had regular screening or in women with underlying immunodeficiency diseases like HIV/AIDS.
It is true as well that some parents may object to the vaccination because they fear it undermines their moral instructions. Why should they, so the argument goes, have to pay for an expensive vaccination (estimated cost is $360 for the required 3-shot series) when they are teaching their children to avoid the only kind of behavior that might make them susceptible to HPV infection? Furthermore, why should their 11-year-old be forced to undergo vaccination for a disease that is uniquely sexually-transmitted? It is not unreasonable to conclude that the benefit to an 11-year-old is not worth the risk of the vaccine.
Nonetheless, taking precautions against untoward circumstances does not necessarily compromise the parent’s efforts to encourage their children to be chaste. Just as I hope my children are never exposed to hepatitis B, I hope they are never exposed to HPV, and I will discourage the risky behaviors that might lead to either. Despite our best efforts, however, our children will not always adhere to our guidance and may choose to engage in sexual activity before marriage (not to mention the unthinkable tragedy of rape). It is also possible that they marry someone who carries the virus from a previous exposure.
And so the decision to vaccinate for HPV might be a reasonable one—as might the decision to avoid vaccination. The point that the editorial board of The Washington Post and Michael Gerson have both missed, is that the public health risks of HPV infection do not rise to the level necessary to justify mandatory vaccination. Not everything that is good for us must be a government mandate. Flu shots, exercise, and eating our green beans are all good ideas but not legal requirements. The choice of whether to vaccinate against HPV or not should remain with parents, not the state.
Denise Hunnell, MD, is a Fellow of HLI America. She writes for HLI America’s Truth and Charity Forum.
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[...] U.S.: Missing the Point on Mandatory HPV Vaccination – Dr. Denise Hunnell, HLI America [...]