The Corpus Callosum

The Next Big Gardasil Controversy

Gardasil is the vaccine from Merck that greatly lowers the risk of
infection from some human papilloma virus (HPV) infections. The href="http://scienceblogs.com/ethicsandscience/2006/06/hpv_vaccine_approved_daughters.php">first
big controversy had to do with the practice of giving the
vaccine to young girls.  To be most effective, it should be
given prior to the commencement of sexual exposure.  So the
recommendation is to give it to girls at age 12.  This led
some persons to complain that it might encourage sexual activity in
contexts they deemed inappropriate.

The ethics of this have been covered in detail href="http://content.nejm.org/cgi/content/full/355/23/2389">elsewhere.

The reason to give it to girls, is that some of the infections increase
the risk for cervical cancer.  Boys, not having cervixes, are
at less risk.

But the risk for males is not zero.  HPV can cause anal cancer
or throat cancer.  The risk is much lower, but not zero.

In February 2008, it was publicized that href="http://scienceblogs.com/grrlscientist/2007/02/gay_men_request_gardasil_vacci.php">some
gay males were requesting the vaccine.  Not much
controversy there, for this would generally be informed adults would
are individually requesting the vaccine.  Presumably, they
would be able to weigh the risk:benefit factors and make an informed
choice.  

But giving vaccines to young people is a different issue, especially if
the use of the vaccine is mandated by government.

Now, consideration is bing given to the notion of administering the
vaccine to young boys.  

href="http://www.washingtonpost.com/wp-dyn/content/article/2007/05/18/AR2007051800496.html">Experts
Debate Giving HPV Vaccine to Boys

By E.J. Mundell
HealthDay Reporter
Friday, May 18, 2007; 12:00 AM

FRIDAY, May 18 (HealthDay News) — Amid the
controversy around mandated vaccination of young girls against the
human papillomavirus (HPV), some experts are beginning to wonder
whether the shot should also be given to boys.

While males cannot get HPV-linked cervical cancer, they make up half of
the equation when it comes to spreading the sexually transmitted virus.
And a new study released last week shows that the virus is also a
leading cause of throat cancer, which affects both sexes.

The debate heated up in May when href="http://content.nejm.org/cgi/content/full/356/19/1944">a
study was published that confirmed a strong association
between HPV exposure and throat cancer.  

The issues are these:

All vaccines have risks, but the risks generally are small, and cannot
be quantified before the vaccine is given to a large number of persons.
 Even then, it can be difficult to know if observed adverse
events were caused by the vaccine.  Indeed, there have been href="http://www.24-7-news.com/archives/2368">reports
of girls dying or developing problems after having been given Gardasil.
 

But the biggest problem with vaccines is that the ideal protection to
an individual is obtained when everyone else, but not that individual,
gets the vaccine.  So from an individual perspective, the
ideal situation is to find an excuse to not get it, but have every one
else get it.  But that is not fair.  So for the
general public good, the only way for vaccines to work, is to compel,
or at least pressure, everyone to get it.  That requires two
things: 1) that there be a sense of community, such that people are
willing to take an individual risk for the public good, and 2) a
vaccine that actually works, and is reasonably safe.  

Of course, what constitutes reasonable safety is open to interpretation.

The vaccination of boys would change some of the factors that
traditionally are considered in the decision of whether to recommend a
vaccine.  For one, the potential benefit may not be as great.
 Two, the risks primarily would be assessed in the large
number of females who already have gotten the vaccine, but that risk
might not be the same for males.  I have no specific reason to
think that the risk would be different, but one cannot assume that it
would be the same.

Comments

  1. #1 kevin
    June 18, 2008

    But the biggest problem with vaccines is that the ideal protection to an individual is obtained when everyone else, but not that individual, gets the vaccine.

    Is this true? I can see it if humans are the only way to get infected, so if everyone else is vaccinated (and hence not a vector) then the unvaccinated individual is protected without the risks/side effects of the vaccination. But don’t some things have other means of infection that are not cut off by vaccinating your neighbors? E.g. via animals, smallpox on blankets (how long does this last?), etc.

  2. #2 ERV
    June 18, 2008

    You forgot one thing– Even though boys/men could benefit from the HPV vaccine, do they have to pay extra for it because the medical establishment isnt ‘recommending’ it?

    Insurance covered my HPV shots because Im a young female, but will they cover the shots for a male my age who could also benefit if its not recommended by ‘experts.’

  3. #3 phisrow
    June 18, 2008

    I’m guessing that, given the level of controversy over Gardasil in young women, that this one will be quite unpleasant if it grows to any size.

    [Hard-Right talk radio host] “Liberal Nanny State and Big Pharma Conspiracy: Would you risk your son’s life to save cocksuckers from ass-cancer?” [/Hard-Right talk radio host]

  4. #4 KiwiInOz
    June 18, 2008

    I was totally happy for my 16 year old daughter to get the vaccine at school, here in Australia, courtesy of the taxpayer.

    And this taxpayer will happily shell out for my two boys (11, 14) to get it in the near future as well.

  5. #5 Rob W
    June 20, 2008

    Another thought — what are the chances of more-or-less wiping out the disease? There are many vaccines that we *don’t* give kids anymore because they were so successful (and very widely administered).

    Also, how exactly are the cancers linked with the virus? Are the specific cancers linked to the type of sex (e.g., oral sex w/ HPV transmission linked to throat cancer)? Just wondering, in the context of phisrow’s concern about the right-wing-radio-host response….

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