The Daoist Diaries

Correction Appended:
What is it that some parents don’t understand about the HPV vaccine, licensed last summer in hopes of preventing most cases of genital warts and cervical cancer?
That infections with human papillomavirus, or HPV, are the most common sexually transmitted diseases?
That there is no treatment for HPV infections?
That cervical cancer is the most serious sexually transmitted disease caused by this virus?
That 70 percent of cases of cervical cancer arise because of two variants of the virus that the new vaccine protects against?
That 90 percent of genital warts cases are caused by two other variants of the virus that are countered by the vaccine?
That most people infected with HPV do not know it, yet can transmit the virus to an unsuspecting sexual partner?
That 20 percent of American girls 14 to 19 are infected, and the vaccine works only if administered before women contract the viral variants it is intended to prevent?
Despite these facts, the vaccine, sold by Merck as Gardasil, has been mired in controversy, and many parents remain wary about using it for the girls and young women it was meant to protect.

Are the Objections Valid?
One commonly voiced thought is that immunizing young girls against HPV will encourage promiscuity and that the message to these youngsters should be abstinence before marriage and monogamy after.
But the abstinence message is rarely effective. Half of all girls become sexually active before graduating from high school. For some girls and women, sexual behavior occurs against their will, through rape, incest and date rape.
Why would this vaccine give girls license to be sexually indulgent? It protects against only one sexually transmitted problem, and there are so many others, including chlamydia, trichomoniasis, H.I.V. and, of course, unwanted pregnancy.
Another concern involves long-term safety. How do we know this vaccine will not eventually cause other problems like autoimmune or neurological disorders or lose its protective powers or foster the dominance of other HPV variants?
Actually, we don’t. But we do have at least five years of safety data that include no hints of long-term risks or waning effectiveness. But if the vaccine should begin to lose potency over time, that could easily be remedied by a booster shot.
In response to suggestions of mandatory HPV vaccination for all girls entering high school, opponents have objected to “forcing” therapy on healthy girls under the presumption that future behavior might result in a disease.
This is exactly the principle on which every form of immunization is based. Not everyone contracted polio or smallpox before the advent of mandatory vaccines to protect every child. We vaccinate the masses, causing herd immunity, to protect the relatively few who would otherwise become ill and suffer devastating consequences.
Finally, objections have been raised about costs. This vaccine is not cheap. Each dose costs $120, or $360 for the three doses needed for full protection, far more than any other commonly used vaccine. If a booster shot is needed later, that could mean another $120. If the vaccine is made mandatory, states might have to pay for immunizing girls not covered by insurance.
Still, HPV infections are far more costly. As noted in the March issue of The American Journal of Obstetrics and Gynecology: “The annual burden of cervical HPV-related disease ranges from $2.25 billion to $4.6 billion in the United States. The annual burden of cervical cancer ranges from $181.5 million to $363 million.”
This is not to mention the physical and emotional costs of cervical cancer to affected women, most of whom can no longer have children and some of whom die of the disease.

Correction Appended:
What is it that some parents don’t understand about the HPV vaccine, licensed last summer in hopes of preventing most cases of genital warts and cervical cancer?
That infections with human papillomavirus, or HPV, are the most common sexually transmitted diseases?
That there is no treatment for HPV infections?
That cervical cancer is the most serious sexually transmitted disease caused by this virus?
That 70 percent of cases of cervical cancer arise because of two variants of the virus that the new vaccine protects against?
That 90 percent of genital warts cases are caused by two other variants of the virus that are countered by the vaccine?
That most people infected with HPV do not know it, yet can transmit the virus to an unsuspecting sexual partner?
That 20 percent of American girls 14 to 19 are infected, and the vaccine works only if administered before women contract the viral variants it is intended to prevent?
Despite these facts, the vaccine, sold by Merck as Gardasil, has been mired in controversy, and many parents remain wary about using it for the girls and young women it was meant to protect.

Are the Objections Valid?
One commonly voiced thought is that immunizing young girls against HPV will encourage promiscuity and that the message to these youngsters should be abstinence before marriage and monogamy after.
But the abstinence message is rarely effective. Half of all girls become sexually active before graduating from high school. For some girls and women, sexual behavior occurs against their will, through rape, incest and date rape.
Why would this vaccine give girls license to be sexually indulgent? It protects against only one sexually transmitted problem, and there are so many others, including chlamydia, trichomoniasis, H.I.V. and, of course, unwanted pregnancy.
Another concern involves long-term safety. How do we know this vaccine will not eventually cause other problems like autoimmune or neurological disorders or lose its protective powers or foster the dominance of other HPV variants?
Actually, we don’t. But we do have at least five years of safety data that include no hints of long-term risks or waning effectiveness. But if the vaccine should begin to lose potency over time, that could easily be remedied by a booster shot.
In response to suggestions of mandatory HPV vaccination for all girls entering high school, opponents have objected to “forcing” therapy on healthy girls under the presumption that future behavior might result in a disease.
This is exactly the principle on which every form of immunization is based. Not everyone contracted polio or smallpox before the advent of mandatory vaccines to protect every child. We vaccinate the masses, causing herd immunity, to protect the relatively few who would otherwise become ill and suffer devastating consequences.
Finally, objections have been raised about costs. This vaccine is not cheap. Each dose costs $120, or $360 for the three doses needed for full protection, far more than any other commonly used vaccine. If a booster shot is needed later, that could mean another $120. If the vaccine is made mandatory, states might have to pay for immunizing girls not covered by insurance.
Still, HPV infections are far more costly. As noted in the March issue of The American Journal of Obstetrics and Gynecology: “The annual burden of cervical HPV-related disease ranges from $2.25 billion to $4.6 billion in the United States. The annual burden of cervical cancer ranges from $181.5 million to $363 million.”
This is not to mention the physical and emotional costs of cervical cancer to affected women, most of whom can no longer have children and some of whom die of the disease.