HPV Vaccination: The Debate About Young Girls' Health

I have seen recent advertisements and public service announcements about a vaccine for human papillomavirus (HPV). I’ve also seen some short news spots about the controversy regarding the efficacy and potential dangers of vaccinating children. Regrettably, I haven’t had the chance to gather much information about either topic, so when I found Vamos, McDermott, and Daley’s (2008) article The HPV Vaccine: Framing the Arguments FOR and AGAINST Mandatory Vaccination of All Middle School Girls, I saw my chance to find scientific facts about the issue in addition to a multifaceted perspective on the debate.

In 2006, the FDA approved Gardasil, made by Merck & Co., a vaccine for the prevention of human papillomavirus, two strains of which are responsible for 70% of cervical cancers and 90% of genital warts in the United States. There are more than 100 types of HPV, and 30 are sexually transmitted; the types of HPV that cause genital warts are considered low-risk, and the types that cause cervical cancer are considered high-risk. HPV is not only a problem for females; the low-risk types also cause genital warts in males, and the high-risk types can lead to anal and penile cancers. In the United States alone, there are approximately 20 million Americans suffering from the virus, with approximately 6.2 million new infections every year. Despite these statistics, HPV is a relatively small problem in the United States; in developing countries, where four out of every five cervical cancer cases occur, it is nearly an epidemic.

It is no surprise, considering the numbers, that news of an effective virus for HPV was met with excitement; however, the scientific evidence about the causal link between HPV and cervical cancer is confusing, at best, even to some medical professionals. As such, there is even more confusion among the media and general public regarding recent health messages about preventing the disease, vaccinating against the disease, and the disease itself. Amidst this confusion, there is also a debate about whether or not to make the use of the vaccine mandatory for all middle school girls; this debate has fueled additional moral, religious, political, economic, and socio-cultural arguments both in support and opposition of the idea.

The arguments in opposition to mandatory HPV vaccinations are that it: (1) gives children permission to have sex; (2) sends mixed messages about sexual habits; (3) usurps parents’ rights in matters of their children’s sexual health; (4) is not as relevant as other mandatory vaccines; (5) is an insufficient solution to the problem; and (6) may cause more problems than it solves.

Those opposed to mandatory HPV vaccination posit that some adolescents are not prepared to completely understand the nature of the vaccination, and may assume that they are protected from all sexually transmitted diseases. Even if they do not make this assumption, opponents argue, mandatory vaccination for HPV will only make it a little more okay to have sex at an early age. In addition, given that the current educational atmosphere in the United States espouses an abstinence-only curriculum, opponents suggest that mandatory vaccination is admission that the current curriculum is insufficient, and that mandating the vaccination sends a confusing message to young people. Furthermore, opponents of mandatory HPV vaccination suggest that the sexual health of children is the sole jurisdiction of the child’s parents; as such, parents, not school administrators or legislators, should have the ability to decide what they teach their children about sexual health, and whether or not to use the vaccine. Still other opponents of mandatory HPV vaccination point out other vaccines are mandatory because of their highly contagious nature; whereas HPV is communicable only through sexual activity. Users of this argument suggest that mandating a vaccine like this one is irresponsible; furthermore, since the vaccination only prevents the types of HPV that lead to cervical cancer, it is not a completely effective prevention.

The most compelling argument against the mandatory use of HPV vaccination is that too little is known about the vaccination itself. Currently, the vaccine seems to be effective only for five years, and it is unclear if or when boosters will be necessary. Additionally, merely 25,000 people were used in the clinical trials for the vaccine, and fewer than 1200 of them were pre-teen girls. Moreover, since the vaccine hasn’t existed very long, there is little research concerning its long-term effects. Since the vaccine’s approval there have already been at least 82 reports of adverse effects due to its use. In short, there is not enough research regarding the effective use and potential risks of this vaccine to even consider making its use mandatory for all middle school girls.

Those in favor of mandatory HPV vaccination argue that they are not concerned with making sexual activity at an early age acceptable; instead they are attempting to eradicate a very dangerous form of cancer. In regards to this concern, the HPV vaccination is a medical breakthrough that the entire world needs and deserves. Furthermore, supporters argue, including the HPV vaccination in the current vaccination schedule for school presents the perfect opportunity to capitalize on the results of other types of mandatory vaccinations such as those for Hepatitis, TB, and polio—diseases whose prevalence has decreased dramatically. Those in favor of the vaccination argue that their opponents are wrong, the vaccine has been proven to be effective against the HPV types that cause cervical cancer, and that it has no adverse side effects in the short or long term. Supporters also argue that the vaccination is not meant to be considered the only means of defense from HPV or any other STD, but that it must be used as an additional tool in the fight against HPV and cervical cancer.

The most compelling argument in support of mandatory HPV vaccination is the financial one. Although the initial vaccination requires three doses that cost approximately $120 each, supporters argue that the cost of the expensive, invasive procedures used to remove cervical cancers is much higher. It is estimated that the cost of treatment of HPV and its sequelae are $5 billion dollars per year, whereas the cost to vaccinate 12 year-old girls against HPV types 11 and 16 (the high-risk types) would only cost $15,000-$25,000 per year.

The authors conclude that careful consideration of the medical and empirical evidence is necessary, and that in order for an open, honest discussion to take place on this issue, all concerned must be educated regarding the facts. Furthermore, the authors suggest that school health personnel ought to have a voice in this issue, as they are usually the people in contact with both authorities and parents regarding children’s health issues.

Overall, the article presented excellent factual information about HPV and the recently released vaccination against it. The authors did an excellent job of presenting all sides of the debate eloquently, and, surprisingly, without bias. I even agree with the authors’ conclusion that understanding of all sides of the issue and the facts will be necessary in order to come to an appropriate solution. Anyone in the position to educate others about sexually transmitted diseases and their prevention (particularly in a public school setting) should read this article.

Given the arguments on each side, I am inclined, personally, against mandatory HPV vaccination, mostly because of the lack of empirical evidence regarding its lack of long-term side effects, and the lack of knowledge regarding an appropriate booster schedule, as well as regarding its efficacy on young girls. It seems to me that there is not enough information for anyone to be sure that we’re not dealing with another Thalidomide. Furthermore, it disturbs me that this vaccination is being promoted only for females. Is it not effective in males? The high-risk strains of HPV cause penile and anal cancers in males; if the vaccine is effective against those types in males, why are they not included in this issue as well? Why would we vaccinate only girls and not boys? Is penile cancer not as much of a concern in this country? In short, I may be more comfortable with the idea if there were ten or fifteen more years of research about it, and if I could understand why it is not being promoted as a vaccine for males as well.

Vamos, C.A., McDermott, R.J., & Daley, E.M. (2008). The HPV vaccine: Framing the arguments for and against mandatory vaccination of all middle school girls. Journal of School Health, 78 (6), 302-309.

Copyright © 2009 NinaCarmen Monroe. All rights reserved.