Should the HPV vaccine be mandatory?
I've covered the approval of Merck's HPV vaccine extensively in the last month or so. It's great news for women everywhere, both here in the United States, and especially in the third world. The question now is "should it be mandatory?" Of course ACIP recommended the vaccine, as I predicted they would, so it's certainly something to consider.
An editorial by someone published in the NYT this past week questions whether the vaccine should be mandatory. Of course, there are some vaccines that are required for anyone entering a public school, for instance. Gardasil could be among these required vaccines (MMR, etc.) for girls aged 9-26. (So that means college students as well.)
I don't see the problem with making the vaccine mandatory. While there are some reasons that this might not be necessary — cancer-causing HPV can only be contracted through sexual contact — there aren't any reasons listed that are compelling safety issues.
So we have a sexually-transmitted disease, and a vaccine to prevent it. Should the vaccine be mandatory?
I present to you two brief arguments for why I believe it should.
First off, someone who has HPV doesn't always know they have it. I have a friend, for instance, who contracted it from a partner who didn't know she was infected it. While he can't get cervical cancer because he's, well, a guy — she can. And she didn't know she had it. From WebMD:
Most people infected with the HPV viruses have no symptoms and may not know they are infected.
Oops. A mandatory HPV vaccine several years ago would mean that she would never have contracted it, and as a result, wouldn't have passed it to my friend.
Secondly, not all sexual contact is voluntary. Rape happens. It's an unfortunate fact of life, but there it is. A woman (or man, for that matter) can contract the human papilloma virus through unwanted sexual contact just as easily as a consenting partner can. STDs don't differentiate between the willing and the unwilling. And there is no cure for HPV once it's contracted.
So why again shouldn't this vaccine be mandatory? If there are no unhealthy downsides, where's the problem? Is it money? I don't think so. How much does it cost to treat cervical cancer? Quite a bit more than it costs for a vaccine. For that matter, the costs of treating repeated outbreaks will add up to be more than the cost of the vaccine which runs around $360 for 3 shots. An ounce of prevention compared to a pound of cure works when comparing the dollars and sense involved with a compulsory vaccine. The cost of a single tube of Aldara cream, for example, is over $100.
In short, I see smoke in mirrors, and not much substance.
DB has got some commentary on the issue as well.
[tags]Medicine, pharmacy, cancer, oncology, gardasil, vaccines, vaccination, hpv[/tags]
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The majority of HPVs are not passed by sexual contact, just the ones that cause cancer. Of the many many HPVs, only about thirty are STDs, and only twelve of those can cause cervical cancer.
As you stated, many people have genital HPV and don't even know it. Almost everyone has a non-genital HPV, such as HPV-5 that rarely manifests clinical symptoms in healthy people. If you're one of the "lucky" ones that is not immune to a genital HPV and show physical symptoms, then the road to irradicating warts is a long one.
I'm in my third year of cryotreatment. While I'm down to one visit per quarter or maybe four months, it was every three weeks for awhile. Mr. Pickle does not like being frozen that frequently, but it was easy. I can't imagine the discomfort associated with treating a woman for the same symptoms. At an average cost of $300 a visit, my treatment has cost over $10,000. Luckily this was picked up by my insurance, but still, $10,000 is $10,000.
The vaccine should be given to everyone. Males don't have the severe medical risk females do, but they are part of the infection chain and treating their symptoms costs a lot more than preventing them.
Comment by DrFaulken — July 24, 2006 @ 11:15 am
Thanks for your comments, DrFaulken. It gives a distinctly human spin to the whole non-controversy.
Comment by RJS — July 24, 2006 @ 12:09 pm
[...] Just when I think I'm done writing about Gardasil for the time being — that nothing more can really be said — I read something new. This time it's an OB/GYN who thinks the best way to protect people is by vaccinating everyone — not just the girls. As someone who thinks the vaccine should be mandatory for the approved age ranges, I concur with the doc's opinion: Dr. Bradley Monk, associate professor in gynecologic oncology at the University of California at Irvine, said the best use of the vaccine would include giving it to girls and boys and all women and men, regardless of their individual risk factors. [...]
Pingback by Gardasil for all? Yes, please. :: OnThePharm — July 31, 2006 @ 4:29 am
[...] Readers of this site know I'm a fan of vaccinations. I've talked about Gardasil, the new HPV vaccine from Merck quite a bit here. I personally think it should be mandatory until there's a compelling reason for it not to be. But maybe we need to place more emphasis on the old standbys while the topic of vaccines is on the table. [...]
Pingback by Diseases eliminated by vaccines making a triumphant return (in certain circles) :: OnThePharm — August 5, 2006 @ 3:37 pm
[...] I post this not because $180 billion is a huge number — it is — but rather because I can envision the HPV vaccine(s) having a similar economic impact should its mandatory use become widespread. [...]
Pingback by Polio vaccine saved $180 billion — what about HPV? :: OnThePharm — January 22, 2007 @ 12:17 am
Vaccinations do cause severe side effects in rare cases. If vaccinations are mandatory there also must be an exception for those who are allergic to any of the ingredients. I for one was one of the 9 out of 100,000 who got arthritic symptoms from Gardasil. I was also the only person to get the vaccine who itched all over with red welps and got severely bruised feeling feet and hands so that I couldn't hold things or walk. So lets be a little more careful when we talk about making things that are injected into your body mandatory!!!
Comment by Marie — February 4, 2007 @ 10:16 pm
Yes of course, Marie. I didn't mean "mandatory" in the sense of "Damn the consequences for anyone who might have an adverse reaction to it."
Comment by RJS — February 5, 2007 @ 9:22 am
I DO NOT believe that the vaccine for preventing HPV should be MANDATORY. But on the flip side, I would vaccinate my daughter (if i had one). I just shouldn't be mandatory. What's will lawmakers try to mandate next. It should be left up to the parents. The only down fall to not making it mandatory is those parents who would not vaccinate.
Comment by Crystal — February 24, 2007 @ 6:28 pm
I agree with your sentiments, Crystal, but the trouble with leaving it up to the general public is that people will almost invariably choose the path of least resistance: that is, the easiest way out. This is the same basic reason why Joe Average doesn't participate in 401k plans until it's too late to have a real impact on retirement savings. Until it's slapping him/her in the face, it's not a priority.
Leaving herd immunity up Joe Average will result in a loss of said herd immunity.
I simply ask why we shouldn't create herd immunity for another, deadly disease. (HPV)
(And no I'm not an undercover, pro-Merck blogger; I just think it's a good idea. :p)
Comment by RJS — February 24, 2007 @ 7:47 pm
The HPV vaccine sounds like it may actually save many lives and save much money in the long term. However, to mandate that girls only be vaccinated or not be allowed to enter school is ludicrous. Any sexually transmitted disease, obviously, takes two partners, and this includes all ages. It appears that once again, the females are research targets. And if they do not consent to this treatment, they will forfeit their right to an education. This is win/win situation for the males; they have a choice.
Comment by Tammy — June 15, 2007 @ 5:34 pm
I do not think Gardasil should be mandatory. First of all, cancer-causing HPV is transmitted sexually. How about the girls who aren't going to be having a sexual relationship? Some of these laws require nine-years-old to be vaccinated! And Gardasil is 100% effective for women who are not exposed to HPV. Meaning?…they aren't sexually active, so of course it is effective. If you are in the 30% that Gardasil does not cover, the $360 you spent means nothing.
Before lawmakers try to pass a law making Gardasil mandatory, they should make sure that the girls they are trying to vaccinate know what an STD is.
Comment by AS — November 27, 2007 @ 11:14 pm
This is a slippery slope.
Giving the government permission to force the application of a patented vaccine is very dangerous.
I am not for or against it. I simply caution against giving away that sort of power. Its much easier to lose freedom than it is to get it back and the last thing I want to see is a world where once a paid off government panel decides something should be mandatory, you see pharmaceutical company swat teams with dogs going through the schools with syringes.
Sound far fetched? Maybe but why take the chance?
Comment by Demosthenes — April 8, 2008 @ 12:45 am
What about a better educational program on the use of condoms and information about STDs, of course this doesnt cover those forced to have sex but the vaccine is not going to cover them from other diseases so is kind of silly to see it as a protection.
Comment by Rikonline — August 16, 2008 @ 5:49 pm