This has been a topic at ScienceBlogs before. Now, finally,
the New England Journal of Medicine is catching up. They have
an editorial on the ethics of vaccination against Human Papilloma
Virus. It turns out that there are many facets to this issue.
The background is this: HPV is a major factor in the
development of cervical cancer. About 10,000 women are
diagnosed with cervical cancer each year in the USA, and there are
about 3,700 deaths per year from the disease.
To put that in perspective, that is more than the total number of
deaths in the terrorist attacks on 9/11.
Previous posts on the topic include: HPV
Vaccine May Be Required in Michigan (mine); Quote
of the Day: The HPV Vaccine Edition (Mike the Mad Biologist);
and two at Aetiology: Well,
this is going to tick some people off, and Cervical
cancer, vaccines, and jackalopes.
Michigan did end up passing a law requiring HPV vaccination in girls as
a requirement for attending school. The big controversy came
from groups who argued against it, citing fear of promoting sexual
activity in teenage girls.
Ethics and Politics of Compulsory HPV Vaccination
James Colgrove, Ph.D., M.P.H.
Volume 355:2389-239, December 7, 2006, Number 23
On September 12, 2006, 3 months after the Food and
Drug Administration licensed a vaccine against human papillomavirus
(HPV), Michigan lawmakers became the first in the United States to
propose that vaccination be compulsory for girls entering sixth grade.
Parents who objected would be able to opt out of the requirement under
the same provisions that apply to other vaccinations. The bill passed
the state senate by an overwhelming margin a week later and awaits
consideration by the house. Other states are likely to follow
Moves to make the vaccine compulsory are sure to ignite a new round of
polarizing debates. Controversy over the product began before it was
licensed, when some religious conservatives expressed concern that the
availability of a vaccine against a sexually transmitted disease would
undermine abstinence-based prevention messages. Advocacy groups such as
Focus on the Family ultimately came to support availability of the
vaccine, but they remain opposed to mandating its use. In their view,
such a requirement constitutes an attempt by the secular state to force
a child to undergo an intervention that may be irreconcilable with her
family’s religious values and beliefs.
It is a mistake, however, to view the contrasting stances on
HPV-vaccine mandates as solely, or even primarily, evidence of a
conflict between science and religion. A more complicated dynamic will
shape the ongoing discussion…
The gist of the argument is this: there is no denying the life-saving
potential for this vaccine. The health issues are
sufficiently urgent that it makes sense to impose policy to maximize
the use of the vaccine. The issue is whether it should be
The counterarguments are as follows:
- There are already many vaccines required for children.
This has been followed by a backlash of sorts, accompanied by
all sorts of antivaccination rhetoric and activism. Adding
another mandatory vaccine could add fuel to the backlash.
- Bioethicists tend to place high value on patient autonomy.
Compulsory vaccination goes against this principle.
Because HPV is not spread as casually as other disease, e.g.
measles or pertussis, the argument for compulsory vaccination is
Dr. Colgrove does not conclude with a recommendation. When I
frist read the editorial, I had the vague impression that he was
opposed to mandatory vaccination. After going through it a
couple of times, I no longer have that impression. I think he
tried to be nonjudgmental about the issue. That is
appropriate, given the nature of the article.
Personally, I think that compulsory vaccination is a good idea.
Given the nature of blog posts, I am free to say that.
I know that the schedule of compulsory vaccinations is
already pretty long. But spread out over several years, it is
not really a burden. The strongest argument is the
libertarian one, that there should be strict limits on what the
government can compel us to do. However, as I pointed out,
there are many facets to this issue. Given that the yearly
mortality from disease from HPV is greater than the loss of life from
the terrorists attacks on 9/11, and the fact that we have put up with a
significant increase in governmental intrusion because of those
attacks, it is at least congruent for us to accept a lesser intrusion
that holds a much greater likelihood of actually saving lives.