Pure Pedantry

Focus on the Family, a conservative social organization located in Colorado Springs, CO, has decided to oppose the mandatory vaccination of young girls for Human Papilloma Virus (HPV), a virus linked to the formation of cervical cancer. Recently the FDA has approved a vaccine for two of the high risk (more likely to form cancer) subtypes that has proved very effective (over 90%) at preventing HPV infection in girls when administered before sexual activity.

Diane Carman of the Denver Post has this coverage:

HPV is a sexually transmitted disease that is the cause of more than 70 percent of cervical cancers – the second-highest cause of death for women around the world. The HPV vaccine could save thousands of lives in the U.S. each year and hundreds of thousands worldwide. As breakthroughs go, this is monumental.

Much like the pill did 46 years ago, this vaccine could dramatically reduce one risk of being sexually active.

So it’s easy to see why spokesmen for Focus on the Family declined requests for interviews last week. In their quest to remain steadfastly anti-sex, they know if they’re not careful with this, they can end up coming off as cynically pro-death. There was no alternative for Focus but to dabble in a bit of old-fashioned moral relativism via the Internet.

The organization’s website spells out a carefully crafted position on a public policy to save women’s lives:

“Focus on the Family supports widespread (universal) availability of the HPV vaccines but opposes mandatory HPV vaccinations for entry into public school. …The decision of whether to vaccinate a minor against this or other sexually transmitted infections should remain with the child’s parent or guardian.”

In other words, Focus supports the right of parents to deliberately allow their daughters to be exposed to cervical cancer.

The logic goes something like this: Unlike measles or polio, HPV is a sexually transmitted disease and therefore – theoretically at least – a deterrent to sex. I guess at Focus they figure if the threat of pregnancy, HIV and eternal damnation won’t keep the girls virgins, maybe fear of cancer will.

Focus on the Family’s official statement is here.

Their rationale is as follows:

– No vaccine is 100% effective against disease

– There are more than one hundred sub-types of HPV and the current vaccines being tested are effective against, at most, four of these

– The sub-types of the virus that these vaccines protect against are the cause of most but not all cases of cervical cancer

– The possibility of HPV infection resulting from sexual assault, including date rape

– The possibility that young persons may marry someone previously exposed to and still carrying the virus

– The HPV vaccines do not protect against other STIs or prevent pregnancy

– The HPV vaccines do not, in any circumstance, negate or substitute the best health message of sexual abstinence until marriage and sexual faithfulness after marriage.

Let’s take these one at a time shall we:

No vaccine is 100% effective against disease. Gee, got me there. It just turns out thatthis vaccine Gardasil was demonstrated to be 93% effective in preventing cytological abnormalities and 95% effective at prevent cervical infection. Let’s contrast that with some other vaccines. During the 1980s, there was a polio outbreak in Taiwan during which the direct effectiveness of the polio vaccine was tested. The effectiveness was found to be “to be 82% after one dose, 96% after two doses, and 98% after three or more doses.” I suppose we shouldn’t be prescribing that either.

In the United States, there are about 10,000 new cases of invasive cervical cancer are diagnosed annually, and about are 4,000 deaths from the disease. This vaccine has the possibility to significantly shrink or prevent those deaths — whether it is one hundred percent effective or not.

There are more than one hundred sub-types of HPV and the current vaccines being tested are effective against, at most, four of these. While not demonstrably effective against the other subtypes, most of the other subtypes are not associated with cervical cancer. And my above argument still applies that any vaccine against the high risk subtypes would represent a substantial decrease in the prevalence of the disease.

The sub-types of the virus that these vaccines protect against are the cause of most but not all cases of cervical cancer. The subtypes in the vaccine 18 and 16 still count for the vast majority. In a survey of the viruses present in specimens of cervical cancer, “HPV 16 was present in 50% of the specimens, HPV 18 in 14%, HPV 45 in 8%, and HPV 31 in 5%.” (from here)

The possibility of HPV infection resulting from sexual assault, including date rape. Did they just make my argument for me? If your primary strategy for the prevention of HPV is abstinence, then the possibility that someone could get HPV from rape — even if they otherwise followed your beliefs to the letter — should encourage vaccine use rather than discourage it. To prevent them from recieving it would be further punishing those who have already suffered terribly.

The possibility that young persons may marry someone previously exposed to and still carrying the virus. Yet another argument made for me. Abstinence is not an effective strategy for the prevention of a Sexually Transmitted Infection which currently has on the order of 80% prevalence in the United States. Say a girl follows your rules. She could still get it from her partner when she gets married, even if she is exclusively monogamous. Again you are punishing someone even when they follow your rules.

The HPV vaccines do not protect against other STIs or prevent pregnancy. Nope. But condoms do. I heard you don’t like them. I reiterate that incomplete effectiveness against all forms of risk is not sufficient argument not to take steps to prevent the soluble risks. We still use seatbelts even though they do not prevent all traffic deaths.

The HPV vaccines do not, in any circumstance, negate or substitute the best health message of sexual abstinence until marriage and sexual faithfulness after marriage. This would be their opinion.

My opinion is that it is completely unconscionable for a group to petition against a vaccine that could save thousands of lives. The alternative that they propose is not an effective means of protection for this disease. If the threat of pregnancy — a very immediate concern — is not sufficient to keep kids abstinent, why on Earth would you think that a virus that can give you cancer in your late 40s would be?

I am not the type to go into hystrionics about health policy or any policy for that matter. I try to see the legitimate moral and personal reasons why people disagree with me, but I cannot for the life of me find one good reason to oppose this vaccine.

UPDATE: I hadn’t realized when I wrote this that is was well covered by everyone else. Here is Abel’s, Ed’s, and Janet’s takes.

Comments

  1. #1 Abel Pharmboy
    June 12, 2006

    Jake, funny that we should both blog indirectly about Colo Spgs today – I’ve added a hyperlink to you in this post. Thanks for linking to my HPV vaccine rant as well.

  2. #2 Rob Cozzens
    June 12, 2006

    You might have missed the point of Focus on the Family’s list.
    That wasn’t a list explaining their rationale for being against mandatory vaccination – it was a list of what they thought parents should keep in mind when decided for or against a vaccination for their children.
    They realize that the date rape argument is an argument in favor of the vaccination and they think parents should consider that.

  3. #3 Jake Young
    June 12, 2006

    Granted they were trying to inform parents about the facts as they see them.

    However, if they are willing to highlight flaws in their argument — I would assert as an attempt to prevent them from appearing totally depraved — I am more than willing to help.

    (Abel and I have CO pride by the way.)

  4. #4 ThePolynomial
    June 12, 2006

    Ups to Rob’s comment. The last bullet on the list, “The HPV vaccines do not, in any circumstance, negate or substitute the best health message of sexual abstinence until marriage and sexual faithfulness after marriage,” indicates that they hope parents will get their kids vaccinated but also take steps to be sure the vaccine doesn’t turn their kids into WILD SEXUAL BEASTS!

  5. #5 Shelley
    June 12, 2006

    The biggest, and saddest fact here is this: giving your child every precaution and oppertunity to live a healthy life is just good parenting. End of story. If you are against the administration of a vaccine that could possibly save your child’s life (and has no other drawbacks), you are a terrible parent. Just because you *know* that little Suzy or Johnny is virtuous (and denial is a river in Egypt) doesn’t mean that their future spouse would have been so virginal. I would say the same thing about ANY health measure whatsoever. If there is a vaccine that might prevent my child from overdosing on heroin if they ever become an addict, damn straight I’d get her vaccinated. I would sincerely hope that it would never come in handy, but I would never want to live with myself if they did OD on heroin just because I *assumed* it would never be an issue.

  6. #6 colleen
    June 12, 2006

    Of course, the reality is that sexual behavior is universal among adolescents. 62% of high school seniors and 80% of college students report having had sexual intercourse. Objection to mandatory HPV vaccination blithely ignores the actual behavior of young people. No doubt, some girls who go unvaccinated will become sexually active before they have a chance to be vaccinated. By seeking to withhold the vaccine, they abide by putting unvaccinated girls at greater risk, all for the petty purpose of having a nudge more sway in the misguided push to keep youth ignorant and ensure abstinence.

    Tina Hoff, et. al., National Survey of Adolescents and Young Adults: Sexual Health Knowledge, Attitudes, and Experiences , (Menlo Park, CA: Henry Kaiser Family Foundation, 2003), 14.

  7. #7 Jake Young
    June 13, 2006

    I agree with Shelley. The reason I posted this was the following:

    I consider public health issues above considerations of moral diversity. If you can save lives by a policy, I do not think it is responsible to question the wisdom of that policy even if you have differing moral concerns.

    Also, I will admit that I don’t have a direct line to what is going on in Focus on the Family, but I think that their presentation of “the other side” is largely rhetorical. If you can’t argue something in a reasonable way, then this may be the only argument that you can make. “We are just saying, you should consider these issues.” I don’t think this kind of rhetorical trick is responsible.

  8. #8 JohnJB
    June 13, 2006

    There’s another aspect to the coverage of the religous right’s opposition to the HPV vaccine that I haven’t seen mentioned in the coverage – They don’t the vaccine since it undercuts their arguments in opposition to contraception, specifically condoms, since they often stress the relatively lesser effectiveness of condoms for HPV prevention.

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