This is a mess. It’s also one of the thorniest questions in vaccination medicine to have surfaced in a long time. From the outset, it must be clear that I am neither endorsing, nor dismissing the question of vaccinating boys. Get a cup of coffee, and let’s kick this one around for a bit.
The issues here are many, so let’s start with some straightforward infectious diseases epidemiology.
Human Papilloma Virus (HPV) is the most prevalent of the sexually transmitted pathogens. The Centers for Disease Control and Prevention have an excellent fact sheet which is a must-read. Click here.
From a strict infectious diseases perspective, the goal of public health is to certainly limit the pool of pathogen within a population, and to eradicate it if at all possible. This was done successfully with smallpox through a determined and aggressive campaign of world-wide immunization. From a strictly scientific perspective, the same makes sense with HPV. Why not shoot for eradication?
Of course, smallpox and HPV are very different diseases, both in their lethality and in their mode of transmission. The smallpox virus is spread through saliva droplets and remains alive for anywhere between 6-24 hours on contaminated surfaces. Someone might have sneezed into their hand, touched an object in the office such as a phone receiver, and thus facilitated transmission to others touching that object.
HPV requires sexual contact. It is that dimension of personal behavior, of choice, that leads to disease transmission and the current debate.
Certainly, as Cardinal O’Connor used to say, good morality is good medicine. Virginity followed by fidelity in both parties to a marriage obviates the need in that couple for any immunization against STD’s. For the rest of the world, we have an imperfect reality. Let’s consider the parent who does not want their child immunized (and we’ll get to the vaccine safety issues shortly).
Regina and I will stress virtue in our children, and would hope that they remain virgins until marriage. Assuming all goes well, there is no guarantee that their spouses will be virgins, despite assurances given verbally. Therein lies the danger. With well over half of the population infected, the probabilities of even the most virtuous among us encountering HPV are astronomical.
Given that the vaccine is only effective before one is exposed to the virus, the question of when to vaccinate becomes a real concern for parents. Children from the best and most faith-filled families succumb to peer pressure and have sex. Many identify virginity with vaginal intercourse and settle on oral and anal sex as compromise activities that bring about orgasm while ‘preserving’ their virginity, such as they define it.
The problem is that HPV can be spread from the genitals to the mouth and oropharynx, with 35% of all throat cancers being caused by HPV. HPV can also be spread from the mouth to the genitalia.
It’s a mess.
In the strictest sense, vaccinating our children against this pathogen can save a great many women from cervical cancer, males from penile cancer, and both women and men from throat cancer. That’s simply a fact.
The problem comes in with some 68 reported deaths from Gardasil given to girls, and tens of thousands of reported adverse side-effects. Still, when one considers the following ANNUAL numbers from CDC:
Cervical cancer. Each year, about 12,000 women get cervical cancer in the U.S. Almost all of these cancers are HPV-associated.
Other cancers that can be caused by HPV are less common than cervical cancer. Each year in the U.S., there are about:
1,500 women who get HPV-associated vulvar cancer
500 women who get HPV-associated vaginal cancer
400 men who get HPV-associated penile cancer
2,700 women and 1,500 men who get HPV-associated anal cancer
1,500 women and 5,600 men who get HPV-associated oropharyngeal cancers (cancers of the back of throat including base of tongue and tonsils) [Note: Many of these cancers may also be related to tobacco and alcohol use.]
The question arises: What is an acceptable risk in vaccinating?
No vaccine is 100% safe. Ever. Period.
People get sick and people die from vaccines. It’s a numbers game. It’s a cost-benefit analysis. If all of the reported adverse effects of Gardasil are actually true, they still represent a drop in the bucket compared to the numbers of HPV-associated cancers reported above. In the cold calculus of public health, it seems an acceptable risk.
Enter again the behavioral component of disease transmission, and the clarity of acceptable risk immediately becomes foggy. Were smallpox once again in the population, I wouldn’t hesitate to accept these numbers as an acceptable risk, precisely because one cannot see the disease coming.
However, people contract HPV through willful behavior. They will the behavior that carries the risk of transmission. In that light, here is the dilemma faced by Regina and me:
Do we risk our children’s lives and health today in an attempt to hedge our bets on their behavior years down the line, or of their future spouses premarital behaviors?
Even if our children remain virgins, there is no guarantee with their future spouses. Do we risk their lives to attenuate a possible case of HPV in a future mate?
If Gardasil is good enough for girls, then it’s good enough for boys.
The question is whether it’s good enough?
I honestly don’t know.
