The Great HPV Debate

Immunization is in the news again. This time round it has rekindled the debate of public health versus private capacity. On Feb 2, Texas governor, Rick Perry signed the landmark order that preteen girls seeking admission in schools in the state be immunized against the HPV – human papilloma virus. Illinois and 17 other states are about to follow with similar laws.

At the core of the debate are several issues that underline how the models of delivery of public health are inadequate at present. Another dimension to the problem is of a moral-social dilemma.

What is HPV and how does it concern us?

The HPV includes four different strains of virus that cause nearly 70% of cervical cancers in women. The virus is the most common infectious agent in the US affecting nearly 20 million people. At least 50% of sexually active people acquire HPV at some point. For about 6 million there is progression into full-blown disease. Cervical cancers are the third most common in women coming behind breast and skin cancer.

Gardasil, developed by Merck and Company, is the latest vaccine against HPV. The product has turned the spotlight once again on the effectiveness of vaccination delivery systems in the US and the large number of adults and children who go without vaccination.

Gardasil is a three-time vaccine with each shot costing about $120. Now, the prohibitive cost is apparent and many would be put off. But, if we were to put forth that an adequate insurance plan would provide for vaccinations, there is only proof that nearly 60% of private insurers do not cover specific vaccination costs. So, roughly 1 million Americans go without vaccination just because their plan does not cover all of the vaccines they should have.

Doctors and public health experts say to deprive people of the benefits of good vaccines just on account of high costs is a grievous social trend. The US government is the largest purchaser of vaccine supplies and vaccination levels are at an all-time high. For children who are identified as belonging to low-income groups or underinsured families, there is the Vaccines for Children program. However, these cover the medically mandatory vaccines. Other vaccines that protect persons from diseases that require high cost treatment or certain fatality are not included.

While all agree there is a need for better coverage of vaccination in the community, issues of shouldering the costs in a fair manner and the social benefits that far outweigh short-run high monetary costs should be examined in detail.

Another aspect of concern with HPV vaccination is the notion that it could lead to permissive attitude and pre-marital sex. HPV vaccination should be ideally administered in the age group of 11-13 although one could start even when a girl is just 9. Parents believe vaccination could prevent girls from acquiring sexually transmitted diseases. Thus, they feel relieved they need not discuss sensitive issues with their daughters. But, what is more relevant is responsible sexual attitudes. Therefore, educationists point to creating adequate awareness about STDs and leave sexual behavior to individual choice.