Yesterday the HPV vaccine was approved by the FDA. It is 100% effective against two strains of the Human Papilloma Virus that are responsible for 70% of cervical cancer cases, and two more that are responsible for 90% of cases of genital warts. (It hasn't been approved yet for use in men and boys for the prevention of genital warts, for an amusing reason:
"Merck had originally hoped to get the vaccine approved for use in boys, too. But while women are accustomed to having swabs taken of their vaginal cells, the company found that men rebelled against the use of emery boards to collect cells from their penises. Researchers eventually discovered that jeweler's grade emery paper effectively removed cells without alarming male subjects."
Get over it, guys.)
This is wonderful news. Every year, cervical cancer kills about 4,100 women in the US, and 250,000 globally; that means that if this vaccine were used universally, it would save 2870 lives annually in the US, and 175,000 lives annually worldwide. However, there are still two important hurdles ahead. First, and most obviously, getting this vaccine to women in developing countries will be a huge challenge. The Gates Foundation is funding research into the obstacles standing in the way of getting this vaccine to women in the developing world, which is a start, but this will take a lot of work.
Second, as feministing reminds us, there are obstacles in this country as well:
"The real battle over the vaccine will be in the coming weeks as the CDC’s Advisory Committee on Immunization Practices (ACIP) issues their recommendations for how the vaccine should be administered. While the ACIP decisions are non-binding, its recommendations set the standard by which states decide if they will mandate vaccination, insurance companies choose to cover the cost, and doctors decide how to advise their patients. (...)
The only member of the 15-member panel to publicly state his opinion about making the vaccine routinely available is Reginald Finger. Dr. Finger nominated himself to the ACIP after the ultra-conservative Focus on the Family was asked to provide a list of scientists to nominate for various federal boards. Dr. Finger (sorry, I can’t get over that name) describes himself as a liaison between the CDC and Focus on the Family. He says, “Focus on the Family wants to have good relationships at CDC - and I can help make those happen.”
He has also said that if “people begin to market the [HPV] vaccine or tout the vaccine that this makes adolescent sex safer, then that would undermine the abstinence-only message.” For the record, Finger would also be wary of approving an HIV vaccine, should one become available."
Let's take this very, very slowly:
First: giving this vaccine to girls does not encourage them to have sex. How many teenagers do you know whose decision about whether or not to have sex turns on the possibility of getting infected with four specific strains of HPV? Most teenagers I know think about a lot more than STDs when they're wondering whether or not to have sex. That minority who are primarily concerned about STDs will still be at risk for syphilis, gonorrhea and chlamydia. Even some (presumably imaginary) girl whose decision whether or not to have sex does turn on the possibility of getting HPV in particular will still have lots of other strains left to worry about. So how could this possibly undermine a message of abstinence?
Second: a lot of conservative Christian groups are saying things like:
"Focus on the Family affirms –- above any available health intervention -– abstinence until marriage and faithfulness after marriage as the best and primary practice in preventing HPV and other STIs."
This is not true. When most abstinence groups talk about abstinence, what they mean is abstaining from sex until marriage, not lifelong celibacy. If you abstain from sex (and any other form of genital-to-genital contact) until marriage, and you are lucky enough not to be raped, your husband can still give you HPV if he carries it. Of course, if he, too, is a virgin at marriage, he will not have HPV. But a girl's own abstinence will not protect her from HPV if her husband has ever strayed from that strait path and that narrow way that leads to eternal bliss.
Third: presumably out of some vestigial hostility to this vaccine, a lot of conservative groups are coming out against making this vaccine mandatory. (See, for instance, here and here , as well as quotes sprinkled throughout the coverage of this story.) This has the potential to do a lot of harm. The best way to start wiping these strains of HPV out of existence is universal vaccination. As with measles and mumps, if most people are immune, the rest have some protection, since the virus has a hard time finding a susceptible person to infect, and thus is a lot more likely to die out before it can infect a new person than otherwise. (Public health people call this 'herd immunity'.) If conservative Christian organizations have concluded that they should not oppose the use of this vaccine -- and, after a certain amount of waffling, many have -- then they should have no reason at all for opposing its being mandatory, unless they are opposed to mandatory vaccination in principle, even for things like measles.
Fourth: some organizations have objected to the fact that this vaccine seems likely to be recommended for 11 and 12 year old girls. They think that this sends the message that girls that young are expected to be sexually active. This is actually not just false, but the exact opposite of the truth: the reason for vaccinating young girls is precisely that they are unlikely to be sexually active. The vaccine only works on people who are not already infected with HPV; since HPV is very common, the best way to proceed is to vaccinate young girls who are not yet sexually active.
This is like objecting to vaccinating young kids against German measles on the grounds that the main reason for vaccinating against German measles is to prevent the serious complications that result if you get it while you're pregnant, and so by giving the MMR vaccine to one year olds, we're sending the message that one year olds are expected to be pregnant.
Bzzz! Wrong! We want to vaccinate girls against German measles before they get pregnant! (Why do we vaccinate boys? See discussion of herd immunity, above. That's why we ultimately need to vaccinate boys against HPV too. Also, while avoiding the minor illness that German measles causes in kids is not the main reason for vaccinating them, it is always a plus.) Likewise, we want to vaccinate girls against HPV before they become sexually active, with their husband, their rapist, or anyone else!
Vaccinating girls against HPV is not about condoning sexual activity, or sending the message that sex is OK, or anything like that. It's about preventing cervical cancer. Some might think that adherents of the much-vaunted "culture of life" would be behind this all the way. One can only hope that just as they seem to be coming around on using it, they will also come around on the crucial question how it's used.