WHO NEEDS THE HPV VACCINE? Merrill Goozner opposes mandatory HPV vaccination for sixth-grade girls in the U.S. He writes:

By insisting that all young women get this vaccine, public health officials (the Centers for Disease Control last June endorsed universal vaccination, although its recommendations are not binding on the states, which carry out public health policy in the U.S.) are in essence saying it is impossible for the health care system to identify and treat older women who have already become infected and are at risk of getting cervical cancer.

Attempting universal vaccination is NOT the same thing as saying it's impossible to treat those at risk. Sure, HPV is not likely to be deadly for upper-class women who are well insured and getting regular reproductive health care. But women who find out they have one of the strains of HPV that is likely to cause cervical cancer must return to the gynecologist multiple times a year for pap smears. Because we're talking about upper-class, insured women, they can likely bear the financial cost. The time and discomfort involved are another matter. I know Goozner has never had one, but pap smears aren't exactly a picnic in the park. I know I'm not in the highest-risk group for dying of cervical cancer, but I'm getting the vaccine because I'd like to avoid having to return to the gyno over and over again to ensure cervical cancer has not developed. Maybe Goozner would feel differently if he faced the prospect of having his penis swabbed every three months.

He also writes,

Since we don't yet know the long term risks, if any, from this vaccine, from a medical point of view it makes the most sense to give it to young women who are most at risk from the disease, for whom the reward-risk ratio is highest.

I agree. But, in my mind, this only strengthens the argument in favor of making it mandatory for school entrance. As I wrote in my TAP Online column a few weeks ago, mandatory vaccination is the best way to reach these lower-income girls who are most likely to have limited access to reproductive health care later in life. Drop-out rates begin at 13, and historically, requiring vaccines for school attendance has helped to close racial, ethnic, and socioeconomic gaps in immunization rates.

Will it be expensive to require this vaccine? Absolutely. But the alternative, if our goal is preventing cervical cancer deaths, is an overhaul of our health care system to ensure that all lower-income women are getting regular pap screenings for the disease. I definitely wouldn't oppose such an effort, but I doubt it would be a cheaper option than widespread vaccination.

Goozner is perfectly comfortable with not having his own daughter vaccinated, presumably because she's currently 13 years old and said "yuck" when she was told that HPV is spread by sexual contact. But I highly doubt that she is going to tell her father immediately when she does become sexually active. "Hey pops, I'm ready for that HPV shot now!" Yeah, I just don't see it happening, even if he's very close to his daughter. Even so, all states allow families to say no to required school-entry vaccines if they object for medical, moral, or religious reasons. So Goozner is welcome to opt out and wait to have his daughter vaccinated until he thinks the time is right.

--Ann Friedman

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