The Slut Shot

Will the HPV vaccine encourage sexual freedom or right-wing lunatics?

Conservatives are winning most of the battles over sex education. Abstinence-only programs have gained such a hold that I've lost hope of people under 18 getting honest, useful information about sexuality in a public school classroom. The right wing's refusal to teach teens or provide contraception to them is supported by flawed ideas: (1) To acknowledge that young people are sexual beings robs them of their innocence; and (2) if we give them sexual information and make condoms, latex gloves, dental dams, and birth control easily available, they will run out and have sex because we encouraged them. When the FDA approved the human papilloma virus (HPV) vaccine earlier this year, women's-health and reproductive-rights advocates braced for another battle engaging sexual freedom, choice, and consent.

In June the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control (CDC) voted unanimously to recommend that all girls age 11 and 12 receive the HPV vaccine. Research has shown that the majority of cervical cancers are caused by HPV. In the U.S., approximately 6.2 million people a year contract HPV; at least half of all sexually active people will be infected with the virus at some time in their lives, making it the most common sexually transmitted disease out there. Studies found that the HPV vaccine was most effective when given before a woman became sexually active; while 11 or 12 is the suggested age, the committee recommended the vaccine be given to females as young as nine. The vaccine, Gardasil, was developed by Merck and targets four (of more than 100) strains of the HPV virus most likely to cause genital warts and cervical cancer; together, the four types cause 70 percent of cervical cancers and 90 percent of genital warts. Although the CDC's acceptance of the committee's recommendations is likely, there are important unresolved issues.

Who will foot the bill for the proposed widespread immunization? (Retail price: $120 per dose or $360 for the full series of three doses.) Insurance companies usually cover ACIP-recommended vaccines, but only Aetna and WellPoint Inc. have officially committed to covering it thus far. The committee also recommended that the vaccine be funded by the federal program that provides no-cost immunizations to children on Medicaid as well as uninsured and underinsured kids. In addition, Merck has said it will establish a program for uninsured women 19 and older to receive free vaccines through private practitioners who offer other free Merck medications. None of these programs are in place yet.

Each state sets guidelines about what vaccinations students must have in order to attend school. (In nearly every state, parents can refuse to vaccinate for personal or religious reasons.) At issue now is whether states will make the HPV vaccine mandatory or not. Most conservative groups, including the Family Research Council, backed off their original objection to the vaccine and now support its widespread use. However, they've clung to their moral high ground in their opposition to making the vaccine mandatory. They claim that it's all about choice (ironic, huh?), but let's be real: They need to separate themselves from the promiscuous masses somehow. It's as if they're saying, "Oh, we totally agree that girls should be getting that HPV vaccine. But our girls don't need to get it because they are virgins now and will be virgins until their wedding day. But we have no problem with other people's skanky, slutty daughters getting the shot." To support its compulsory use would contradict their investment in teaching—and believing their kids are practicing—abstinence until marriage.

Their morality hits the most disadvantaged girls: If a state does not make the vaccine mandatory, it may not receive necessary federal funding to support programs for low-income and uninsured girls. Right-wing parents' opposition to mandatory vaccination could also put their own daughters' health at risk. Teenage girls can get STD information, birth control, and in 17 states, an abortion without parental permission or notification. Yet doctors need permission from parents to administer any vaccine to someone under 18. Parents in denial about their teenagers' current or future sexual activity can prevent them from getting the HPV vaccine unless a law is passed saying otherwise.

There is a small but dedicated group of people who oppose other vaccinations, and I wondered where these people would come down on this issue. After all, this vaccination could prevent not just a serious disease but a deadly form of cancer—one with which, in 2006, the American Cancer Society estimates that 9,700 women will be diagnosed and from which 3,700 women will die.

The National Vaccine Information Center (NVIC) critiques vaccines and educates the public about the risk of serious reactions. According to its website, the NVIC believes that Gardasil was fast-tracked by the FDA without proper safety testing. Their chief concern is that "Gardasil contains 225 mcg of aluminum and, although aluminum adjuvants have been used in vaccines for decades, they were never tested for safety in clinical trials. . . . Animal and human studies have shown that aluminum can cause nerve cell death and that vaccine aluminum adjuvants can allow aluminum to enter the brain, as well as cause inflammation at the injection site leading to chronic joint and muscle pain and fatigue." The NVIC claims that 90 percent of study participants who received Gardasil and 85 percent who took the placebo (which, incidentally, also contained aluminum) complained of one or more adverse reactions including pain, swelling, headache, fever, nausea, dizziness, vomiting, diarrhea, and myalgia.

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