HPV Argument

Kate -------------

Argument Paper
26 March 2008

HPV Vaccine

The human papillomavirus is the most common sexually transmitted infection in the United States. Over Six million Americans are diagnosed each year for HPV; the virus linked to causing 99% of cervical cancers in women. The HPV vaccine has numerous benefits, but due to the unknown risks it is the subject of a highly controversial debate among politicians. Nevertheless, the human papillomavirus vaccine should be required for all children ages nine to eighteen because its many benefits significantly outweigh the possible risks, and because it offers the best means to stop cervical cancer.

There are numerous advantages to the new vaccine, not only in saving lives, but improving the quality of lives for many men and women. The vaccine targets HPV-16 and HVP-18 which are “the strains implicated 70% of the time in HPV-related cervical cancer” and HPV-6 and HPV-11 which “are almost always implicated in genital warts and recurrent respiratory papillomatosis” (Palhivala 1). Numerous studies have been conducted on both the efficacy and safety of this new vaccine. Lawrence Gostin, JD, and co-author Catherine DeAngelis, MD, write in their paper, “Mandatory HPV Vaccination: Public Health vs. Private Wealth,” that “Clinical trials among 16- to 26-year-olds show that the quadrivalent HPV vaccine is almost 100% effective in preventing infection and disease associated with HPV types included in the vaccine” (1). This is a major advancement in medicine and science. Cervical cancer is extremely difficult to detect because there are few outward signs until it is too late. Since the vaccine does not prevent all types of HPV, which can cause cervical cancer regular pap-smears, are still recommended for early detection of abnormal cell growth.

For the first time, we have found a way to definitively prevent a deadly cancer. The Food and Drug Administration (FDA) released a statement on the vaccine in June of 2006 stating, “The vaccine is approved for use in females 9-26 years of age” (FDA 1). Under the FDA’s priority review process, Gardasil (Merck &Co.) was approved in less than six months. The priority review process is in place to evaluate and decide on drugs quickly and effectively, which have the chance of providing major health benefits.

There are some who believe the vaccine should be administered to everyone regardless of risk factors, gender, and other demographics. Dr. Bradley Monk, doctor of gynecologic oncology at the University of California at Irvine said, “The best use of the vaccine would include giving to girls and boys and all women and men […]” (Guardasil 1). Both men and women can become infected with HPV, while only women can develop cancer as a result of being infected. Men who are infected can transmit the disease to an uninfected woman. By vaccinating both genders, we can significantly reduce the number of HPV cases in the United States. Unfortunately, the FDA only approved the vaccine for the use on women and girls.

As with any new treatment, vaccine, or medicine, the HPV vaccine carries both known risks and unknown risks. The Food and Drug Administration reports that the HPV drug is safe, citing a study of 11,000 individuals and stating that the “Most adverse experiences in study participants […] included mild or moderate local reactions, such as pain or tenderness at the site of injection” (FDA 2). The reported adverse reactions of the HPV are minimal, short-lived and appear to be no more harmful than any other vaccine. This can be attributed to the fact that this vaccine contains no live virus and is regarded as a recombinant vaccine. Unknowns about the vaccine are the same as any new drug in that they stem from the absence of data collected over a long period of time. Thus, the long term affects and efficacy the HPV vaccine are unknown. In “Who Should Receive the New HPV Vaccine?” Patricia Camillo claims “It will probably take twenty years or more before the impact of the HPV vaccine can be measured, since HPV infection can occur at a young age, but cancer may not develop until decades later.” Because the most adverse risk of receiving the HPV vaccine is temporary rash and soreness, the scientific community endorses its widespread use. Opponents of the vaccine, such as Angela Griffiths believe that “[Kids] should not be guinea pigs of the state” (Yi 1). Until the long-term affects indicate otherwise, the government should mandate the vaccine be given to all children in the approved age ranges. In this case, the potential benefits outweigh the risks.

The political aspects of mandating a vaccine for school-aged children are also controversial. There are three main objections: it might encourage sexual promiscuity; it is government intrusion into the private lives of citizens and parental discretion; and it is costly and the mandate does not determine who will pay for the vaccine.

Social conservatives oppose the vaccine mandate, fearing it will cause “people to feel like sexual behaviors are safer if they are vaccinated and may lead to more sexual behavior” (Stein 2). These parents promote sexual abstinence before marriage and they fear that the HPV vaccine undermines that value by promoting sexual promiscuity. The same parents, however, do not have an issue with the mandated tetanus vaccine because it has the potential to save lives and prevent a painful and deadly illness. The required tetanus vaccine for all school-aged children has not resulted in an increase in children intentionally cutting themselves on rusty objects with the mentality that the vaccine they received will prevent Tetanus disease. Moreover, children today are maturing faster and becoming sexually active at a younger age than forty years ago. Many teenagers do not classify oral sex as really having sex and do not believe that sexual activity should be withheld until marriage. Regardless of what parent’s desire, given the reality of teenage behavior, it would be irresponsible to not require the human papillomavirus vaccine for all school-aged children.

Those who seek to minimize the role of government, such as Libertarians, are also opposed as a matter of principle to government mandates regarding the private lives of citizens. In addition, some religious sects, such as Christian Scientists, oppose all vaccines on religious grounds. And, an increasing number of parents are not vaccinating their children out of misplaced concerns that vaccines may cause autism. All three of these opposition groups are best countered with the argument that the benefits to public health outweigh the individual’s freedom to choose whether or not to be vaccinated. Moreover, as with other mandated vaccines, government exemptions can be granted for religious or personal reasons. If only a minority of people use an exemption, then the overall threat to public health could be minimized.

The high cost of vaccinating all school-aged children raises the question of who will pay for it: insurance companies? The individual? Or the government which is mandating it? The cost is about $350 dollars per vaccine and it is a three series vaccine meaning that per child it will cost over a thousand dollars to vaccinate. Because it would be a government mandate, many will argue that the government should pay the cost and use its position to negotiate a lower cost from the pharmaceutical companies. But that would result in an increase in government spending, which itself is controversial in a time of high budget deficits. Currently, most private insurance companies do not cover the HPV vaccine and they could resist being forced to offer coverage. They may have sufficient political influence to oppose the mandate. Even if private insurance companies and Medicaid do cover the vaccine, the large segment of the population that is uninsured will need to be covered, and there currently is no mechanism to ensure their inoculation.

Addressing the question of paying for the HPV vaccine is probably the most serious political factor in the debate, but it too, can be addressed in the context of what the cost to society will be if the vaccine is not utilized. The cost of treating cervical cancer far outweighs the costs of each HPV vaccine. In addition, the cost of all vaccines diminish over time, and perhaps the cost could be reduced faster be encouraging competition among the pharmaceutical companies---if it nationally mandated, then, there would be inevitable savings over time.

In conclusion, the human papillomavirus vaccine should be required for all children ages nine to eighteen. The vaccine can significantly reduced the occurrence of HPV within the American population, which in turn can significantly reduce the occurrence of ovarian cancer, one of the most deadly forms of cancer afflicting American women. These benefits far outweigh the minimal risk of a temporary rash and soreness. In addition, the probably political opposition to mandating the HPV vaccine can either be addressed or minimized so that the overall benefits to public health are ensured.


Works Cited

Camillo, Patricia. “Who Should Receive the New HPV Vaccine?” Medscape Nurses. 09 August 2006. 12 Feb 2008 .

“FDA License New Vaccine for Prevention of Cervical Cancer and Other Diseases in Females Caused by Human Papillomavirus.” U.S. Food and Drug Administration. 08 June 2006. U.S.
Food and Drug Administration. 12 Feb 2008

"Gardasil for all? Yes, please." On The Pharm 31 July 2006 1-2. 13 Feb 2008 .

Gostin, Lawrence ‘and’ DeAngelis, Catherine. “Mandatory HPV Vaccination.” The Journal of the American Medical Association 297.172 May 2007 1921-1923. 12 Feb 2008

Palkhivala, Alison. “Available Data Support Safety, Efficacy, and Cost-Efficacy of HPV Vaccine.” Medscape. 17 May 2007. 12 Feb 2008

Stein, Rob. "Cervical Cancer Vaccine Gets Injected with a Social Issue." Washinton Post 31 October 2005 1-3. 13 Feb 2008 .

Yi, Matthew. "Cervical Cancer Vaccine Bill Stalls." San Fransisco Chronicle 14 March 2007 1-3. 13 Feb 2008 .