HPV Vaccine: The Real Story

About two years ago, I took a course in epidemiology out of UCBerkeley extension. The instructor was an expert in HPV, and she frequently used the peculiarity of that virus - human papillomavirus - to illustrate the trickiness of combating disease on a population (rather than individual) level. The fundamental quirk of HPV is that it is largely benign - some 75% of women carry the virus (and conceivably an equal number of men, though no thorough studies on male carriage have been done as far as I know). But of those 75%, HPV is a major contributing factor for cervical cancer; indeed, the upswing in cervical cancers in recent decades can be almost entirely attributed to the spread of HPV. All of this is backstory to what's recently hit the front page: the availability of a HPV vaccine and, inevitably, the backlash against the vaccine from the Christian Right. The vaccine is controversial because it's most effective when given to girls (not women) *before* they start having sex. It doesn't do squat once you already have the virus.

And thus the conflict - from a public health POV, it makes absolute and total sense to deploy a HPV vaccine as widely as possible, as early as possible - thus warding off as much HPV (and hence cervical cancer) as possible. But from a "moral" POV, giving a vaccine to prevent a sexually transmitted disease - which is what HPV is, after all - is tantamount to granting permission to girls as young as 9 years old to go ahead and start having sex.

As I say, I've only become familiar with HPV in the past couple years, but it's interesting that it is only recently - like in the last 6 months - when HPV has become a widely recognized public health issue. That's obviously due to the FDA's approval of the Merck vaccine. But what's truly amazing is that the backlash took so long to happen.

What I mean is exemplified by this great story in Sunday's Washington Post: mandatory vaccine programs in Virginia, Texas, and elsewhere are facing a backlash from conservatives. What surprises me is that these vaccine programs got off the ground in the first place. I would've thought it would've gone exactly the other way. Typically the public health scare - the HPV virus - would've been noted, but conservatives would've headed off a vaccine program the way they defeated similarly common-sense programs to distribute condoms in schools. Such condom programs are verboten in most of America, no matter how effective they may be at preventing disease, because the specter of 'encouraging kids to have sex' always seems to trump a public health argument (Puritanism is alive and well...). But in this case, the vaccine programs were actually up and running in the most conservative of states, because the public health people got there first with their pragmatic, rational, and compelling argument - vaccinate, and you can elimate cancer.

My hunch: 'cancer' is a big factor in this. It's a terrifying word, and a terrifying disease that few Americans really understand. Having a 'cure' in the form of a vaccine is incredibly alluring - almost miraculous - and that notion trumps any prudery about teenage sex. Politicians can see a score by supporting a program that so clearly eliminates a cancer.

At least at first.

Now the backlash is up and roaring. It'll be interesting to see how this plays out, with the anti-sex conservatives playing catch-up for once.

Thomas Goetz1 Comment