The HPV Vaccine controversy -- choice and responsibility

This morning’s newspaper (Orlando Sentinel) had a column by Susan Reimer of The Baltimore Sun in which she discussed the arguments by some parents against mandatory vaccination for the HPV virus that can cause cervical cancer. Some states have considered making it a mandatory vaccination at 11 or 12 years old before they become sexually active. Groups of parents have protested, saying that it will encourage their children to have sex.

She quotes Sarah Brown of the National Campaign to Prevent Teenage Pregnancy who says that she can understand parents being concerned about their children being required to be vaccinated with a drug that is new and does not yet have long term data on its effects. But, she added that their argument that getting vaccinated will change a young woman’s thinking about whether or not to have sex strikes her as ‘intensely unreasonable.’

And, another part of the issue is that the vaccine does not prevent all cervical cancers, and not even all that are caused by HPV. (It is estimated that it can prevent half of those caused by HPV.)

So what do you do? Do you allow future generations of women to be exposed to a virus that half of men have and that contributes to 7500 cases of cervical cancer per year? She states that 40% of those who develop cervical cancer die of the disease. Do you force those who object because of their beliefs (no matter how you view those beliefs) to comply? Do you force parents who think their daughter will never have sex until a certain age or marriage? (I wonder if they plan to have her vaccinated at 15 or 18?) Do you force parents to take risks of unknown side effects or limited efficacy of a new drug? Do we force parents who wonder if it is just a ploy by pharmaceutical companies to make millions or billions more?

I don’t know that requiring vaccination is the answer. And yet, polio vaccine was required early on. Other vaccines are required for entry to school.

My first thought was ‘if parents choose to NOT have their child vaccinated, and that child later develops cervical cancer associated with that particular virus that the vaccine prevents, they should be required to pay for medical treatment of the cancer, or at least 50% of the cost. In spite of the attitude of entitlement in this country, I think patients bear certain financial responsibility for their decisions. Taxpayers, insured, businesses, hospitals, public health assistance programs should not be required to absorb the cost of something that can be prevented. (On the other hand, where would that lead us if we actually held people financially responsible for their lifestyle choices -- smoking, obesity, unprotected sex with multiple partners?)

Perhaps more importantly, parents have a responsibility to safeguard their children’s health. What will it be like for a child who becomes a young woman and develops cervical cancer when it could have been prevented? What will it be like for her parents, who remember they had a chance to provide some protection, but did not? I wouldn’t want to be either one of them.