The Corpus Callosum

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.  

 James Colgrove, Ph.D., M.P.H., writing in the New England Journal of Medicine, acknowledges that point, but goes on to say that it is more complicated than that...

The 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 Michigan's lead...

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 compulsory.  

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 weaker.  

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.