Governor Perry’s executive order requiring all girls (I think at age 12) to receive the HPV vaccine—with a parental opt out—has become a legitimate political issue in the Republican primary, and I think, nationally. Representative Bachmann charged Perry with “crony capitalism”—which we need not deal with here—and made the ludicrous and reckless claim that the vaccine can cause retardation. But Megan McCardle over at The Atlantic, breezes past those issues, and in a thoughtful column, gets to the ultimate question: How much power should the state have in a free society to force children to receive the HPV vaccine?
First, she points out that thousands of women die each year from cervical cancer, a malady that is often caused by HPV (about 70%). True. She also points out that HPV has caused throat and neck cancers, implying that it can be spread through oral sexual behavior. True again, as I have discussed here at SHS. The primary purpose, she says isn’t to protect the vaccinated person but his or her sexual partners. I wouldn’t put it that way, but the point she is making is that the vaccine not only protects the person who will not be infected, but also those who might have been infected by that person but for he or she receiving the HPV vaccine. Thus, as in all vaccines, it both keeps people from getting infected by the virus, and if they are not infected, they can’t spread it.
Allow me to add, the vaccine does not work if a person is already infected, and since the virus is spread sexually, if it is provided before the child become sexually active, it is more likely to actually prevent HPV infection. The vaccine is very effective with an extremely low—but importantly for our discussion, not nonexistent—potential for serious side effects. (For example, disability has been reported in connection with the vaccine, as well as Guillain-Barré syndrome, but no causality has yet been demonstrated.)
Given these factors, McCardle advocates that the vaccine should be mandatory. From her column:
Now, maybe you think that this wasn’t compelling enough to mandate the vaccine. As it happens I disagree—I think that preventing the transmission of communicable disease is a clear public health issue, and that frankly if this wasn’t an STD, no one would even be questioning whether we should vaccinate for a disease that kills at least 3,000 people a year—more than died of measles in the late 1950s, by the way. And of course, thousands of more have to go through invasive tests and treatments.
If McCardle is right, all children should receive the vaccine, not just girls. Indeed, I saw a Merck ad the other day urging parents to have their sons inoculated to protect his future sexual partners.
But should it be mandatory? We force children to have vaccines against measles, chicken pox, mumps,etc., or not go to school—even though there is a very minor risk of serious side effects—not autism!—precisely because they are readily communicable, in the sense of being spread by air or touch. HPV isn’t. That is a crucial distinction, I think. The state interest in preventing a future sexually transmitted disease, which most people will not contract in any event, is therefore less compelling. Hence, I think the proper approach is to recommend inoculation, but not require it. I can even get behind an opt-in system in which the vaccine is made available in the nurse’s office at school if parents want their kid to have it, but not an opt-out system, in which kids are vaccinated automatically unless the parent says no.
But the culture wars are not irrelevant here. I believe there are some advocates who want teenagers to be treated as if they were adults—that is freed from parental oversight—particularly with regard to sexuality. I’ll even be more blunt. I think some in society want teenagers to have sex (I mean, other than teenagers). Mandatory HPV inoculation would serve that cultural purpose. Indeed, some even want it provided without parental knowledge along the same line as we’ve seen with abortion and birth control. No wonder some parents object.
That point aside, when it comes to medical issues, parents should be in control of their children’s health care absent a compelling state interest. The HPV threat doesn’t rise to that level of concern. No forced HPV vaccinations, and no vaccinations without parental knowledge and consent.
The cartoons that accompany this post show how the issue paradoxically cuts both ways—enriching a fat cat drug company on one hand, and mocking uptight Christian parents worried about their kids having sex on the other. But for me, it boils down simply to a matter of parental rights.
