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The Human Papillomavirus (HPV) VACCINEIntroduction
The Human Papillomavirus (HPV) is one of the most common sexually transmitted infections in the world. The infection is asymptomatic meaning people infected with it do not usually know they have it, making it easy to spread. In most cases, the body’s immune system can clear HPV on its own. However, at times the HPV fails to clear leading to the formation of genital warts and cervical cancer and other cancers of the anus, oropharynx, penis, vulva and vagina. The introduction of the HPV vaccine aims at protecting males and females against the common strains of HPV that cause disease and cancer.
More than 40 strains of HPV affect at least fifty percent of sexually active people in their lifetime. It is with this in mind that the state of Connecticut had a debate to know whether it will be a requirement to vaccinate girls against HPV. This resulted when the national Advisory Committee on Immunization Practices (ACIP) recommended having girls between 11 and 12 years of age to receive routine vaccination. Even though ACIP passed the recommendations, state legislatures are the ones who decide on the requirements for school vaccination. In a January 2007 session, the General Assembly of the State of Connecticut raised a bill that wanted to have guidelines concerning prevention strategies for diseases that are caused by HPV. The bill necessitates the vaccination of children with human papilloma virus vaccine before admission into sixth grade, in consistence with the National Immunization Practices Advisory Committee (Connecticut General Assembly, web).
In some states, the legislature grants regulatory bodies such as the Health Department the power to require vaccines. However, funding has to come from the legislature. The availability of the vaccine has received support, but it is the mandate that schoolchildren should receive it that voices some concern. Issues have been raised about the cost of the drug, its safety, parents’ rights to refuse as well as the vaccine playing a part in sexual activities, in adolescents. As of 2011, the Food and Drug Administration (FDA) approved two HPV vaccines in the market. Merck manufactures Gardasil, which protects against HPV strains 6, 11, 16 and 18, and GlaxoSmithKline manufactures Cervarix, which protects against HPV strains 16 and 18.
An article in the Christian Science Monitor (print) notes the fact that a vaccine against HPV is beneficial in regards to reducing cervical cancer and deaths caused as a result, but the mandate to make it compulsory, for school-aged girls is inappropriate. The main concern is on the safety and the efficacy of the vaccine. It also removes the right of a parent to decide on what is right for their daughters. The long term effects on pre-teens is unknown since during the initial testing of Gardasil only five percent of the patients who took part in the study were below the age of twelve (Christian Science Monitor, print). It has been argued that the HPV vaccine can prevent seventy percent of growths that will lead to cervical cancer.
Another rising controversy is the fact that giving adolescents the vaccine that in essence protects against a disease resulting due to sexual activity may send a message that sex is permissible (Weekly Standard, print). Although this argument has been mocked, the fact remains that there is an urge to engage in sexual activity that begins when we reach puberty. However, if looked into objectively, cervical cancer could be forgotten by the time the current pre-teens reach middle age. Advocates for the vaccine claim it is more effective in people who have not engaged in sexual activity; eleven or twelve years of age and in some states as early, as age nine. Girls and women between the ages of thirteen to twenty six are recommended to have a “catch up” vaccination.
For women who are sexually active, it should be noted that the vaccine is not a cure and, therefore, does not treat existing infections of HPV. However, vaccination can prevent infection of other cancer causing HPV strains not yet contracted. Although the vaccine protects against most cervical cancer strains, it is necessary to taken pap tests. These tests are able to detect pre-cancerous cells not caused by HPV.
In the state of Texas, the governor in February 2007 issued an executive order mandating vaccination of young girls against HPV (Natural News, web). This was seen as a way of the government intruding on an individual’s right to decision making. However, such laws have the view that having a high number of herd immunity will protect all community members, including those not able to receive vaccination due to medical contraindications. Some states have an opt-out option for parents who reject the vaccine on religious or secular philosophical concerns. Others may look for alternative healing and preventive measures against HPV such as adequate sunlight exposure, adequate intake of selenium and zinc, regular exercise and increased consumption of trace minerals and iodine (Natural News, web).
Vaccines previously mandated for use were those that protected the public against easily communicated agents that were responsible for epidemics, or caused mortality or morbidity to those exposed, passively, to the illness (Weekly Standard, print). Since HPV is not casually transmitted, there have been arguments that vaccination should not be made compulsory compared to protection against pertussis, diphtheria, hepatitis B, measles, polio and mumps, which have been mandated in recent years.
Predictions cannot be made regarding the future behaviors of children that will put them at high risk once they are vaccinated against a disease (Washington Post, web). The vaccine for hepatitis, a disease that affects the liver and is transmitted sexually, was surrounded in controversy when a choice was made to have infants vaccinated. It was argued that although children represented a small percentage of people infected with hepatitis B, they were likely to become carriers (Washington Post, web). In the case of measles, immunization rates increased as it became a requirement before admission to school. However, in the case of HPV vaccine it is vital to consider factors such as cost of the drug and public awareness. At $360 for the full three shots, Gardasil is the most expensive vaccine to date.
The immediate rush to market Gardasil in particular was of concern to many in the public. Usually vaccines are licensed and observed to see how safe and efficient it is before making it mandatory. Currently, it is unknown for how long the vaccine will last or if booster shots will be required. It is premature to mandate the vaccine until a time when its long-term safety with widespread use; supply stability and economic issues have been sorted out. There is also no guarantee that the HPV vaccine will not elicit any side effects (Washington Post, web). Merck manufactured vaccines for chickenpox that was licensed in 1995, but it was made a requirement in 1999, its hepatitis B vaccine was licensed in 1986 but later on became mandatory.
Will everyone who needs the vaccine receive it? That is the question. In most cases, parents do not have the knowledge or awareness about HPV. It is only when they are told that it is a requirement before entering the sixth grade will they know about it. Even at that point, the issue of the vaccine cost crops up. When a vaccine is mandated, it must be free to those who cannot afford it (Washington Post, web). However, there is already a struggle with state health officials who cannot provide the existing mandated vaccines such as MMR (measles, mumps and rubella), DTP (diphtheria, tetanus and pertussis) and chickenpox. The money to buy this vaccine for parents who cannot afford it is simply not there.
Drug companies should step in and send the vaccines to those who need it yet they cannot afford it. However, this cannot happen because the companies need the profit generated by the selling of the products (Natural News, web). Health workers usually hit out at pharmaceutical companies claiming that they ignore their real clients who cannot afford the medication. Drug companies may argue that they spend a lot of money in the research and development of vaccines so as improve health care, but in the case of the HPV vaccine which has been pushed for by the drug makers, Merck, it seems like a grand moneymaking scheme that will exploit the bodies of young girls (Natural News, web).
Countries in Latin America and the Caribbean have failed to reduce the mortality rates associated with HPV due to inadequacies in treatment and follow up (Weekly Standard, print). It is areas such as these and developing countries in Africa where it causes cancer deaths especially in women that urgently need the vaccines. There are government programs available that cover the HPV vaccine in the US. The Vaccines for Children (VFC) is a federal program that provides free vaccines to children under the age of nineteen. Sites that offer VFC vaccines include hospitals, private and public clinics.
Works Cited
Allen, Arthur. “The HPV Debate Needs an Injection of Reality,” The Washington Post. Web. 30th November 2011.
Adams, Mike. “HPV Vaccine Texas Tyranny (comic),” Natural News. Web. 30th November 2011.
Connecticut General Assembly, Raised Bill No. 6977. 2007. Web. 30th November 2011.
Fumento, Michael. “A Merck-y Business: The Case Against Mandatory HPV Vaccinations,” Weekly Standard, vol. 12, no. 25, March 12, 2007. Print.
“Keeping Choice on the Gardasil Vaccine,” The Christian Science Monitor, February 13, 2007. Print.
