Monday, June 12, 2006

Rejecting Vaccine "Choice"

By now, pretty much every blog reader in the Western world knows two things about human papillomavirus (HPV), the virus which causes cervical cancer: the FDA has approved an effective vaccine, and the Religious Right doesn't want children to be vaccinated.
"I've talked to some who have said, 'This is going to sabotage our abstinence message,' " said Gene Rudd, associate executive director of the Christian Medical and Dental Associations. But Rudd said most people change their minds once they learn more, adding that he would probably want his children immunized. Rudd, however, draws the line at making the vaccine mandatory.

"Parents should have the choice. There are those who would say, 'We can provide a better, healthier alternative than the vaccine, and that is to teach abstinence,' " Rudd said.
Enough has already been said about the outrageous awfulness of preferring the risk of cervical cancer to the risk of sexual activity - my personal favorite comment comes fromKatha Pollitt: "Faced with a choice between sex and death, they choose death every time."

My major concern is that they not be permitted to get away with co-opting the language of choice for pernicious purposes. The idea of vaccine choice sounds reasonable on its face; Americans tend to believe that parents should be given wide latitude to make health decisions for their children, and some parents from both sides of the political spectrum choose to refuse all vaccinations for their kids. So Focus on the Family's position statement [PDF] - "Focus on the Family supports widespread (universal) availability of HPV vaccines but opposes mandatory HPV vaccinations for entry to public school." - looks, at first glance, like a reasonable compromise.

But "choice" is a red herring. Focus on the Family has religious objections to the HPV vaccine? Religious exemptions to mandatory vaccines are already available in every state but West Virginia and Mississippi. (Anyone think that Focus on the Family would have trouble convincing the Mississippi or West Virginia state legislature to add in a religious exemption for the HPV vaccine? Me neither.) They will have the right to opt their daughters out of this health-, fertility-, and potentially life-saving vaccine, mandatory or not. What they're really angling for is a way to deny it to other people's daughters.

If it's easy to opt out, why the battle over mandatory? Because mandatory = affordable. States cannot make a vaccine mandatory for school entry unless they are willing to provide it to those who cannot pay. And thus, through the CDC's Vaccines For Children program, every state supplies children with required vaccines free of cost. But optional vaccines are a different story. For example, check out this price list for various optional vaccines at the Shelby County (Tennessee) Health Department; the price per shot is as high as $96. Required vaccines at the same clinic cost $8. And that's at a health department, which is pretty much the cheapest place to get vaccinated anywhere. Put simply, if the HPV vaccine is not made mandatory, it probably won't reach the low-income women and girls who need it most. Of course, that means that the Religious Right's tax dollars won't go towards providing women with an immunological license for promiscuity... and don't think that they aren't thinking of it that way.

It's important not to underestimate the threat that the HPV vaccine poses to the Religious Right. For years, they have used HPV as the centerpiece of their anti-condom, anti-sex-education campaign. "The HPV Epidemic: Condoms Don't Work", proclaims a widely-reprinted statement from the Family Research Council. The National Physicians' Center for Family Resources has a pro-abstinence, anti-condom broadsheet that focuses exclusively on HPV. When Tom Coburn tried to get cigarette-style warning labels placed on every condom, HPV was his justification. It's true that condoms don't provide full protection against either HPV or herpes, because viral shedding can occur from areas not covered by a condom. But condoms do reduce transmission risk, and of course they provide excellent protection against other STDs. But the anti-sex Right has misused HPV to tell teenagers that condoms are completely useless. (Is it any surprise that teens in abstinence programs are less likely to use condoms when they do have sex?)

The development of a safe and effective vaccine for HPV means that the abstinence movement just lost its poster virus. They're going to fight this one, and fight it hard.

So what can you do?

1. Contact the members of the CDC's Advisory Commitee on Immunization Practices and tell them that you want the HPV vaccine to be added to the mandatory schedule. You might want to specify that you believe that state religious exemptions provide adequate protection to parents with religious objections.

2. Contact your state's Vaccines For Children coordinator. Let them know that you want the HPV vaccine to be included in your state's free vaccine program.

3. Find out whether your state allows adolescents to be vaccinated without their parents' consent. If not, lobby for the right of girls to receive the HPV vaccine regardless of their parents' consent, just as they are currently able to receive STD treatment without parental consent.

4. Spread the word: the CDC funds free or low-cost breast and cervical cancer screenings in every U.S. state and territory. If you've been avoiding a Pap smear because you don't think you can afford it, give them a call at 1-800-CDC-INFO.

5. Write a check to Planned Parenthood. They're going to need the money.