The Politics of the HPV Vaccine Debate
September 9, 2011
Web and Social Media Assistant, Global Health Policy Center
Gardasil - the vaccine that protects women and men against four types of Human papillomavirus (HPV) that together cause 75% of cervical cancer cases and 90% of genital warts cases - has been making headlines recently.
- According to a new study by the Centers for Disease Control and Prevention (CDC), the use of Gardasil has stagnated in comparison to other vaccines. Only 49% of teenage girls have received one of the three required shots.
- In California, Bill AB499 which mandates vaccination of all 6th grade girls in the state, just narrowly passed the legislature along party and ideological lines. It triggered strong anti-vaccine sentiment from religious conservatives.
- And Governor Rick Perry, who is now running for President, reversed his 2007 decision to mandate the use of the vaccine in Texas, calling the order "a mistake."
Historically, vaccines have innately been controversial. Debate abounds as to whether vaccines are a matter of individual choice, parental choice, or state rights. When it comes to Gardasil, however, the argument becomes even more heated because this particular vaccine is relatively new and it pertains to adolescent sexual behavior.
While I understand the inherent controversy, Gardasil – in my opinion – appears to be a smart and obvious choice. HPV is the most common sexually transmitted infection. With over 40 types of HPV, the CDC reports that "HPV is so common at least 50% of sexually active men and women get it at some point in their lives." In America, approximately 20 million people are infected with HPV and another 6 million will become infected every year. Certain strains of HPV can cause genital warts and lead to cervical cancer, a disease that kills over 3,000 American women every year. And yet, people are strongly opposed to Gardasil - a vaccine that helps protect against four types of HPV. Why is this?
In an insightful op-ed in the Huffington Post, Jeffrey Levi - Executive Director of Trust for America's Health, lays out possible reasons for why HPV vaccination rates are so low: the high cost of the vaccine (Gardasil is not covered by all insurance policies), lack of education about the vaccine, and racial, ethnic and poverty disparities for HPV vaccination completion. I believe many of these reasons translate to why there is low use and in some instances, active opposition towards Gardasil.
There also exists the argument that only a tiny percentage of people with HPV develop cervical cancer and those who develop genital warts can live with their condition.
Additionally, there is a very significant religious dimension to the debate. In both the California and Texas mandate deliberations, people worried that promoting Gardasil was an endorsement of sexual promiscuity. Indeed when defending his 2007 decision, Governor Perry had to phrase his backing of the vaccine as a “pro-life” attempt to protect women’s health. In the September 7th Republican debate, however, when challenged on this very decision, Perry returned to defending his mandate, saying he acted to protect girls against cancer.
While all of these present plausible reasons why the vaccine is not gaining widespread popular support, I believe that America’s highly partisan political environment and the upcoming Republican primary are reshaping the HPV vaccine debate. Instead of hearing about Gardasil as a life-saving vaccine, we are hearing arguments that mirror the platforms of our Republican presidential nominees: we don’t want government interfering in our lives. In the September 7th Republican Debate, candidates Ron Paul, Michelle Bachmann, and Rick Santorum attacked Perry’s 2007 mandate on these grounds. In a recent interview, Rick Santorum stated:
"To require [the HPV vaccine], and have parents have to be aware of it and have to opt out, that is the heavy hand of government… That is something I’d expect from Barack Obama, not someone who says they’re a conservative.”
Whether you agree or disagree with state mandates for the HPV vaccine, I think it is extremely unfortunate that our current political environment is branding Gardasil as an engine of big government. Here we have a powerful new tool to protect millions of women and girls against a sexually transmitted infection and cervical cancer, but it is has been reduced to a prop in our national political debates. When stigmatizing the HPV vaccine becomes a talking point of our candidates, the important value of this vaccine is lost. Parents are no longer presented with reasonable facts upon which to make their decisions, but rather divisive partisan bickering that impedes substantive discussion.
In the end, the debate behind the HPV vaccine needs to change. Gardasil is neither a tool of government control nor a mandate that should be enforced upon citizens; Gardasil is a smart choice for both men and women to protect against a sexually transmitted infection. It needs to be presented and understood as such.
- Video: Heidi Larson Speaks on Vaccines and Public Behavior
- GAVI Going Forward
- GAVI Pledging Meeting Brings Good News