Brownfemipower has a really interesting post about the governer of Texas’s decision to make the HPV vaccine compulsory for all girls sixth grade or above. This would also make the vaccine available for free for those who were uninsured or whose insurance doesn’t cover the vaccine:
I’m really conflicted about the news that the governor of texas just wrote into law the requirement that all girls get vaccinated for HPV virus (the same one that causes cancer).
Unlike a lot of Texans who oppose the shot, I don’t for a minute think that this shot is going to cause girls to run out and screw anything that moves. But as a parent who has had to make the decision to vaccinate my child (or refuse to, depending) for anything from ear infections to polio–I’m really wondering if this governor is writing this requirement into law because he’s some big lover of women (as a lot of the leftist blogosphere seems to be thinking), or if he’s just gotten himself some pretty pocket money from the drug companies who make this vaccination (according to the article, at least 6000$ in campaign donations).
In New Zealand there is an immunisation schedule, and immunisations on the schedule are free (see we still have some tatters of a socialised medicine system left). However, there is no requirement for parents to get their child immunised, either before starting school, or at any other time. I am a strong supporter of the HPV vaccine going on the immunisation schedule, because I believe all women have the right to protect themselves from cancer. But here, we don’t have to make any trade-offs.
As I understand it the only way a vaccine can be available to all, and publicly funded in America is if it is compulsory before a child can attend school (there are exemptions available to parents for conscience reasons). I can understand the public health argument which says that a kid must be immunised from certain infectious diseases before they start school (I don’t necessarily agree with it, but I understand it), disease can travel very quickly among unorganised children at school and this can cause an epidemic. But this logic does not apply to the HPV vaccine, HPV is a lot harder to contract than measles, so it isn’t going to spread round a school in the same way (it is clear that the vaccine is as important for later in life as it is for 6th grade, unlike other vaccines) and any genuine worry about the disease spreading would require both boys and girls to be immunised. There appears to be two reasons to support compulsory vaccination, either because your in the pay of the drug company, or you believe that it’s important that poor women get access to the vaccine (or both). Neither of these are based on genuine health concerns, which would be solved by making the vaccine compulsory.
This puts feminists in an impossible position. I’ll leave it for American feminists to discuss how they deal with this problem; I’ll just be glad that I don’t have to choose between access and choice.
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Maia, I don’t know how you do things in NZ, but in the United States one of the reason children are immunized against ‘adult’ diseases is so that they will be immunized at all. When it’s presented as simply another childhood vaccination, you get more people immunized. It’s the same reason we vaccinate children against Hepatitis B. If you figure they’ll do it when they’re sexually-active adults, well, they won’t; it’s not as though teens are going to say “Mom, Dad, time for me to get my Gardasil!” And, sadly, it’s not as though 11-to-13-year-old girls are free from worrying about sexual assault.
Unless Texas is very unusual, it allows parents to opt out of immunizations if they object.
I also doubt that Perry took a big wad of cash from Merck to do this. Merck may well have him on the payroll, but that would be for “tort reform” and anti-consumer work, not for Gardasil.
This kind of confused me, Maia:
Maybe I’m missing something, but how is believing that it’s important for poor women to have the same access to vaccines as wealthier people not a genuine health concern?
I don’t see what’s the problem here. Why are feminists in a bind? Forcing girls (who attend public school, which is the vast majority of them) to be vaccinated as children ensures that women won’t have the opportunity to “choose” to risk cancer in the future. This seems like a uniformly positive outcome to me. Did I miss a memo on how the ability to choose to risk getting a horrible disease is an important feminist principle?
As I understand it the only way a vaccine can be available to all, and publicly funded in America is if it is compulsory before a child can attend school…
Not sure why you’d think that. You can get vaccines on the private market (so it’s available to all) and there’s public funding for vaccines for everyone who gets public funding for their healthcare (all poor kids).
robert;
vaccines available on the private market are only available to all in a technical sense, since some people can’t afford them
Speaking about vaccinations in genral, not just the HPV issue, I tend to believe that if there’s a conflict between vaccination and choice (which I do not really believe), then vaccinations need to win, for both men and women.
By choosing not to receive a vaccination, I’m not only making a choice for myself, I’m potentially making a choice to be an infection vector for the people around me, not knowing who’s vulnerable and who’s not. Universal vaccinations are really the only way to wipe out certain diseases, and I think this is a situation where the good to society as a whole is more important than any one person’s choice.
It’s kind of an extreme situation, though.
—Myca
Yes, curiousgyrl. Similarly, food is technically available only to SOME Americans. However, the fact of food stamps and soup kitchens – parallel to the fact of Medicaid and child health programs – mean that in actual fact, it is very unusual for anyone to go without.
health care does not meet the same standard of availability in the US currently, while there is medicare/caid for the very poor, lots of people (like me) are uninsured or underinsured and cannot afford much in the way of healthcare.
I think that his issue shows the hypocrisy of many in the feminist blogosphere: they have absolutely no problem forcing parents to give their 6th grade-meaning 11 and 12 year girls-a vaccine to go to school but let someone tell them what they should or shouldn’t do with their bodies and they can’t complain loud enough. It doesn’t matter why a parent doesn’t want to get their child vaccinated against HPV because it is the right and responsibility of the parent to make choices for their child, not the state.
As Maia pointed out already, HPV is not something you get by people breathing on you so why should a vaccine be required for school attendance ?
Robert, the fact of Medicaid does not mean that it is “very unusual for anyone to go without” health care in this country. It might have meant that back before our treasury was sacked (remember when there was a surplus? unimaginable now), but the requirements have tightened. From the CMS website:
“Apply if you have very high medical bills, which you cannot pay (and you are pregnant, under age 18 or over age 65, blind, or disabled).” [my emphasis]
You may be eligible if you are leaving welfare. Your children might be eligible if they exist. You might be eligible if you’re over 65, but then, you’re eligible for Medicare anyway, so why don’t you go get that?
I’ve been too sick to work since July of last year, I’ve had two surgeries and countless procedures and prescriptions and examinations that I have no way to pay for…you’d think I’d be the model of what Medicaid is supposed to be there for, but, uhm, there’s a war on didn’tcha know?
ok, /rant
The most important point everyone has missed on this issue is what are the long term side effects to young girls of reproductive age??
What if in 10 or 20 years they find out it makes our girls infertile or causes them to miscarriage like the drug DES (diethylstilbestrol) that was given to women a generation or so ago. All I ask is that as parents you research what studies have been done in the long term and what are the long term side effects.
Yes it’s wonderful that the report states that it’s 90 something % effective against HVP but what potential damage can it wreck on our young girls later?? Is this really worth rushing into and making it mandatory for everyone across the board to be injected??
Why not just let every parent choice for themselves if they want their child to have the vaccine. Why should parent’s who are not yet convinced of the safety issues have to jump through whoops to op out?
We need to step back and ask ourselves if we had serious doubts about the long term safety of this vaccine to our daughter would we want to be on the other side trying to fight the government and the medical establishment because others rushed in to quickly to make it mandatory without having all the facts. It should be the responsibility of the parents who want the vaccine to ask for it and not the parent’s who don’t to op- out.
God every drug out there has side effects just watch the TV commercials the drug companies puts out and listen to the long list, many of them are deadly.
Are you really willing to gamble your daughters reproductive future on limited clinical history/data of the biological effects it may have down the road? I’m not, not till I know more.
When are we as parents going stop letting the pharmaceutical company’s and politician’s scare us into making health decisions for us and our kids without our input?
“I think that his issue shows the hypocrisy of many in the feminist blogosphere: they have absolutely no problem forcing parents to give their 6th grade-meaning 11 and 12 year girls-a vaccine to go to school but let someone tell them what they should or shouldn’t do with their bodies and they can’t complain loud enough. It doesn’t matter why a parent doesn’t want to get their child vaccinated against HPV because it is the right and responsibility of the parent to make choices for their child, not the state.”
Because people want parents to have choice in this matter for the same reason they don’t want women to have choice elsewhere: sluts who have sex must be punished. Unwanted pregnancy, cancer, it’s all good.
Even if we had as narrow a perspective as you, there’d still be no contradiction. The ‘right and responsibility of the parent’ has no equivalent in the abortion analogy, excepting perhaps the issue of parental notification. One could easily argue that bodily autonomy entails that parents do NOT have this ‘right’, as in the case of religious nuts withholding medical treatment for their child in favour of silly prayer.
The idea that the HPV vaccine should not mandatory is ludicrous. This isn’t the flu shot – this vaccine is the first of its kind, the first cancer vaccine. A new vaccine of this magnitude has never been made optional. Also, most places allow for religious exemptions for vaccinations anyway – the only reason to oppose a general vaccination program for everyone, is to prevent other people’s daughters from getting it. If you make it as difficult as possible, some people are bound to slip through the cracks, and some of them must have skanks for daughters who’ll engage in the premarital. Keep your fingers crossed.
Here’s my complaint: Why isn’t the vaccine being given to boys, as well? It would be more effective to vaccinate everyone, so that boys can’t be carriers of HPV.
Oh no I understand that, and the same happens in New Zealand, in fact most of the programmes are run through the schools. It’s just that the vaccination can only happen if it is specifically authorised by the parents, it’s an opt in not an opt out sysem (we still have pretty high levels of immunisation). It’s not the immunising kids for adult diseases I object to, it’s making it compulsory before those kids go to school.
I worded that badly – what I meant is that neither of these are health concerns that are solved by making the vaccine compulsory, it’s making it free, not making it compulsory that solves that health concern. A sixth grade girl who isn’t vaccinated is not a risk to herself, or to others, there is no reason why she shouldn’t attend school.
Incidentally I think it is young women, not their parents who should be making decisions about vaccines at that age.
Cost, probably. If every girl is getting it, doubling the cost by adding every boy would have only a tiny impact on the overall effectiveness.
Incidentally I think it is young women, not their parents who should be making decisions about vaccines at that age.
In sixth grade?
Agreed completely. I believe that these vaccines should be compulsory and universal, for both boys and girls.
I don’t think that it’s a valid ‘choice’ to be a serious public health risk.
I feel also that I should clarify that I’m not anti-immunisation, and I can’t think of a single good reason why people wouldn’t get immunised against HPV. But the same is true of pap smears, and they’re not compulsory. Just because I think a particular form of health care is a good idea, doesn’t explain why it should be compulsory before a child can attend school.
I agree with Amp as well – not vaccinating men puts unvaccinated women (who presumably are going to be the daughters of conservative christians) at much greater risk.
Robert: Sixth grade is eleven or twelve right? I think kids of that age are capable of making decisions for their own lives, and don’t think parents should be able to refuse health care for children who are old enough to be making their own decisions.
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They’re certainly old enough to articulate their own preferences, and parents should listen to those preferences. But the general cultural consensus, in the US at least (I think – anybody?) is that age group are still children, and parents still have final say.
Do you believe that kids that age should be able to refuse medical care against their parents wishes?
I ask because when I was 11, getting a shot scared the crap out of me, and I would have refused a tetanus shot, whether it was needed or not.
—Myca
Me:
Cost, probably. If every girl is getting it, doubling the cost by adding every boy would have only a tiny impact on the overall effectiveness.
On the other hand, it occurs to me that if you’re likely to get spotty compliance (say 80%), then there would be real value to doing the other gender as well. You’d go from stopping 80% to 96% by adding another screen in the other gender. Certainly worth doing, it’s night and day in terms of outcomes.
On the principle of harm reduction, you’d want to take one gender off the vaccine once you had near-universal compliance, to reduce the side effects. But that’s something for the grandkids to worry about. (Good luck, kids! Sorry about the whole melting planet thing.)
There was just a paper that came out last month that did a big statistical analysis on different vaccination strategies with Gardasil, and it came out that vaccinating only girls ended up being the best deal, as in disease prevented per dollar. I wrote about it here.
(I’m sorry if the comment monster didn’t eat the previous one of this and I’m double posting:)
In a way it almost makes *more* sense to vaccinate all the boys, since there’s no way (yet) to test males for HPV. Guys can’t know if they’re carriers*, so it seems important to make sure they can’t be.
*Plus, while men can’t get cervical cancer, they can get warts from HPV, which seems worth preventing.
Some googling suggests that it’s not yet approved for men. I assume they put all their initial efforts into getting it approved for women because the cost/benefit ratio is so much greater. It does prevent genital warts, though, so I it’ll probably happen at some point.
The other things to keep in mind about boy/girl vaccination is that Texas doesn’t exist in a vacuum. It’s surrounded by states that don’t have mandatory HPV vaccinations, so from that standpoint, I would think it’s more crucial to vaccinate absolutely everyone.
Also, if the goal is to wipe out the virus in the Americas, as we did with polio, the benefits of universal vaccination seem to outweigh the drawbacks.
For the life of me I can’t figure out why this vaccination is any more of a “choice” issue than vaccinations for polio, measles, diptheria, whooping cough, the whole crowd. Do we ask the children if it’s OK with them? No, because they’d say, “Yikes no needles,” and there are good public health reasons for universal vaccination that outweigh, in our adult judgment, the natural fear of being stuck with a needle.
Parents have a choice on this one ONLY if they object to all vaccinations for religious reasons. We’re all hoping there aren’t too many of these folks, and that their kids will be protected by herd immunity.
So, why should feminists of all people be upset about this? If it’s the right of feminists to demand that children reject vaccination for HPV, then it follows that they have an equally good argument about polio. It’s YOUR body, right? Don’t you have the right to “choose” whether you’ll have your immune system thus altered? So polio vaccination is now suddenly a feminist issue?
Someone lost me at the curve.
Maia;
what percentage of NZ’ers DO get vaccinated? How does that compare to the US? Does anyone know?
There’s a goldmine of information at this site.
For DPT, the rate for 1-year olds is 90% in NZ, 96% in USA.
For measles, it’s 85% in NZ, 93% in USA.
For polio, it’s 82% in NZ, 92% in USA.
Perhaps they do it later in NZ.
Susan: The usual argument for vaccinating for things like diptheria, polio, etc., is that they’re very contagious. Mandatory vaccinations for school attendance are primarily to keep diseases that would spread easily through a student population from doing so; it’s a public health issue, as well as an academic one (sick kids means low attendance, disrupted classes, etc.). HPV, though, isn’t something a sniffly kid is going to pass along to her classmates, so it can seem disingenuous to make it a prerequisite for attending school.
An example of this kind of thinking is the meningitis vaccine, which isn’t required in many places until university, when students are in dorms. Students wouldn’t normally be at risk for meningitis in primary/secondary school, so even though meningitis is a potentially deadly disease, it’s not required to have the vaccine. In college, though, there’s a chance that an infected kid will spark an outbreak, so everyone’s got to have it.
Granted, I don’t think making the HPV vaccine mandatory is a bad idea at all, mostly because HPV could arguably be considered highly contagious once someone’s sexually active, but I see the logic behind Maia’s argument.
Well, sure, you’re not going to spread HPV by sneezing on someone, but in light of the studies that show that kids who make abstinence pledges are actually more likely to be sexually active, I think we have to face facts that, absent vaccination, HPV will be spread among students.
Kids aren’t going to stop having sex. We need to stop imagining that they will.
As long as the future slut in question is my now prepubescent daughter, the decisions for what is and isn’t best for her need to be left up to the parents.
So because it’s the first of it’s kind every parent must make sure their kid gets it before the novelty wears off or something?
A vaccine for HPV is not the same thing as a vaccine for mumps or rubella which can be contacted by touch. Furtheremore, “because this is what we have always done” is not a logical reason to continue to do something. Things change.
Thanks to everyone who answered my question. Lack of FCC approval is certainly a good reason!
Sara, thanks as well for your link. It does seem possible that the money spent on vaccine for boys might save more lives overall if spent elsewhere.
As I said it’s not about the vaccine for me, it’s the issue of compulsory health care.
I just don’t understand how people could argue that vaccines are the sole sort of healthcare that should be compulsory. If we think the state is the best way to decide what health care is available then surely other forms of healthcare should be compulsory besides vaccinations.
Robert the vaccinations you mentioned are all on the New Zealand schedule for the under 1 years. Although the difference is unlikely to be the fact that the vaccines are compulsory to attend school, since 1 year olds aren’t in school.
Just out of curiosity is Rubella/German Measles compulsory for girls in America?
I think the problem is that if you ‘opt out’ of getting your teeth cleaned, getting your broken arm treated, or taking your insulin, you don’t actually infect the people around you with plaque, broken bones, and diabetes.
It makes sense for there to be public policy making vaccinations compulsory, because it’s a public health issue. Check out the statistics Bean posted in comment #34, especially the last one:
If there is other medical care preventing the contraction and limiting the spread of a potentially fatal disease, and that medical care is as non-invasive as a vaccination, I think it ought to be compulsory too.
Sensible, bean.
Also sensible, Myca.
In Anglo-American culture, health care is always voluntary with a few exceptions. There was a big fat fuss over quarantines back in the day, but they were upheld in the interest of limiting the spread of disease. Vaccination went through the same process. The default, for English-speaking peoples, has always been, and remains, you do NOT touch me without my consent. For medical care or for any other reason.
But we decided long ago that with a few exceptions for religious reasons (and then it has to be ALL vaccinations, not pick and choose) we will mandate vaccination against contagious diseases, in the interest of protecting other people. HPV is contagious. No quibbles on that point.
So unless you think vaccination in general is some kind of Big Wrong Violation of Someone’s Rights – and if you do think that, you’re majorly out of step, sorry – I can’t see why this vaccination should be treated differently from any other.
And how this or any other vaccination became or might become a feminist issue is quite beyond me, I just don’t get it.
I hate that I’m technically defending the fundies here, but that’s not actually true, as much as I know it’s been repeated. Do a quick Google search on it. Recent studies have shown that while abstinence pledges do correlate with a delay in sexual activity, the kids who take them are more likely to contract an STD. And, in fact, I think that’s a more valuable lesson: sure, they’re a little helpful on the one end, but they’re a whole lot of harm on the other. It makes sense that having formally stated that you wouldn’t do something might go along with holding out for a few more years (especially with teenage peer pressure being what it is), but of course these are also the kids who have *no* knowledge about contraception and STD prevention.
To bring it back around to the point, it’s the kids of the parents who wouldn’t want their child to get this vaccine who are the most in danger, so I’m all for making it a huge pain in the ass to opt out. I don’t get the sense that anyone’s really comfortable with the idea of an absolutely 100% no exceptions compulsory vaccination (or anything else, for that matter).
Bean – I’m questioning the validity of making vaccines a condition for receiving services (which doesn’t happen here). There’s no more logic to that than making screening a condition for receiving services.
To the extent that unvaccinated people are a public health issue why aren’t they actually compulsory? Why are they just required for attending public school? Why aren’t they a requirement for adults?
Because with some exceptions attending school is compulsory (the vaccination requirement applies to private schools too) and it’s easier than trying to chase everybody down wheresoever. We know the kid will show up at school at 6 or so, we have them all together, and we can check records for something less than a zillion dollars.
This isn’t New Zealand. We have 300 million people here, of every description, all over the place. This is an easy way to check up on them.
The sort answer is, vaccination is compulsory, when you work it out, UNLESS you can show a religious objection.
Vaccination isn’t a requirement for adults because as a practical matter we can’t round them all up.
Maia, you still haven’t explained why vaccination is a feminist issue. Unless it’s because you think it’s a human issue and women are human? I’m totally confused by your argument, which I cannot figure out what it is.
A vaccine for HPV is not the same thing as a vaccine for mumps or rubella which can be contacted by touch.
I am still waiting for y’all to explain to me why you are A-OK with compulsory vaccination for Hepatitis B, which is not contacted by touch and is not generally something passed around by schoolchildren.
Yet again, here are the reasons for mandatory (but opt-outable) vaccination:
–Herd immunity.
–Making sure that health insurance covers the vaccine and that it is available to poor kids.
–Getting everyone vaccinated long before they need it, rather than hoping that they will take care of it on their own.
Ah, my bad Trillian. Thank you for the correction.
—Myca
I’m not sure why nobody has mentioned this in the discussion of Perry’s motives but Texas is working on securing an investment of $3 billion dollars over 1o years to eradicate cancer. I think this could be one step in that direction. It builds political will and excitement over this initiative…and yes, it does have the side effect of will drawing more research and pharm. companies to the state.
To the extent that unvaccinated people are a public health issue why aren’t they actually compulsory?
Because we’re free people.
Why are they just required for attending public school?
Technically, they are not required. You can opt-out. You also have to accept the consequence of that opt-out, which is usually that if there is an epidemic or public health emergency, you won’t be allowed in the school.
The objections to this vaccine — whether by feminists or religious moralists — are nonissues and smoke screens: in terms of safety with speculations it might be dangerous or believing that it will make girls promiscuious. The primary reason for this is that it eliminates a cause for 90% of cervical cancers. The virus that causes it is everywhere and not many informed mothers would not want their daughters to have the opportunity to avoid a cancer that they’ve had a lifetime of pap tests in fear of getting. The main reason boys are not being vaccinated is primarily a public health reality: the vaccination is horribly expensive and girls are the ones who get cervical cancer so it makes since to prioritize them for protection. In fact, the costs of this is a major reason it is not more available to date:
http://www.cnn.com/2007/HEALTH/conditions/02/02/cancer.vaccine.ap/index.html
I believe the vaccine only works to prevent the formation of cervical cancer cells, NOT that it prevents the transmission of the virus that causes cancer. It is useless for boys for this reason.
Also, it is more effective if the vaccine is given before a female is exposed to the virus, that’s why it’s now being recommended for young girls, with perhaps a booster shot later. Articles did mention that it is also somewhat effective in women who are already sexual active.
http://www.mayoclinic.com/health/cervical-cancer-vaccine/WO00120
Half of the OP’s rant would have been eliminated if she had read one freaking medical article on the subject.
Mais, you are no journalist, and you did a dis-service to your readers today. Congratulations.
I suspect the primary reason the Texas gov is making the vaccine available free to those who can’t afford it is to shut up the feminists (I am one) who complained about the religious bias preventing it’s approval by the FDA.
Some people are never happy no matter what.
Making vaccinations compulsory makes sense because of the significant public interest in vaccinating a critical mass of individuals so that the disease vaccinated against is effectively stopped from spreading at all anymore. Why is that not a compelling enough reason for you?
Mass vaccinations allow diseases to be eradicated altogether, and mass vaccination is incredibly difficult to achieve if it’s not required.
Johanna, the first story you link to explains clearly that Gardasil works by blocking infection from the HPV virus. No infection = virus in your system = you can’t pass it along. Immunizing boys would work just fine. (But it does make sense to immunize girls first, since they’re the ones who actually get sick.)
Johanna,
The link you provide is not particularly clear on the points you mention.
However, if you check wikipedia, you will find that you are wrong about how the vaccine works (it prevents infection, it is not a therapy), wrong about whether it is effectively used on men (it can be, although it doesn’t yet have FDA approval for use on men), and confused about why the vaccine is useful even if you are already sexually active (and therefore likely infected with HPV): the vaccine protects against 4 strains of HPV, so sexually active people may still not have been infected with all 4 strains.
Actually, I don’t see why it makes sense to immunize girls first (its not like there is a requirement to immunize one sex before the other sex), but I can see why Merck initially tested it on women (since they wanted to see if it prevented the formation of precancerous lesions, and that doesn’t happen to men), and so why its use on men is delayed by lack of FDA approval.
Actually, I don’t see why it makes sense to immunize girls first
Partial penetration coupled with visible vs. invisible
harmsbenefits.If you immunize 1000 girls and stop, you won’t solve HPV in the population, but you will have a pool of 1000 girls you can point to and say “these girls will never get cervical cancer from HPV.”
If you immunize 1000 boys, you’ve likely had the same statistical impact on the disease’s spread, but you can’t point to a pool of people who won’t get cervical cancer. They still exist – they’re the ones who would have been infected by those boys, except for the boys’ vaccinated status – but you can’t find ’em.
It’s the same political reason we tax companies instead of consumers, when we can. Same revenue, same economic impact – but companies don’t vote, and consumers don’t understand that they’re paying the tax, so they’re not mad.
Blast. Benefits, not harms.
[Fixed! –Amp]
“sylphhead Writes:
February 4th, 2007 at 1:56 pm
“I think that his issue shows the hypocrisy of many in the feminist blogosphere: they have absolutely no problem forcing parents to give their 6th grade-meaning 11 and 12 year girls-a vaccine to go to school but let someone tell them what they should or shouldn’t do with their bodies and they can’t complain loud enough. It doesn’t matter why a parent doesn’t want to get their child vaccinated against HPV because it is the right and responsibility of the parent to make choices for their child, not the state.
Because people want parents to have choice in this matter for the same reason they don’t want women to have choice elsewhere: sluts who have sex must be punished. Unwanted pregnancy, cancer, it’s all good.”
As long as the future slut in question is my now prepubescent daughter, the decisions for what is and isn’t best for her need to be left up to the parents.”
For all of you out there who can’t follow an argument – being able to quote Proverbs or ever having used the word ‘feminazi’, or both, is a dead giveaway – this is called dodging the argument. My argument there had no bearing on whether parents should or should not be given the choice in this matter. In fact, I started addressing that in the sentence immediately after where you cut it off. Where you quoted me, I’m afraid, was me proving that there is no inconsistency between a crazed sexual puritan force pregnancies, while also forcing vaccines i.e. giving the green light to fellow crazed sexual puritans out there to force cancer.
It IS up to the parents. By far the majority of states allow for religious exemptions for vaccinations (I don’t agree that even these should exist, but the fact is that they do exist). So if the parents wanted to, they could pull their kids out of the program. The only reason to not make this vaccination mandatory as a loose, general rule, is to prevent other people’s children from getting it. Poor people are a start.
” The idea that the HPV vaccine should not mandatory is ludicrous. This isn’t the flu shot – this vaccine is the first of its kind, the first cancer vaccine.
So because it’s the first of it’s kind every parent must make sure their kid gets it before the novelty wears off or something? ”
Huh? If you relate this sentence to the next one, which you must have read because you’ve quoted it also, you’ll have seen what my point was. Who needs computer programming, when we’ve got a machine of a reductionist here, being able to read each sentence not as part of a progression but in a vacuum. (Or break a two-part response into its constituent parts, and then quote the wrong half as it pertains to an argument.) I think even computers have moved beyond this sort of reductionism, though. About the time they left behind being sliding wood beads on a stick.
No, the significance of the fact that it’s the first of its kind, by which I mean the first cancer vaccine, isn’t that it’s a novelty. It’s that it’s essentially the first cancer vaccine in history. When was the last time a vaccine for a major disease like this – and cancer is in many ways the major disease of major diseases – was not made mandatory, and instead
“A vaccine for HPV is not the same thing as a vaccine for mumps or rubella which can be contacted by touch.”
Thanks mythago, for backing me up with the hepatitis example. As for whoever brought up the meningitis example, it is absolutely not true that meningitis does not affect children. It doesn’t affect them NOW, thanks to vaccinations and the like – which were mandatory. I think (s)he was referring to meningococcus B, a specific type of bacteria that can cause meningitis, for which vaccines are now being conducted on college students.
Should read: “there is no inconsistency between OPPOSING crazed sexual puritan from forcing pregnancies, while SUPPORTING forced vaccines i.e. not giving the green light to the same crazed sexual puritans out there to force cancer.”
Sentence is a mess.
The herd immunity doesn’t apply in this case, there will be no herd immunity to HPV, because even at best only half the population will be immune.
As for the others this is where New Zealand does it differently. You can still run an immunisation programmes through schools and not make it compulsory to attend school (takes care of your last point). You can provide immunisations free for all without making it compulsory to attend school.
The fact that it doesn’t work that way in the US doesn’t make it impossible.
I think making receiving services conditional on certain health care decisions is a really shitty way of getting people to undertake those health care decisions, no matter what I think of the health care decision. I think it’s true for HPV, Polio, HepB and all other vaccinations (none of which are compulsory in this country).
The herd immunity doesn’t apply in this case
You keep drifting between talking about required vaccination, period, and required HPV vaccination. Herd immunity applies in the case of all the other diseases against which American schoolchildren are required to be vaccinated, unless their parents state a religious or ethical objection to the process. As for HPV, I’d think that having half your potential carriers immune would limit the spread of a disease somewhat.
I think making receiving services conditional on certain health care decisions is a really shitty way of getting people to undertake those health care decisions
I think that just encouraging people to do the healthy thing on their own, especially when you’re talking about 400 million people, is a really shitty way of protecting public health. I don’t know about NZ, but in the US we have periodic outbreaks of things like measles and chicken pox in communities where people didn’t vaccinate their kids. Sometimes it’s people who are deeply distrustful of all medicine; sometimes it’s idiots who think they can free-ride off everyone else’s shots and are deeply shocked to find out that measles and whooping cough are, like, SERIOUS.
On the lower immunization rates in NZ for 1 year olds, the reason for the higher rates of immunization in the US is probably related to the mandatory immunization for school attendance rule.
If you take your infant to the doctor and the doctor says, “Your child should get immunized, this is the standard age to do these immunizations,” and you say, “Well, I’ll think about it,” the chance that your child gets the shots goes up if the doctor can then say, “Well, your child is going to have to get these shots before she goes to school, so why not do them now?”
Robert,
The visible versus invisible benefits makes sense. And actually, with incomplete vaccination coverage, each vaccination is much more effective if the vaccinations are given to girls, since if 50% of boys get vaccinated, if the average woman has 3 sexual partners over her life, then the chance that one of them is not vaccinated is 87.5%. If 50% of girls are vaccinated, then that means that 50% of women are protected no matter who they sleep with. Also, of course, vaccination of girls protects lesbians as well as straights, while vaccination of boys only protects straights.
However, it would still be better if whatever areas are doing mandatory vaccination mandated it for boys too.
Mythago – you gave three reasons why compulsory immunisations were good, two aren’t necessarily true, and one doesn’t apply in this case. I don’t agree with making vaccinations compulsory to attend school, but think that most of the arguments in favour of compulsory vaccinations don’t apply in this case, because there is no her immunity, and schools are not going to be the epicentres for the disease.
People keep bringing up the fact that America has 400 million people is ridiculous when it is clear that immunisation programmes are run at the state level.
I really don’t understand why immunisation, as a public health issue, is seen as so different from so many other public health issues, such a screening. Or why people trust parents to raise children, make many complex decisions for them, but not to make decisions about vaccinations (or given that I think that children should be able to be the final decision maker in medical decisions from about age ten – why children should be able to decide whether or not to take medicine but not about vaccinations).
Immunization is seen as different from screening because immunizations are used to prevent contagious diseases. If you don’t bother to get screened for cancer, you may end up dying unnecessarily, but you won’t end up killing anyone else.
I agree that the 300 million people thing is a complete red herring.
On the other hand, I really don’t understand why you find an opt out system to be radically more oppressive than an opt in system.
Also, the reference to poor people in the post title also seems like a complete red herring. Most children in the US go to public schools, not just poor children. Also, the vaccination requirements generally apply to private schools as well.
I believe in an opt-in system becaues all other health-care is opt in. Because I don’t believe in restricting access to services on the basis compliance to government orders.
The title of this post was a reference to my understanding (that no-one has refuted) that the only way poor people were going to get access to this vaccine in America if it was compulsory (now I understand that it could be compulsory but not free, but that it would probably not be free if it wasn’t compulsory). My whole point is that that seems to me to be a really difficult position to make a decision, because of course I believe this vaccine should be available to everyone, but I don’t believe in compulsory health care.
The attitude towards contagious diseases seems to me really inconsistent (and of course in this case completely irrelevent, because half the population will continue to be able to infect people). Not screening for infectious diseases could lead to you infecting and killing someone else, but we don’t make HIV screening compulsory. There is no requirement to go to a doctor when you’re sick to find out if what you’ve got is contagious. There’s not requirement (or for many people no ability) to stay home from work if it is.
I have to say I’ve no idea where this very strong attachment to vaccinations being different from other non-emergency public health measures and compulsory comes from.
Maia said:
I asked this upthread, but there have been so many responses since that I wanted to ask again.
Do you believe that kids that age should be able to refuse medical care against their parents wishes?
I ask because when I was 11, getting a shot scared the crap out of me, and I would have refused a tetanus shot, whether it was needed or not.
—Myca
I donno, New Zealand, what we do here sort of works for us, and to the (very large) extent that it doesn’t, we’re working on it.
We’ve decided over here that vaccinations are important enough to virtually require them. You think we shouldn’t do that? OK. We disagree. I personally disagree. Vaccinations have so little downside, and so much “upside” for everyone involved, including the kid vaccinated, that for me it’s a no-brainer.
We don’t ask 10 year olds for their opinion because we think, and rightly, I believe, that they aren’t mature enough yet to see the big picture. All they tend to see is the needle. There’s more to it than that. Adults understand that; children don’t. We are not yet ready, and may the day be long postponed, when we turn important decisions about public health over to children.
You don’t like it that we use school enrollment to “require” vaccination. We do it that way for reasons of ease and economy. I don’t know how or if this is done in New Zealand, but we’ve been doing this in the USA for time out of mind, and it works for us. Requiring adult vaccination would probably be wise, but we lack the ability, as a practical matter, to find every adult and check on this. We can’t even perform an accurate head-count every ten years.
Everyone thinks vaccinations should be easily available and free to those who cannot pay for them. There’s no one here, and probably no one anywhere, who would dispute that statement. How exactly we manage that in our particular situation has proven to be something of a problem, but again, we’re working on it. The currently sad state of the American health care “system” is acknowledged now by all, and is probably a better discussion for a different topic.
No one here has yet explained to me why vaccinations for HPV should be treated any differently than vaccinations for whooping cough. Both are contagious diseases with serious potential impacts on some of – not all of – the population (adults with whooping cough are in no real danger), and the vaccinations are, so far as we can tell, harmless. When the FDA decides that HPV vaccinations are safe and effective for males, they will undoubtedly be required for them too.
For the umpteenth time I ask, please to explain why any of this is a feminist issue.
Why doesn’t herd immunity apply in the context of HPV?
The rate of HPV transmission is so rapid once a person becomes sexually active that in order for the vaccine to have any assured benefit to that person, it must be administered prior to sexual initiation. And it is my understanding that HPV can be transmitted by sexual contact other than intercourse — though I would imagine intercourse is the mostly likely means of transmission.
Hepatitis B is the most analogous situation — we immunize infants at birth and require immunization for school attendance EVEN THOUGH there is virtually no way that a child will become infected without engaging in seriously risky activity (riskier than simply having sex), once the possibility of transmission from mother to child is eliminated (that’s why it’s given to newborns — so as not to have to test every pregnant woman for the infection — which has always seemed a little crazy to me, except that the disease does have some profound consequences if it is contracted, so even though the disease is unusual vaccination confers real public health benefits).
So in summary:
Vaccination works best for populations only if most of the population is protected, which means that mandatory vaccination is the only real way for a population to be protected (otherwise, too many free riders quickly dissipates herd immunity for those who legitimately can’t get vaccinated, like people who are HIV+). If you don’t believe me, Google articles about the rising incidence of measles in Britain, where large numbers of parents are taking advantage of their right not to vaccinate their children. Basically, some scientists believe that the rate is now so low that herd immunity no longer exists.
Which diseases are vaccinated against is largely a function of the success of R&D efforts for specific compounds. It would be even better to have a vaccine for TB or for HIV than HPV, but R&D has never been able to give us a vaccine for those diseases, at least not yet.
The vaccine for HPV is imperfect because it only protects against some and not all strains of HPV. Women still have to act as if they are unprotected, but the benefit is real, it’s just not as big as it appears to be.
One of the taboo subjects at the CDC is that the CDC often leans toward recommending (it can’t mandate) mandatory vaccination in order to ensure that companies continue to do vaccination research (i.e., so that they know that it can still be a profitable undertaking). Whether you live in NZ or USA, assuredly, you do benefit from continued research into vaccines.
Don’t knock vaccines too hard, even if you find the financial aspects a little disconcerting. It’s one of the true public health achievements of the modern age, compared to all the other vaunted medical miracles that benefit a lot fewer people and subject them to continuing, often expensive treatment and the continuing possibility of side effects.
Notwithstanding that I do plan to have my daughters vaccinated, I do think it’s a bit early to mandate HPV vaccination.
Another reason to make the vaccine compulsory is that it makes it guilt-free. If it’s compulsory, doctors don’t have to discuss with parents why yes, it really is a good idea and no, it will not turn your daughter into a slut. Parents who secretly think it’s a good idea but whose pastor told them it would turn their daughter into a slut don’t have to wrestle with their consciences. I would like to see it become compulsory by age 12 nationwide for both boys and girls, except of course for those who opt out of all vaccines.
Absent vaccines, something like measles will infect a lot of people obviously and quickly; HPV will do it quietly and slowly. Both are legitimate public-health threats.
The fact that the governor’s motives may not have been entirely pure (and really, whose are?) doesn’t change the value of compulsory vaccination for everyone, rich and poor.
To be honest, I wouldn’t even really have a problem with mandating vaccination for all children attending public school with no opt-out provision.
If you insist on choosing to be a public health risk, that’s cool, but I see no reason for us to include you in our government mandated public services.
Now, granted, this isn’t our system now, and that’s probably a good thing, but I don’t think that we’re out of line, as a society, to insist on some basic health provisions.
Sensible comments, Barbara, Lu.
An effective vaccine for HIV is the current Holy Grail for vaccine researchers. I am told that it is a very tough nut to crack because the virus mutates so readily. (That’s also why there is no vaccine for the common cold, and why flu shots only work sometimes.)
I am also told – I haven’t researched this – that in fact there does exist a vaccine for (most strains of) TB. The reason vaccination is not mandatory, in fact it is not encouraged, in first world countries is that so far the disease is fairly rare in those countries, and, most to the point, if you get the vaccine you test positive for TB for the rest of your life. This hampers efforts to locate and isolate the disease when it does show up. Vaccination is encouraged – WHO is trying, I hear, anyway – in countries where TB is more common. How much sense all this makes is for the more scientific than myself to worry out.
The only potential questions I can see about mandatory vaccination for HPV circle around effectiveness and safety and so forth, the very same questions we have asked ourselves about polio vaccine, measles vaccine, the lot.
We’re talking about a killer disease here. It has been shown to be related to a virus which can be passed from human being to human being. We now have a vaccine which is at least partly effective, and which can save many lives. Given that we’ve come to peace about requiring vaccination in other such situations, the problem with this one would be what again?
1. To answer your question ‘way upthread, Maia, about German measles vaccinations: in the U.S., they are mandatory for everyone unless there is a health or religious objection to getting the vaccine. I had to get a booster after the birth of my second child (i.e., 12 hours after) because my titer during that pregnancy showed that I was no longer immune. My husband had to get a titer done after mine showed up negative, and if his had come back negative, he would have had to go get a booster immediately.
2. School is actually the 2nd catch basin for vaccination in many states. The 1st catch basin is daycare/preschool. Vaccinations must be up-to-date and on-schedule for children to be allowed to go to any licensed daycare facility or preschool in my state, which actually caused a problem with one of my kids because we had to delay giving the chickenpox vaccine (the kid kept getting ear infections just before we’d go in for the vaccine, and you’re not allowed to get the vaccine if you have a fever).
3. For colds and similar illnesses, children do not have to see the doctor to return to school, because while contagious, they are generally not serious or potentially life-threatening to the general school population. My kids’ school has a rule that children must be fever-free for 24 hours before returning to school, but they generally do not need a doctor’s note unless they are out for more than 3 days, which is a yardstick for seriousness of the illness. Exceptions include parasitic infestations, eczema, shingles, and contagious diseases like scarlet fever that don’t have immunizations available – these generally a doctor’s note no matter what in order for the child to return to school.
4. I will probably get the HPV vaccine for my daughter when she turns 12, but I would feel a lot better about it if it were not so new. I am one of those people who distrusts the new drug on the block automatically, though. I remember when the chickenpox vaccine was still relatively new, and there were reports that children who had gotten the early version of the vaccine were more susceptible to shingles. Friends worried that giving their children the vaccine would doom them to a lifetime of shingles outbreaks. But now that does not seem to be the case, so probably the HPV vaccine will turn out to be an equally good thing – it’s just that we won’t know for sure for years and years to come.
I took both of my preteen daughters to get the Gardasil vaccine. No qualms about it, at all. I think it’s hysterical how we (rightly) excoriate the religious right about not listening to science when it comes to evolution and global warming, but then when it comes to vaccination, we all go back to our inherent “well, I feel it’s icky and scary” standpoint instead of relying on real data. Vaccination is THE public health success of the 20th century. It’s about as non-controversial in the scientific community as, well … evolution and global warming.
I think that’s an excellent, excellent point, Lu. Plus, the only trait more American than wingnuttery is laziness (I’m being half-facetious there, but only half), so even some parents who do somewhat oppose protecting their daughters from cancer will probably go ahead an vaccinate them anyway just because it’s easier than opting out.
The thing that sticks in my mind about HPV when I hear all this debate is that, if I’m recalling the numbers correctly, 85% of women (and who knows how many men) will be infected with some strain at some point in their lives. The always-absurd slut-shaming seems all the more ridiculous given that it’s the minority that won’t be affected. Do these people also think that Pap smears encourage promiscuity? Or do they just not realize that they’re looking for the same thing that they don’t want to vaccinate against?
Also, I’d like to second (or fifth or eighth or however many times it’s been said now) the statement that children should not be entrusted with their medical decisions. Rare is the eleven year old kid who would voluntarily receive a shot, so no one would get vaccinated for anything.
Vaccination is THE public health success of the 20th century. It’s about as non-controversial in the scientific community as, well … evolution and global warming.
Ever talk to a parent of an autistic child? Do a search on “vaccine autism” and you’ll find plenty of controversy.
I’m not arguing against this. If my kids were home I’d have (at least her) get this. But as this gets more well known you’ll see a lot of people who aren’t conservative Christians say to themselves, “Let’s see this be out in the market for a while and get some history” before they go for it.
I was wondering a bit about the claim immunizing women only wouldn’t result in herd immunity in this particular case. I know that for most diseases it would not. But in this particular case, the contagion path is, for the most part, man->woman->man->woman and so on. In contrast, for measels, the path is person->person->person.
So, if a very, very large fraction of women were immunized — say 95% of women– it seems to me you might end up with pretty decent herd immunity from a practical standpoint. At the very least, it’s not reasonable to estimate the level of heard immunity by assuming the herd immunity level would be comparable to the level one would get with a 47.5% immunization rate for non-sexually transmitted infectious diseases.
As I understand herd immunity, if 80% of the population has immunity, for all intents and purposes, the disease will be eradicated within the entire population. Although it would be decades and decades before that could happen with the strains of HPV that are immunized against with Gardasil, I fail to see why it wouldn’t be feasible in theory.
So many of the arguments here come down to the fact that people don’t trust people to make good decisions about vaccines, so they believe the state should make the decision for them. I disagree with that analysis – fundamental to my political positions is trusting people in the decisions they make – but can understand where it’s coming from.
Just to clarify my position on children’s consent to medical procedures. People appear to think that arguing that children should actively consent to medical procedures means that they should make the decisions alone. That’s not what I was saying. I think the current situation where parents make the decisions until the child is 18 is ridiculous, and obviously not how it works in practice. I think there should be a formalised staging in process of a child taking responsibility for their own medical care. I think from about age ten the child’s signature should be on the dotted line (possibly also with their parents). If there is a choice between two procedures they are the person who should make those decisions. And if a procedure is refused it should be the child, not the parent who is making that decision.
In my experience 10-12 year olds take any decision they have to make very serious (because they get to make so few). You can’t realistically give medical attention to an eleven year old who doesn’t agree. I’m saying that that process should be formalised and children should be taken seriously.
Barbara herd immunity doesn’t apply in the context of HPV because only half the population is going to be immunised. As Bean says the other half will only be able to infect unimmunised women, but it makes it hard to argue that immunisation will affect and protect anyone but the person being immunised.
Bean can you give me an example of a state funded vaccine that isn’t compulsory? (I think you misunderstood me, by the way, or maybe I misunderstood you. I wasn’t arguing that vaccines that at the moment were given at six weeks should be held off until someone was ten, just that once someone was ten they should be able to make decisions on their own health care).
Do people really support compulsory Rubella vaccinations as well? (you must have this vaccine because if you one day get pregnant and get the disease it may cause birth defects – talk about treating women like baby making machines).
I think this is a feminist issue, because I think women’s health issues are feminist issues and HPV is a women’s health issue. And because, as a feminist, I trust women (and girls) to make their own decisions about their health care.
Grrr. I should have ended the blockquote in a different place.
No, it’s that I don’t feel other people should be making decisions on stuff that fundamentally affects the health of us all.
The fact that I favor meat inspection doesn’t reflect that I don’t trust butchers to make good decisions about hygene.
—Myca
Ever talk to a parent of an autistic child?
You can talk to one right now if you like, RonF. Kindly don’t use my and my family as an example you think will bolster your arguments.
Maia, it really seems as though you don’t particularly care to listen to or consider anything anyone has to say about vaccines, because you don’t like compulsory vaccination and you don’t like using school enrollment as a catchbasin, so that’s that.
You can’t realistically give medical attention to an eleven year old who doesn’t agree.
You can’t possibly be serious.
You betcha I do. Because it costs almost nothing, is a minimal infringement on the rights of the person being vaccinated, it’s safe, and it will save thousands of people from serious suffering. Sometimes, lifelong suffering.
There are lots of things which are compulsory. It’s compulsory in this country at least to wear clothes in public, not to defecate in the street, not to throw trash in the street (and in some places, to keep your own property reasonably clean), not to have open fires in cities, on and on. And to be vaccinated against a list of diseases unless you have a religious reason for refusing.
I guess so. Sort of. But merely being a woman doesn’t confer some sort of right to object to sensible public health measures, at least not in my opinion. I just don’t see it that way, and I gather that a lot of public health folks agree.
Rather than class HPV with other “women’s health issues” I think it’s more sensible to class it with “communicable diseases for which we now have a vaccine.” If viewed in that light, given that those who know these things have decided that the vaccine is reasonably effective and safe, I think it’s a slam-dunk to argue that vaccination should be required.
Having had four ten-year-olds (not all at once, thank God!) to say I don’t think that important public health decisions should be made by ten-year-olds is a considerable understatement.
The Facts About GARDASIL
1) GARDASIL is a vaccine for 4 strains of the human papillomavirus (HPV), two strains that are strongly associated (and probably cause) genital warts and two strains that are typically associated (and may cause) cervical cancer. About 90% of people with genital warts show exposure to one of the two HPV strains strongly suspected to cause genital warts. About 70% of women with cervical cancer show exposure to one of the other two HPV strains that the vaccine is designed to confer resistance to.
2) HPV is a sexually communicable (not an infectious) virus. When you consider all strains of HPV, over 70% of sexually active males and females have been exposed. A condom helps a lot (70% less likely to get it), but has not been shown to stop transmission in all cases (only one study of 82 college girls who self-reported about condom use has been done). For the vast majority of women, exposure to HPV strains (even the four “bad ones” protected for in GARDASIL) results in no known health complications of any kind.
3) Cervical cancer is not a deadly nor prevalent cancer in the US or any other first world nation. Cervical cancer rates have declined sharply over the last 30 years and are still declining. Cervical cancer accounts for less than 1% of of all female cancer cases and deaths in the US. Cervical cancer is typically very treatable and the prognosis for a healthy outcome is good. The typical exceptions to this case are old women, women who are already unhealthy and women who don’t get pap smears until after the cancer has existed for many years.
4) Merck’s clinical studies for GARDASIL were problematic in several ways. Only 20,541 women were used (half got the “placebo”) and their health was followed up for only four years at maximum and typically 1-3 years only. More critically, only 1,121 of these subjects were less than 16. The younger subjects were only followed up for a maximum of 18 months. Furthermore, less than 10% of these subjects received true placebo injections. The others were given injections containing an aluminum salt adjuvant (vaccine enhancer) that is also a component of GARDASIL. This is scientifically preposterous, especially when you consider that similar alum adjuvants are suspected to be responsible for Gulf War disease and other possible vaccination related complications.
5) Both the “placebo” groups and the vaccination groups reported a myriad of short term and medium term health problems over the course of their evaluations. The majority of both groups reported minor health complications near the injection site or near the time of the injection. Among the vaccination group, reports of such complications were slightly higher. The small sample that was given a real placebo reported far fewer complications — as in less than half. Furthermore, most if not all longer term complications were written off as not being potentially vaccine caused for all subjects.
6) Because the pool of test subjects was so small and the rates of cervical cancer are so low, NOT A SINGLE CONTROL SUBJECT ACTUALLY CONTRACTED CERVICAL CANCER IN ANY WAY, SHAPE OR FORM — MUCH LESS DIED OF IT. Instead, this vaccine’s supposed efficacy is based on the fact that the vaccinated group ended up with far fewer cases (5 vs. about 200) of genital warts and “precancerous lesions” (dysplasias) than the alum injected “control” subjects.
7) Because the tests included just four years of follow up at most, the long term effects and efficacy of this vaccine are completely unknown for anyone. All but the shortest term effects are completely unknown for little girls. Considering the tiny size of youngster study, the data about the shortest terms side effects for girls are also dubious.
8) GARDASIL is the most expensive vaccine ever marketed. It requires three vaccinations at $120 a pop for a total price tag of $360. It is expected to be Merck’s biggest cash cow of this and the next decade.
These are simply the facts of the situation as presented by Merck and the FDA.
There are two sides to every discussion, of course. This vaccine does appear to confer some benefits. If I were a sexually active woman who disliked condoms and liked to have multiple sex partners who had not yet been exposed to any of the four strains of HPV that this vaccine protects against, I just might sign myself up.
But that’s not the same thing as making this vaccine MANDATORY for a preteen population it was not rigorously tested on a scant 8 months after its initial rush job FDA approval.
Aside from all the known risks of all vaccines, the unknown risks of this three shot regimen for preteens along with their other vaccine load, and the unknown long term risks of this vaccine for all populations, we have to look at cost vs. benefit.
7861 of the placebo subjects contracted 83 cases of HPV 6-, 11-, 16-, 18-related dysplasias during the testing period compared compared to 4 cases among the 7858 subjects who were given GARDASIL. That’s after counting out every subject with any prior exposure to these strains. This includes 42 of the less serious HPV 6-, 11- related low grade dysplasias.
Merck has published no data for how many non-HPV 6-, 11-, 16-, 18-related dysplasias were contracted by these subjects over these periods, but some practitioners have commented that they expect the vaccine to protect against 40%-50% of all dysplasias.
In terms of every possible kind of dysplasia for which this vaccine confers protection, Merck’s own clinical evidence suggests that this vaccine saved about 10 patients out of each 1000 injected from the painful process of having these dysplasias treated (over the entire course of follow ups which ranged from 18 months to 4 years). Note that the populations for these studies were not preteens but women at the height of their sexual activity. Further note that since the vaccine uses virus-like particles (a new vaccine technology) and is only about five years in testing now, there is no guarantee that it has any long term efficacy.
Of course, the pre-teen population is so less sexually active (and when active, so much less likely to be active with a previously contaminated partner) that I think it would be conservative to estimate that preteens are 5 times less likely to contract HPV dysplasias than the 16 to 26 year olds who were tested by Merck. So instead of saving 10 women per 1000 from painful treatments for HPV dysplasias, this vaccine would save perhaps 2 girls per 1000 from these procedures among the much younger population that Merck and Merck’s politicians are targeting for mandatory vaccination.
Do we really want to pursue a public policy that costs $360,000 to vaccinate every 1000 girls while exposing each and every one of these thousand girls to the known adverse short term and largely unknown long terms side effects of three injections of a new vaccine just to save two of the more sexually active of these kids from having to have their dysplasias treated conventionally?
What kind of a risk and cost vs. benefit trade off is that?
Note that nowhere are we discussing actual incidences of cervical cancer because there is no clinical evidence whatsoever that GARDASIL reduces cervical cancer rates, and even if we place our hope in the the fact that it might, cervical cancer is simply not a meaningful health risk for any girl in the target vaccination population who is getting an annual pap smear.
While it is a widely accepted medical theory that HPV “causes” cervical cancer, it’s not close to being a fact. Although the vast majority do, many cases of cervical cancer don’t show any association with HPV. It’s a very good guess that certain strains of HPV are necessary co-factors for certain highly prevalent types of cervical cancer to emerge. The two really bad strains protected for in GARDASIL go hand in hand with 70% of CURRENT cervical cancer cases. My point is that there are 36 nasty strains of HPV screened for currently, and the human body is an ecology. We have no idea how protection against the two strains of HPV that are CURRENTLY most prevalently associated with cervical cancer (typically decades after initial exposure) will affect overall cervical cancer rates far in the future.
What we instead DO know is that current practices of annual pap smears and screening for ALL bad strains of HPV continue to reduce rates of cervical cancer among the US population annually. If all US women received a pap smear every year and were then promptly treated for any abnormal growths encountered, both the cervical cancer contraction and mortality rates would plummet even further to the point where HPV-associated cervical cancer would kill no more than a handful of US women a year. Yes, that is a guess as well, but it’s a far better guess than assuming that conferring protection against four of the myriad of current and future strains of harmful HPV will somehow do the trick.
Certainly GARDASIL’s benefit data against the four strains of HPV it targets are compelling. HOWEVER, the benefit data against ALL forms of HPV are not published by Merck and estimated by OP-GYNs to be a mixed bag. The benefit data against cervical cancer itself are nonexistent. The long term risk data for any population are nonexistent. There are almost no risk data at all for pre-teens. The fact that the “placebo control” was a shot of alum that was recently shown to cause neural death in mice is particularly problematic in terms of interpreting the small amount of risk data that were gathered.
Studies of the long-term benefits of a new drug or vaccine take a long time. It would take several decades to prove conclusively that this vaccine prevents cervical cancer deaths. So why the rush to make these three injections COMPULSORY for preteens?
Perhaps this would be excusable if GARDASIL conferred protection against HPV generally, but it does not. We have absolutely no way of even guessing how conferring protection against four strains of HPV will affect cervical cancer rates decades down the line. If you do, please quantify the expected benefits in terms of the expected reduction of cervical cancer contraction and mortality rates for the population of US women who get annual pap smears. The only thing you can say about these numbers are that they are unknown and tiny.
I am not trying to stop anyone from signing up themselves or their kids for this. If you want to pay $360 to make your little girl one of Merck’s test subjects, please do. As I said, the vaccine shows promise. It may be a life saver for a small segment of the population (especially those too poor or uninformed to get annual pap smears), and it offers protection against most genital warts and a good percentage of HPV dysplasias. The procedures to remove these warts and dysplasias are very painful, so these benefits are compelling. However, the risk and cost vs. benefit profile of this vaccine is not such that it is good public policy to mandate it — especially not for a pre-teen population on which it has never been sufficiently tested — even with an “opt out” clause. If Merck wants to make sure that women and parents who want it and can’t afford it can get it, they should offer it to low income individuals and families on a sliding scale rather than lobbying state and federal governments to pony up the billions.
mythago – if an eleven year old is determined to resist medical treatment they can. They’re big enough and strong enough and smart enough.
I have listened to everything people have had to say – I have responded to it. No-one has explained why they see compulsory vaccinations as so very different from other medical care. I honestly have no idea why people are so very attached to having one form of public health made compulsory, in a country where people can only get most forms of medical care if they can afford it.
But I understand that people are attached to the way they are used to things are done. Just like making vaccinations a condition of school enrollments seems bizarre and coercive to me, it seems natural to you. I’ve spent enough time in the blosphere to get used to its Americancentric nature and the difficulty of challenging that, so I think I’ll sign out of this debate.
Shorter Maia: Too bad you self-centered American sheep can’t see it my way. Kthxbye.
What you said here is not factually true.
Several people, myself included, have explained why we see it differently.
Personally, I explained in post #38.
—Myca
What mythago said.
“Ever talk to a parent of an autistic child? Do a search on “vaccine autism” and you’ll find plenty of controversy.”
Not all controversy is legitimate, and this isn’t actually a controversy among responsible scientists. (There is all but one peer-reviewed paper which supports this conclusion, and many which debunk it.) Some people enjoy using vaccines as a convenient scapegoat. That doesn’t actually say anything about vaccines.
An anecdote.
Back in the day, of course, there was no such thing as a Rubella vaccination. So what you did was to wait until there was a Rubella case in your neighborhood and then you took your female child over there long enough to expose her. (Such fun for the mother of the sick child!) Then when your daughter contracted the disease, of course, you had to host the “party.” (No, Maia, we didn’t poll the children for their opinions on this practice. Get real.)
I did this for my older daughter, now 36. So, six years ago, when she decided to get pregnant, she called me and mentioned that Scottish National Health was going to test her for Rubella immunity, and vaccinate her if she wasn’t immune. I said, “Not to worry. You’re immune.” (The big advantage of the old method is that whereas immunization can expire, having actually had the disease confers lifetime immunity.)
So she called me up afterwards to proclaim that her titre was “very high” for Rubella immunity, and I said, “Told ya so.” (What she did NOT say, and what would have been in order, was “Thank you, Mom.”)
Should I not have done this, Maia? Was I violating my daughter’s “rights”? What if she had gotten pregnant by accident, and I hadn’t done it, then what?
You can’t be serious.
Sarah, I’m the parent of an autistic child too, and I agree. All responsible studies have exonerated vaccines of all sorts from blame for this condition.
Actually, I think Maia’s right.
NZ uses an opt in system and gets better than 80% vaccination rates by age 1. As someone pointed out 80% vaccination rates are sufficient to provide herd immunity, so NZ does a sufficiently effective job by an opt in system.
So why is it that people here (on this site, in the US) are so offended by the idea of an opt in system instead of a opt out system, or by the idea that enforcing vaccinations is an authoritarian statist approach?
I think part of it is that we want to ensure that vaccinations happen, and Americans have a pretty low opinion of the intelligence, moral quality, and diligence of other Americans. We have a lousy civil society, and we basically don’t trust each other, so, when it comes to something as important as making sure that 80% of every one is vaccinated, we don’t feel we can trust that only 20% of the population is made up of free-loaders, fundies, science doubters of one ilk or another, etc (and who we fear to be the idiots probably just varies with our own allegiances) so we’d rather depend on state enforcement to make sure that those other idiots do what they have to to make sure that there aren’t epidemics of preventable infectious diseases. And those of us of an anti-authoritarian bent aren’t pleased to be told that favoring state enforcement of medical decisions is an authoritarian practice.
But, of course, it is.
80% of people being vaccinated does not translate into 80% of people being immune (though with multiple shots it comes closer). And 80% is quite low for herd immunity to kick in — it’s a minimum goal, not an ideal goal.
But if we think that people are really truly intelligent and moral and diligent enough to make these decisions about vaccines, why have laws about seatbelts? I mean, we’re all smart people, right? We know seatbelts are good, low (but non-zero) risk, high reward, etc etc. So we shouldn’t need to force people by law to wear seatbelts. Or helmets, either on motorcycles or bikes. Or laws against gambling, or illegal drugs, and so on. (If you’re not for any of those kinds of laws, then congratulations on your consistency.)
1. The US is not New Zealand. We have a zillion people here from a zillion cultures. And collectively we have our own thing going. Which actually works pretty well, considering. The most important point is, the culture in the United States is not the same as the culture in New Zealand.
2. I’m not “offended.” What works in NZ works in NZ. What works here works here. The culture is quite different here than it is in NZ. Not better, not worse, just different. We don’t have to do it the way it works for them; they don’t have to do it the way that works for us. The way we do it works for us, and has done so for a long long time.
3. It is not our mission here to please Maia.
So shoot us. We’re Americans, not New Zealanders.
Why are people who adore an opt-in system so hell-bent on characterizing anyone who dares to disagree with them as offended, America-centric, statist, pro-autism, oppressors of children, and on and on?
By the way, the NZ Immunisation Advisory Centre has some rather interesting links regarding the supposed research showing a link between MMR and autism.
NZ may have avoided new outbreaks of the measles, but the UK and some other European countries have not. Sweden has had serious outbreaks of whooping cough in the last decade. All because highly educated parents opt out of vaccines. Problem is, infants and children who are too young to get the vaccine are thereby rendered extremely vulnerable. And the compulsory nature of vaccines relates directly to school or daycare attendance, so if you keep your kids out of those settings you don’t have to get them vaccinated. And if you have been following news about the CDC’s report on measures to any potential flu pandemic, you will have read that schools are the single most densely populated locations in nearly any community. Vaccines are mandatory for those who attend because they are prime breeding ground for infection, for instance, only when schools were closed for significant periods of time did the influenza epidemic of 1918 begin to wane in most American cities. As you might imagine, closing schools would have a significantly disproportionate effect on the lives of poor people, so a vaccine would be, on the whole, a rather significant benefit to poor people in particular.
As others have highlighted, the same dynamic is not at work for the HPV virus, which is not spread by casual contact. So we can argue whether this vaccine should be mandatory but to argue about vaccines in general is kind of silly. But before you diss a program that would require the vaccines to be provided free, you might want to consider that since poor women are less likely to have pap smears on an annual basis (not always because they can’t afford them, sometimes because they can’t afford to take off work to get them), they would disproportionately benefit from the HPV vaccine. Indeed, public health measures by and large disproportionately benefit poor people because the rich can buy their own protection.
Are you in favor of laws against pollution, or should we leave it to the good will of your fellow man?
Are you in favor of laws against rape and murder, or should we leave it to the goodwill of your fellow man?
Are you in favor of laws to make sure that your food and water are safe, or should we leave it to the goodwill of your fellow man?
Are you in favor of regulating antibiotics so that we don’t see strains of super-resistant bacteria, or should we leave the judgment in the hands of the public?
Right.
That’s how I feel about immunizations.
I’m not an American, so I don’t know for sure, but I was under the impression that vaccinations are not compulsory for public school attendance, contrary to popular belief. It IS required for attendance in certain private daycares,
“So why is it that people here (on this site, in the US) are so offended by the idea of an opt in system instead of a opt out system, or by the idea that enforcing vaccinations is an authoritarian statist approach?”
We’re not ‘offended’ by the idea that vaccinations are an authoritarian statist approach. It’s just that we can smell wingnut apologia coming from about ten miles upwind. In a nation where there are 1.7 million reported instances of child abuse a year and a creepy anti-sex culture, the inconvenience of the opt in system is a surefire way of ensuring that more girls fall through the cracks.
When arguing opt out, there are a few things we need to remember:
1. First, the ad populum argument about making decisions for ‘my kid’ have quietly receded. In either situation, you have the choice. The dispute between opt in and opt out is purely about what happens to other people’s children, and note here again that the people who would have no problem procuring this vaccine are the ones talking about nonsensical abstracts about ‘authoritarian statism’ for the government trying protect you against fricking cancer, while no such luxuries exist, for instance, for those who are unfortunately too uneducated to know that a vaccine exists, or that HPV is linked to cervical cancer, or what ‘HPV’ is.
2. Wingnuts are probably antsy about the prospect of opting out because it means having to explain their bizarre hangups to their cancer. Does anyone remember the days when religious people weren’t discriminated against, when we had prayer in schools and a cross in every dining room and good Christian mothers weren’t scared out of saying to their doctor that if their daughter has sex she deserves all the cancer she gets? It’s a brave new world out there, my friends.
You can talk to one right now if you like, RonF. Kindly don’t use my and my family as an example you think will bolster your arguments.
Maia, Susan, I’m sorry about that. I didn’t make it clear enough, perhaps, that ny poinr was not whether or not the old controversy over Thimerosal having anything to do with autism had any current validity – it’s that the use of vaccines is not necessarily going to automaticaly be viewed as scientifically (as opposed to morally) non-controversial by the general population, regardless of what the FDA says. Especially, I should think, a new one. Although balanced against that would be that it’s a protection against cancer, not something like the flu.
wtf ‘cancer’?
‘… explain their bizarre hangups to their DOCTOR.’
Gaagggh