Immunized Against Innocence?

 

Do 9-year-olds need to be immunized against the possibility of a sexually transmitted disease known as Human Papilloma Virus? The pharmaceutical company Merck certainly thinks so. They are currently filing for approval with the FDA to market a vaccine for this disease which has been tested on males and females aged 9 to 26. According to a recent article in the Wall Street Journal, the company is gearing up to launch this product. It is providing funding to medical societies (including the American
Academy of Pediatrics) to educate doctors about the product’s pending availability, as well as launching a campaign and a website to generate consumer demand.

Already doctors are being asked if they would recommend the vaccination to pediatric patients, and, according to a study conducted by an interested pediatrician, Jessica Kahn, they are responding overwhelmingly in the affirmative—75%. But here’s the rub-—they’re worried that parents will be reluctant to take the advice and go ahead and immunize—in fact, their biggest concern is “getting parents to face up to the threat of STDs”—as though they happen randomly, like cases of chicken pox. According to a non-profit group called American Social Health Association, parents need to get their heads out of the sand and realize that “one in two sexually active adolescents will contract an STD by age 25”.

HPV can be extremely dangerous, causing genital warts and the overwhelming majority of cervical cancer. But it seems to me that this fact should be the very argument against early sexual activity, not just for vaccination against one particular STD.

The whole of the medical establishment, from the mighty Merck & Co, to vast numbers of pediatricians, to supposed pro-health non-profit groups, is gearing up to move this product into the general population of preteens in order to save the kids from their own lack of self-control. It is clear that this establishment believes chastity and abstinence to be unworkable and unattainable in the majority of cases.

If this weren’t depressing enough, there is the approving tone of the article’s author, esteemed “Informed Patient” Laura Landro, which leaves the reader with the distinct impression that to abstain from vaccinating one’s 9-year-old would constitute bad parenting. And to top it off, it becomes obvious, on thorough reading, that the target here is really girls: the research doctor admits that “it is possible” that the vaccine will be recommended to “boys as well as girls”.  Clearly the deadlier aspect of the disease (cervical cancer) affects only women.

All of this cheerleading is passed off under the guise of concern for sexual health, which I have no doubt is genuine. But what about caring enough about our kids to make sure they avoid playing Russian roulette with their health, fertility and ultimately life? To constantly impart the values and inner strength they need to resist the immense pressure to start sexual activity when it is neither healthy nor appropriate? To make sure they are mature enough to understand the terrible risk they are taking, not only to their physical health but their emotional and mental health as well?

I fear that blanket vaccination will give us false confidence that kids will be protected—and thus we’ll be less likely to give the issue the constant vigilance it requires. Being the perceptive creatures they are, kids will no doubt see the “protection” of the vaccine as proof that we don’t believe they’ll be able to resist. Not only that, they’ll perceive themselves as protected, which could lead to more risky behaviour.

Certain behaviours that are deemed dangerous—smoking, for example—are clamped down on in every possible way, from PSAs to fines for vendors who sell cigarettes to minors. Others are treated with the old Monty Python routine—nudge, nudge, wink, wink, say no more. There seems to be a grave difference in attitude—on the one hand, we WILL keep you from smoking, no matter what; on the other, well we know we have to say no to sex, but, kids will be kids. It’s almost tacit approval.

Yes, kids will be kids. They will experiment, they will do incredibly stupid things, they will take terrible risks for ridiculously low payoffs. But that’s supposed to be the difference between children and adults--we’re the ones who “know better”.

 

Comments

[Mary O]

Immunizing children against HPV is going to be very controversial. I support any vaccine which will prevent cancer and save lives, regardless of how the disease is spread. At the same time, I'm disturbed at the pathetic response of our society to the increasing levels of sexual activity among teens and the resulting spread of STDs. Parents aren't the only one who need to get their heads out the sand. How about schools, public health departments and medical organizations?

Yes, many adults have no problem campaigning against kids smoking and drinking. These campaigns have been largely successful (except apparently for girls smoking), high school kid smoke and drink less now than 25 years ago. Why are so many adults afraid to campaign against kids engaging in sexual activity? On this subject we're squeamish and throw up our hands?

[Anonymous]

I'm responding anonymously for personal privacy reasons. I am a cervical cancer survivor. Fortunately, my disease was caught early enough that a cone biopsy was sufficient to cure my disease. However, I would have been unlikely to carry a pregnancy to term following the surgery. Happily enough, my family was complete.

I also have genital herpes, which my husband (unknown to him, he was totally asymptomatic) acquired from his first wife. We were married for 13 years before I had the first outbreak.

I am counseling and teaching my children that abstinence from sexual relations before marriage is in their best physical, emotional and spiritual interest.

But I also plan to have my daughter immunized against HPV when the vaccine is available. Why? Because of my personal medical history.

You wrote, "Being the perceptive creatures they are, kids will no doubt see the “protection” of the vaccine as proof that we don’t believe they’ll be able to resist. "

I disagree. An immunization will not cancel out years of parental guidance as to behavior. Let me give you an analogy: I teach my children to be very careful about cleanliness, yet I still immunize them against tetanus.

[Victor Lectus]

Excellent blog Elizabeth -

Not only does the medical and pharma cast believe chastity and abstinence to be unworkable and unattainable, but most importantly for them....UNPROFITABLE!!!

From the evidence surrounding the use of thimerosal in immunization formulas, and possible links to autism, ADD and other disorders, to marketing Rogaine for hair growth when originally developed as a treatment for high blood pressure, the conflict between a person’s good health and more money for the interest groups continues to injure the uninformed.

And you are correct to prepare us for the tiresome and eventual “…but its for the CHILDREN” incantation, to intimidate parents into an unproven and potentially dangerous program. An STD immunization package for adolescents (read: “magic bullet”), when mixed with the sense of indestructibility inherent in youth, will result in, not just a tacit approval, but increased and unsupervised activity derived from a false sense of security and parental abdication.

Why are there no PSAs for restraint and abstinence? Why is self-control not an option of value? It almost seems that the adults advocating and marketing the unavoidability of immature intercourse are vicariously enjoying the idea of kids engaging in sexual activity; almost as if they wish they had “got more” when they were younger, and haven’t gotten over the disappointment.

There continue to be magnificent developments in medicine; however they should not mistaken as a substitute for properly protecting our children.

[Elzabet]

IMO it is one thing to create a vaccine that helps prevent an illness that one cannot predict the appearance of; it is an entirely different thing to create a vaccine for something that can be prevented with just a little self control. Apparently it is better to give a false sense of blanket safety than to actively teach the benefits of self control and delayed satisfaction to our children.

[L.B.]

I know that I plan to get the vaccine, essentially for the reasons that "anonymous" mentions.

[L.B.]

I was vaccinated for the sexually transmitted type of hepatitis as a young teen, but I didn't see it as a free pass to go out and have consequence-free sex. I plan to get the HPV vaccine when it's available, myself.

[Anonymous]

Elizabeth said, "vaccine for something that can be prevented with just a little self control. "

Let us propose a hypothetical couple, Sarah and Samuel. Sarah is celibate until marriage. Samuel was celibate, too, except for one lapse of judgement with his former fiancee, Lucy. After that, he returned to celibacy. However, Lucy also had had previous sexual partners, and unknown to either Lucy or Samuel, she had acquired HPV, which she gave to Samuel. When Samuel and Sarah became engaged, Samuel concealed his previous sexual history from her--she believed he was as chaste as she was. Sarah acquired HPV, and cervical cancer. Because she was a young woman, the disease was not caught sufficiently early to have a good outcome.

Now, where was Sarah's "loss of self control"?

This is why I plan to make sure that my daughter is vaccinated.

[karen]

It seems to me that to not immunize your children (granted that the vaccine has been tested rigorously and the results treated ethically), you would be the one taking a terrible risk. Yes, it is vital to teach children to abstain. But picture this: your 16-year-old daughter is out shopping. She gets attacked in the parking lot and raped. Now she's not only traumatized and violated, but has genital warts or worse, cervical cancer. Will the idea that if she HAD been immunized, she MIGHT have taken that as license to ignore everything else you've ever taught her, give you any comfort then?

It doesn't even have to be a dark parking lot and a thug. It could be molestation by someone you know, but would never have suspected of doing something like that. Or a perfectly innocent date that ends with him slipping something into her soda.

All of this self-righteous moral indignation about kids and sex and responsibility and parents is all well and good, but it ignores a little thing called reality, where bad things happen to good children, and good children make mistakes even though their parents are paragons of virtue.

[Concerned Reader]

This piece states that "HPV can be extremely dangerous, causing genital warts and the overwhelming majority of cervical cancer." I am not sure if I am reading this sentence correctly, but if the author is suggesting that the majority of people who have HPV end up getting cancer this is a falsehood.

In case there are readers here who have the virus (over 70% of adults have it) and are alarmed by the sentence I quoted above, they should know that infected women who have regular check ups (1-2 times a year) rarely develop cervical cancer. Talk to your doctor.

[Christine (Rambling GOP Soccer Mom)]

I can tell you that under NO circumstances will I let my children be vaccinated with this. Forget it!

And, as far as the "Kids will be kids" stuff...it's said so often to kids that they basically have the idea that they "are going to do it anyway, so you might as well give us free birth control so we don't get 'in trouble.'" It's a self-fulfilling prophecy. Kids need to be shown the higher standard and be told that it's POSSIBLE for them to reach it.

Modesty is just the first step in this whole thing. Instead of working everyone down towards the lowest possible denominator, we need to help children work towards higher standards and goals!

I'm sure there are medical reasons to selectively vaccinate for this, but as a blanket vaccination - bad idea.

[sunnyday]

Frankly, I'm not sure if it's fair to write what I have in mind, but what I know is that there is some truth to it. The planned campaign of the pharmaceutical company responsible for this vaccine -- which is geared basically toward generating higher demand -- is a way to cash in on the general decline in morals in society. The pharma industry will make a mint out of this. And putting the idea in people's heads about the "need" to administer this vaccine even to children? I personally believe that is crossing the line. I don't have documents with me to back up my assertion, but I do know that drug companies come up with all sorts of vaccines that are not necessary at all and even have ill side effects, thereby making people more sick.

If the pharma companies keep manufacturing such vaccines and drugs, I hope doctors would fight for the best interest of their patients instead of doing whatever it takes to make a buck.

[Liz Neville]

Thanks to all for your thoughtful comments. However, I wanted to clarify a few points in the hopes of moving the debate along.

To Anonymous #1-- One would immunize against tetanus because contracting tetanus is the result of an unpredictable accident; to immunize against tetanus does not carry the same moral message as an immunization against what is in the vast majority of cases planned behaviour. Please note that this vaccine is not meant to assist in the minority of cases where the cervical cancer is NOT caused by HPV. Thus I believe your analogy is not instructive in this instance.

To L.B.-- you state that you will get the vaccine when available for reason alluded to by the commenter who had survived cervical cancer. Good for you. I said nothing about adults making the decision to vaccinate themselves.

To Anonymous # 2-- I used the phrase "lack of self-control" to describe impetuous youth. Adults make (or have the responsibility to make)informed decisions as to whether or not to risk STDs (among other things) by engaging in sexual activity, as well as whether or not to vaccinate themselves. I notice that in your scenario of Samuel and Sarah, Sarah was the victim of Samuel's lie (he represented to her that her was a virgin like her) and that precluded her being aware of the risk of STD transmitted by him. I also note that you describe Samuel's earlier sex with Lucy as a "lapse of judgement"-- is this an editorial comment? Finally, Sarah could have had regular testing for HPV along with her annual Pap, and this would have brought to light the cervical cancer, hopefully in time to cure it. (See below for more on this.)

To Concerned Reader-- You are not reading the sentence corectly. When I said HPV causes the overwhelming majority of cervical cancer, I meant exactly that-- the overwhelming majority of cervical cancer is caused by one of several strains of HPV. I did not mean that the overwhleming majority of HPV BECOMES cervical cancer. You correctly point out that a large majority of sexually-active adults do get and carry any number of the many strains of HPV, and that the majority either become virus-free on their own or simply do not progress to cervical cancer. However, if the development of HPV into cervical cancer is so rare, why would we require blanket immunization? With a regular test for HPV, the very slow-evolving cervical cancer is thankfully both easy to diagnose and highly curable.

To Karen-- How is my moral indignation about children and sex "self-righteous'? I would argue that it is simply "righteous", in the dictionary sense-- "meeting the standard of what is just and right". In your example of the rape of one's daughter--of course one would hope to avoid the added trauma of concern about HPV/cervical cancer. In that same secenario one would also be dealing with the potential for both pregnancy and AIDS. My problem with this campaign by the medical establishment is not that the vaccine be used in cases where it is clearly warranted (i.e. rape) but that it may be used an excuse to give tacit approval to situations where sexual activity is neither healthy nor appropriate, i.e. children. And if I understand the usage of the vaccine correctly, it can be used AFTER the introduction of HPV into one's body, in order to prevent the progression of the virus' lesions into cancer.

Finally, a general point: I never said no parent should make the decision to vaccinate against this virus. My objection is to a policy of blanket vaccination, at the urging of one's pediatrician to children as young as 9. The power of the medical establishment to market this vaccine to ALL, and the consequences for society at large, are very dangerous.

[Jayme]

Regardless of whether one chooses to vaccinate their child or not, what does it say about our society that we are choosing to treat the byproduct and not the problem itself?

The problem is not that teenagers contract STD's; the problem is that teenagers are not taught the essential function of rational thought. Society continues to ignore the basic underlying issue with most people today; they do not know how to think.

Teenagers (and by extension the adults they become) are the victims of our societies aversion to reason and rationality; it is too hard to engage in and therefore to hard to teach. Instead of teaching our teenagers to make better decisions, why don't we just treat the consequences of those decisions? How absolutely ridiculous....and how incredibly destructive.

[ema]

There's a medical reason why preteens need to be vaccinated. Briefly:

-~75% of the population is exposed to HPV.

[Once infected, most people's immune system, and/or treatment keep the infection in check. The majority of people with the disease do not progress to cervical cancer. Unfortunately, it is not possible to predict how any one individual will react to being infected with HPV.]

-Currently, the way we deal with HPV is to intervene *after* the infection has occurred. However, the ideal approach is to prevent infection in the first place (hence the development of a prophylactic HPV vaccine).

-In the United States, the average age of menarche [first period] is about 12 years of age. Girls typically initiate intercourse in their mid to late teens. By the age of 20 many would have been exposed to HPV.

Bottom line: The aim of the HPV vaccine is to prevent infection. This is why it needs to be administered to an unexposed patient population (young children).

Also, a couple of notes:

Do 9-year-olds need to be immunized against the possibility of a sexually transmitted disease known as Human Papilloma Virus?

Keep in mind that the vaccine immunizes against cancer. [Of course, there are quadrivalent vaccines--against both cancer- and genital warts-causing HPV strains--in development.]

It is clear that this establishment believes chastity and abstinence to be unworkable and unattainable in the majority of cases.

It's not a question of belief, it's a question of HPV's mode of transmission, and population distribution. For cervical ca, short of complete abstinence (never being sexually active), abstinence does not protect from exposure. Your partner's infectivity status is the deciding factor.

My problem with this campaign by the medical establishment is not that the vaccine be used in cases where it is clearly warranted (i.e. rape) but that it may be used an excuse to give tacit approval to situations where sexual activity is neither healthy nor appropriate, i.e. children.

What makes a case warranted is exposure (or, rather, the lack of it), not the type of exposure (rape vs. consensual intercourse). You administer the vaccine to children because this is the unexposed population, not because it is healthy/appropriate for children to be sexually active.

And if I understand the usage of the vaccine correctly, it can be used AFTER the introduction of HPV into one's body, in order to prevent the progression of the virus' lesions into cancer.

The vaccine is designed to work before HPV exposure. It's been found to be 100% effective in *preventing* infection, not disease progression.

[Liz Neville]

Full disclosure for ema, who commented above: Please see website thewelltimedperiod.blogspot.com, with particular reference to the column "Extending America's Influence" dated January 15, 2006, as well as the one comment linked thereto.

[karen]

Liz,

It's self-righteous because you are very, very proud of yourself for being so modest and having such an 'morally upright' view of how a vaccine administered in the manner scientifically understood to be most effective is going to ruin our children.

If a teenager wants to justify having sex, despite the morally upright admonishments of her pro-abstinence parents, she'll be able to do so whether or not she's been vaccinated against a disease that is spread through sexual contact. "My parents don't know what they're talking about, and I know everything, and I'm invincible" is a much more common attitude than "My parents know what they're talking about and I care what they say, but secretly they don't really mind if I have sex - I know this because they had me vaccinated against a disease that I could catch if I had sexual contact, willing or unwilling, at any point in my life." If they're going down a list of reasons to ignore their parents, a childhood immunization is going to be WAY WAY down on the list, if it even appears.

Take it from someone who was a fairly rebellious teenager, despite having fantastic parents. You should want your child immunized at a young age, but perhaps more importantly, you want *other people's children* immunized at a young age. You're not just betting your daughter's health on your own (apparently bulletproof) parenting, but the parenting of her future in-laws, and the decision-making and responsibility of her future mate, and also luck (you know, that whole non-consensual issue).

If you feel comfortable with that bet, I feel sorry for your daughters, and I hope your sons never come ANYWHERE near my own daughters.

[Liz Neville]

Karen-- I wasn't trying to pick a fight with you, and I don't want this debate to degenerate into acrimony and personal slights. I assure you that my parenting style is not "bulletproof", nor do I harbor any illusions about Pollyanna children. In fact, I said just that in the last paragraph of my original piece.

I maintain my objection, not to parents taking advantage of what may be a very helpful medical advance, but to the power of the medical establishment to push this product-- along with all that it implies about our attitude toward sexual activity among children-- fully into the mainstream. Even granting that the vaccine is safe and effective (which is a leap of faith, given the instances of "safe" vacines that over time were proven harmful, or at the least, ineffective), I do not trust the medical establishment to decide what is right for the whole of society. We must consider the vast amount of power it has to influence and possibly intimidate parents. A case in point of this danger is the mass marketing of stimulants (amphetamines and derivatives) to children with potentially unfounded diagnoses of ADHD.

Finally, there is more to this than simply the medical aspect. Any discussion of sexual health will naturally be fraught with passion, witnessed here in these columns and comments. I am always suspicious of the stampeding crowd, regardless of the direction in which it is headed, and I detect a whiff of social engineering in this campaign to inoculate. I will continue to question the motives and agenda of the medical establishment in pursuing it.

[BlogReader]

Karen - Where are these daughters of yours coming from?

_BR

[mkubovchik]

The question I have to dissenters here is simple: Do you ever expect your daughters to become sexually active/get married? If the answer is yes, is it not clear that their partner/husband may be well carrying the virus already and thus will pass it on to your daughters? Very few of us would decline to marry someone we loved because he/she had had sexual activity prior to meeting them. Life just doesn't work like that.

It is Russian Roulette to guess when that first sexual activity may occur. You could well miss an opportunity to PREVENT CANCER. In any other context then sexual activity, why would parents not jump at this opportunity?

And why not give the vaccine to preteens when they are usually seeing a provider for other vaccines and medical care. This way an opportunity to PREVENT CANCER will not be missed. Once a teen is beyond the regular pediatric care checks and balances, she may not enter the medical system again until she has a problem or has already begun sexual activity.