HPV Vaccine Fuels Familiar Battle
AUSTIN, Texas _ Advocates of mandatory HPV vaccines for Texas schoolgirls rest their case on sound science _ medical evidence that a few shots could nearly eradicate the sexually transmitted disease and the cancer it can cause.
Their opponents, who fear sending mixed messages on premarital sex, are fighting to protect the fundamental parental rights: knowing what’s best for your own children.
It’s the latest frontier in the war between social conservatives and the science community. And its front line is in Texas.
But in this battle between personal values and medical reasoning, the sparring sides are drifting onto each other’s turf. Public health experts question the moral judgment of parents who deny daughters the vaccine. Religious conservatives are questioning the validity of the medical studies on the drug and its usefulness.
Scientists and ethicists say they have anticipated debates over abortion, stem cell research, the teaching of evolution and end-of-life treatment, but they didn’t see the HPV vaccine uproar coming. Now that it’s here _ prompted by Texas Gov. Rick Perry’s order to require the vaccine and legislation in dozens of other states to do the same _ it’s not going away.
“I’m a little staggered by it, honestly,” said Chris Mooney, an author who chronicled the ongoing fight between social conservatives and researchers in his best-selling book “The Republican War on Science.”"A lot of people didn’t think this would escalate to the scale of other fights. But it’s really erupting.”
On the surface, it seems like a simple public health equation.
Close to 4,000 women die of cervical cancer every year, a 10th of them in Texas. The human papillomavirus _ which will infect more than half of sexually active people at some point in their lives _ is the leading cause of the disease. A new vaccine, Merck’s Gardasil, prevents almost all of the strains of HPV responsible for 70 percent of these cancer cases, as well as 90 percent of genital warts.
What’s the harm, proponents ask, in requiring the vaccine for 11- and 12-year-old girls?
“We have a vaccine that is going to save young women’s lives, that is going to save the state huge amounts of money, that is going to allow for women to be able to have productive fertility in their adult years,” Perry said in an interview with reporters last week. “Every day that goes by, I think there are more and more Texans that understand, `You know what, this is wise public policy.’”
To social conservatives and many Texas lawmakers, the order is all wrong. They fear the vaccine is too new, too untested and prohibitively expensive. They don’t like that Perry acted unilaterally. And some suggest the governor is pandering to a drug company that employs his former chief of staff.
But mostly, they see the state stepping into their business as parents, possibly even promoting sexual activity.
“They’re hitting two nerves: They’re not only taking away parental rights, but they’re talking about a vaccine against a purely sexually transmitted disease,” said Linda Klepacki, a sexual health analyst for the evangelical group Focus on the Family. “Does the public health industry truly believe that all children and adolescents are sexually active? This is not something kids are going to contract sitting in the classroom.”
For proponents of a mandatory vaccine, arguments against it don’t hold up against sound science.
The vaccine, which the Centers for Disease Control and Prevention recommended for preteen girls seven months ago, has been tested in more than 11,000 young women over five years with no serious side effects. Perry’s HPV mandate _ the first in the nation _ allows anyone to opt out of the inoculation for personal or religious reasons.
The vaccine, which would be required for schoolgirls entering the sixth grade in September 2008, generally costs $360 but is covered by most insurance companies and would be available for underprivileged kids through the Texas Vaccines for Children Program.
“There’s a bit of hypocrisy going on here,” said Dr. John Santelli, an adolescent health expert at Columbia University in New York. “You’ve got this major killer of women, this major cancer among women around the world of a certain reproductive age, and a vaccine that is almost 100 percent effective. However you’ve got groups opposing it because they’re afraid it’s going to cause a change in sexual behavior.”
Abstinence educators and socially conservative organizations say the mandatory nature of Perry’ order is the problem.
Many parents spend years educating their children to wait for marriage to have sex. Forcing them to be vaccinated for HPV “sends a double message,” said Andrea Lafferty, executive director of the Washington, D.C.-based Traditional Values Coalition. “It says, `I don’t want you to be sexually active, but here, I’m going to protect you from it.’”
And the opting-out option is unacceptable because it puts the burden on parents, said Wendy Wright, president of the socially conservative Concerned Women of America.
“They’re going to have to justify themselves to very forceful government officials, who’ll present it like, `You don’t care about your child and want her to get cancer,’” she said.
But beyond the rhetoric about parental choice and drug companies, proponents of the vaccine point to another underlying factor: the role HPV plays as ammunition for abstinence-only educators.
Of the 25 sexually transmitted diseases or infections abstinence educators showcase in their pitch to get kids to save sex for marriage, HPV is a star player.
It’s the most common sexually transmitted disease or infection in the U.S.; 20 million people are currently infected. And it’s got a direct link to a deadly disease, cervical cancer. Men generally suffer no life-threatening effects but can carry and transmit the virus.
Until recently, condoms were not thought to be effective in preventing HPV, bolstering educators’ argument that the only safe sex is no sex. If a mandatory vaccine wipes out HPV altogether, supporters of comprehensive sex education say, it could serve as a serious blow to the abstinence-only movement _ and possibly its funding.
A primer on Focus on the Family’s abstinence Web page notes that there is “no conclusive evidence” that condoms protect against HPV, “the primary cause of cervical cancer, which kills more women than AIDS does.”
The Web site for the Catholic abstinence group Pure Love Club warns kids that “condoms don’t offer much protection from HPV.”
And a news release on the Traditional Values Coalition’s site says condoms “provide no significant protection against human papillomavirus.”
These organizations and others have been equally quick to rebut the latest study on condom use and HPV published last summer in the New England Journal of Medicine, which found that women whose partners used condoms were 70 percent less likely to get the infection.
“Their tactic has been, `You can’t prevent HPV, and if you have HPV then you get cervical cancer and you die, so don’t have sex,’” said William Smith, vice president for public policy for the Sexuality Information and Education Council of the United States, which promotes teaching a range of protective measures, including prophylactics. “Anything that has the slightest remote possibility of making sex outside of marriage a safer activity is what they’re against.”
Abstinence educators say that HPV is just one of the infections they warn students about and that they spend no more time on it than other sexually transmitted diseases. But it gets some special attention because, as Libby Macke, director of the abstinence group Project Reality, says, it’s “an STD condoms offer very little protection against.”
Macke, whose organization provides abstinence curriculum for the Dallas Independent School District, says they tell kids the vaccine is available, “but of course we’ll let them know that, even if they get the vaccine, there’s no such thing as truly safe sex.”
“When a disease is sexually transmitted, anytime that you are promoting something that will cause you not to have a consequence, there’s a chance young people will take that as an, `OK, I can do this and be completely safe,’” Macke said.
But there’s debate even among abstinence educators. Marilyn Morris, who founded the Dallas-based national abstinence program Aim For Success, said anyone who’s under the impression the vaccine will make kids promiscuous isn’t thinking straight.
“There are 24 other significant STDs this will do nothing for,” she said, “so there’s no reason anybody should see this as a license to go out and do that.”
And while she doesn’t blame parents for feeling blindsided by the mandatory inoculation, she endorses it even for women waiting until marriage to have sex. What if they’re date-raped in college, she asks? What if their future husband has HPV?
The debate has quickly taken on a tenor no one on either side anticipated when the vaccines first debuted.
When rumblings began, Mooney, the author, figured they would evaporate quickly. The vaccine had nothing to do with evolution, stem cells or abortion, the three traditional lightning rods. To him, it didn’t seem to encroach on abstinence education.
“It’s a vaccine that prevents cancer,” he said. “How do you, as a matter of public relations, oppose that?”
But he soon realized the debate wasn’t going anywhere _ he updated his book to include the HPV controversy.
“The battle is tougher than I thought it would be, for sure, and more long-term than I imagined,” said Ms. Klepacki with Focus on the Family. “But we’re just really trying to stand on science. There is no reason to mandate this vaccine in order to protect the public.”
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(Dallas Morning News correspondents Christy Hoppe and Amy Rosen contributed to this report.)
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(c) 2007, The Dallas Morning News.
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