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On Oct. 25, 2011, the Advisory Committee on Immunization Practices (ACIP) recommended that all 11- and 12-year-old boys be routinely vaccinated against human papillomavirus (HPV). This questionable decision should make Catholics re-examine the issue of HPV immunization and redouble their efforts to build a culture of life, particularly in matters of health and health care. A little history is in order to put this decision into proper context.
In June 2006, the ACIP recommended routine immunization of girls against HPV to reduce rates of cervical cancer among women. About 12,000 women in the U.S. get cervical cancer each year, and HPV, a sexually transmitted disease (STD), is the main cause of cervical cancer.
There are several reasons why the Catholic Medical Association (CMA) has recognized that immunizing girls against HPV can be an acceptable public-health policy and an ethical option that individuals or parents may choose.
In reputable clinical trials, Merck’s Gardasil and GlaxoSmithKline’s Cervarix have been shown to be safe and effective at protecting against some three to five strains of HPV, respectively (out of more than 40 total genital strains), which cause most cervical cancer. Both drugs are expensive, at about $130/dose, with three doses recommended for complete protection.
Still, cost-effectiveness models have estimated that a program of universal vaccination of adolescent girls will cost $23,000-$45,000 per quality-adjusted life year (QALY) saved, which falls within a range generally deemed acceptable for preventive medicine.
HPV immunization can be an ethical option for individuals and parents to choose. Of course, no one should choose a means of protection in order to purposely facilitate immoral action. But the Church does not demand that individuals be made to suffer the full effects of their bad judgments. And healing and preventing diseases, no matter what their source, are acts of mercy.
While it is possible to screen for and treat cervical cancer without immunization, such interventions bring their own burdens. False-positive results during cancer screening cause significant emotional distress for an individual and a couple. And surgically removing precancerous lesions can cause increased rates of both preterm deliveries and cesarean-section deliveries.
However, even with the most generous interpretation of the public-health policy and ethical analysis, significant questions remain. For example:
— What is the long-term effectiveness of HPV immunization? No studies have yet been published on whether the vaccines confer immunity for an extended period, e.g., 15-plus years. Moreover, it is still not certain whether HPV immunity in the teenage years will truly reduce cancer rates 20-40 years later, when most cervical cancer develops.
— What is the real (not theoretical) cost-effectiveness of HPV immunization? Current cost-benefit ratios are based on 70%-75% of all girls being fully immunized. But less than 50% of girls have received even one dose of vaccine; only 33% have received all three.
— Will there be negative behavioral responses to the immunization campaign? If immunized girls improperly feel “protected” — engaging in more risky, immoral behaviors and failing to consistently receive annual pap smears — then HPV immunization will fail to deliver the hoped-for benefits.
Even if a case can be made for the routine immunization of girls (while always respecting the free and informed consent of parents and individuals), the same case cannot be made for boys.
ACIP officials attempted to put the best spin on their decision — appealing to the goals of preventing more cancers, “gender equity” and adding a layer of protection for girls. But key differences exist in terms of public-health goals and cost-benefit analysis.
For starters, while Gardasil can prevent some precursors to cancer resulting from male homosexual activity, these cancers are less common and generally more treatable than cervical cancer in women. Because of this, and because the marginal benefit to girls of immunizing boys is relatively limited, the cost of prevention would rise from $23,000-45,000 to hundreds of thousands of dollars per QALY. This makes no sense in terms of sound public policy. Nor is it in the best interests of one of the ACIP’s target populations — boys engaged in homosexual acts.
If immunized boys feel protected, and engage in more risky, immoral behavior, while seeking less medical attention, the consequences for their physical and moral health will be devastating.
The ACIP’s questionable decision illustrates some key individual and institutional failings that are bringing our nation to a point of crisis. On the one hand, the promiscuous sexual behavior of many individuals is creating an epidemic of STDs, including the symptomless disease of HPV, which causes cancer years after it has been contracted.
On the other hand, a technophilic approach to medicine, combined with a big-government approach to spending and intervening in family matters, will create an expensive, bureaucratic solution of questionable prudence to a problem that can be better met through formation in the virtues.
Ideally, the ethical evaluation of HPV immunization should be conducted in terms of reliable data and moral prudence, yet the real world of American health care and public policy is charged with a variety of agents and agendas.
For example, the ACIP recommended routine immunization of girls in June 2006, even though the first phase-3 trials of the HPV vaccine with clinically relevant end points weren’t reported until May 2007.
From the start, Merck engaged in a political full-court press to persuade states to mandate HPV immunization. And, as the Catholics for the Common Good has revealed, Merck has given hundreds of thousands of dollars to medical societies like the American College of Obstetricians and Gynecologists to help persuade key decision-makers to encourage HPV immunization.
Most recently, these efforts culminated in a new law in California that permits children as young as 12 years old to accept HPV immunization without parental consent.
Catholics should not recuse themselves from this debate. They should be engaged both in challenging the secular solutions that are being put forward and in creating alternatives that better protect human health and human life.
John F. Brehany, Ph.D., is executive director of the Catholic Medical Association. Maricela P. Moffitt, M.D., M.P.H., is president-elect of the Catholic Medical Association.
Tim Drake: Catholic Doctors Gather to Express Concerns
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When the Polio Vaccine came out in 1955 I along with countless other children in NYC were the first to get it. Without prior in vivo testing at all. I do not regret it. Illness has no moral meaning other than to prevent it.
I wonder how many parents will immunize their kids against bad behavior but won’t continue to drill into them that that behavior is bad.
My husband and I were married in 1987. I had never had an STD in my life, but my husband disclosed to me that he had genital herpes. At that time, the current wisdom was that he could infect me with herpes only if we had sexual contact during an outbreak. Turns out this isn’t true. So although we were “careful,” within a year, I was infected with genital hepres, too. (I was made so sick from it, that for an entire summer, I could barely leave our home.)
Although it is true that the manner in which my husband contracted herpes represented a moral failure on his part, this is not true on my part.
The point of all this is that innocent, faithful spouses can also become infected where the other contracts an STD. And also babies may become infected with an STD transmitted through contact with their mothers’ bodies as they are being born.
This is not just about making risky behavior safer - it’s also a good thing to protect spouses and infants: to protect families.
The polio vaccine one commenter mentioned actually increased the rate of polio, as many people got it FROM the vaccine. As for Gardasil, I wonder why no one has mentioned the way it is produced. That is a whole ethical can of worms right there.
More propaganda from and money for the pharmaceutical industry drug pushers and the godless quack distributors that call themselves medical professionals… disgusting and loathsome parasites.
The HVP vaccine has caused numerous deaths and thousands of adverse affects (many life-altering like Guillain-Barre Syndrome). This is largely due to the fact that the vaccine was made available to public after few tests(the fact that all major vaccine safety tests are funded by the pharmacutical companies themselves should also be noted). As long as Big Pharma is able to financially persuade politicans to mandate unnecessary and unproven vaccines (and not be held responsible through a Congressional act that let all vaccine-makers off the hook for adverse reactions), our children will just be lab rats and money-makers for the rich.
While the authors are absolutely right to encourage ethical reflection, caution, and careful study of the vaccine’s effectiveness, their analysis does not account for one major benefit of vaccinating boys: herd immunity. (see http://en.wikipedia.org/wiki/Herd_immunity for a short summary of the concept). HPV, a sexually transmitted disease, is passed from male to female (or female to male) in the heterosexual population. Vaccinating boys allows us to break the “chain of infection,” since a boy who is immunized cannot be infected with these HPV strains, and thus cannot pass them on to a female sexual partner. By administering Gardasil to boys, we can indirectly prevent girls and women from being infected, which (as the authors and others have shown) is fairly effective at saving QALYs and has substantial private health benefits.
Of course, it may turn out that vaccinating boys in large numbers has only small indirect effects on womens’ infection rates, and is thus not “cost-effective” in the public health sense. Only time and experiment will tell. But I believe that the authors (and all Catholics) should include the possible benefits of herd immunity in their discussion of this (and all other) vaccines.
Unfortunately HPV is endemic and continues to cause much suffering & death. Death from this disease can truly be horrific, leaving children without mothers and husbands without wives.
If we can save lives with a vaccine why is it treated differently than the polio vaccine example. This is a public health issue. There are risks with all of the common vaccines we have today. Imagine a world without vaccines. If this was a vaccine for breast or colon cancer, would it be different.
AVVA: that is a fair observation—but how many twelve-year-olds do you know who are even thinking about getting married?
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I am concerned with all these girls who are getting the first dose and not the others, could that be worse than having none at all? Like taking only a half course of antibiotics? I don’t know, I am just wondering if anybody behind the vaccine had the foresight to ask it.
After reading the article, and then all the posts following, I must say that I am confused.
“If immunized boys feel protected, and engage in more risky, immoral behavior, while seeking less medical attention, the consequences for their physical and moral health will be devastating.”
This is just idiotic. Young men are virtually all unaware of HPV and its delayed consequences to women (surfaces as ovarian cancer 20 years + later). So it is implausible that HPV immunization would have a measurable effect on behavior.
Its an insidious virus that causes cancer that we can now control - do you want your daughters to get this virus? (Because it is likely they will.)
Its not “moral” issue, its a stupid virus that happens to be transmitted largely through sexual contact. By immunizing starting with today’s teens we can systematiclly drive down the rate of HPV in the population over a few decades. It is mathematical. The risks of gardasil are exceeded by the benefits. If this virus was spread by an insect vector we would not object to the vaccine.
Yet one more thing to “infect” our kids with. They receive way too many vaccines as it is and now another that they don’t need. One of the developers even admitted that they give it so young because it takes 20 years for the vaccine to actually take effect. Then it really doesn’t work in most and it does harm a large percentage of people that receive it. The researcher admitted that the only and best way to prevent cervical cancer is through Pap smears.It’s just like giving a newborn that is less than 24 hours old a hepatitis B shot because they may be sexually promiscuous when they grow up. These poor don’t need all these shots.
It’s also a fact that HPV is found in 80% of the population. Yes, it transmits sexually. It also transfers to children. Still, the STD is in most cases benign. The vaccine does nothing to improve the odds of a bad reaction. In fact, it hurts it. The video above links to primary sources, and touches on how immoral the business practices behind this vaccine are
better then I can in one paragraph: http://www.youtube.com/watch?feature=player_embedded&v=O7LH9TRCHuA
It is remarkable how often opinions are offered as facts, and facts are manufactured out of opinions.
Karen, polio cases did occur from the vaccine but that was 1955 or so and the manufacturer, the Cutter Corporation, was found to have been responsible for an error in manufacture. Since then, look at the collective experience of humanity - polio is close to being eradicated because of the use of vaccines. Kelly, none of the numerous vaccine-reaction databases support your assertion of “numerous deaths and thousands of adverse effects.” Vaccine licensure in the United States is a lengthy and oversight-filled process. It is not a casual, devil-may-care-if-you-pay-us-enough approval process, regardless of what you believe. Finally, nowhere in the ACIP recommendation is there any mandate for use.
What if the child chooses to go into religious life where sexual contact is not even a possibility?
Just call me Thank God I’m A Virgin
@ LRoy If that were true we would not have all these law suites!
Maybe if dch & all the other “experts” were to take these vaccines (at their own expense) & IF they survive, then they might have a case, EXCEPT that God says something else: THE WAGES OF SIN IS DEATH, & any sex outside of a proper marriage is SIN. With all the new super strains of STDs (mostly caused by the actions of P.P. & “sex education” it would be impossible to prevent any of them except by God’s way: abstinence. I would have to believe that those informed people that say the risks is small & the “benefits” great, don’t have any daughters whose lives have been destroyed or taken away. Condoms are dangerous & useless and as was properly mentioned in the article, these shots will make people feel “safe”. For all those that say right on to any type of shots are the ones that need to save themselves for their mates & not for their sinful desires. The woman above that “thinks” this shot would have prevented her from her nightmare is so far from the truth. She should have gotten an annulment, which in her case, would have legitimate. As for the beginning of the article, especially by the “catholic medical association”: WHAT IN THE WORLD ARE THEY THINKING? It surely isn’t the teaching of the Roman Catholic Church!!! Have mercy on us dear Jesus. +JMJ+
JMJ any sex outside of a
proper marriage is SIN. If only the clergy knew this truth. Those are the FACTS.
I’m a current Catholic MD/PhD student attending a Catholic medical school in the US and I strongly disagree with this article.
We vaccinate boys from Rubella virus and we should vaccinate boys from HPV. When I received my Hepatitis vaccinations as a child (mandatory vaccinations to start school), I wasn’t told this would make illicit drug use safer for me.
I wish premarital sex was viewed by culture as wrong as illicit drug use. Still, I think we have an ethical and moral obligation to prevent disease as able. I don’t think preventing disease encourages risky behavior but the data should be carefully reviewed on that.
I think this is the wrong fight, and as Catholic medical professionals we ought to be focused on the sin of contraception rather than attacking very good vaccines. Let’s spend more time developing creative, life-giving ways to promote abstinence.
I would argue that if such a vaccine saves even a single life, it makes it worth it. That is to say, morally speaking, that a life outweighs potentially ‘sinful’ behavior that might be caused. This is, of course, my personal belief, but i believe it to be one generally accepted.
Elizabeth, where are you getting your information? HPV shows no symptoms in the majority adults. Yes, deaths do occur from HPV, but you’re more likely to get hit by a car. The problem I see with the vaccines is that there is documented proof that there are more deaths from people immunized than there are from untreated HPV. Vaccines induce the virus into a person with the hopes that the person will create anti-bodies, and beat the virus. You’re giving people HPV to protect them from HPV - a virus that either does nothing, or can kill you. The vaccine simply makes sure you’re HPV positive.
On June 1, 2008 we buried our 23 year old daughter Kristen after a year long courageous battle against HPV caused cervical cancer. Our family sure would have liked to have had her male friend vaccinated. Case closed.
Vaccines are not a cure, but a prophylactic measure (preventative). The HPV vaccine, however, is more often than not a non-prophylactic, or secondary prophylactic treatment, as 80% of people in the world are positive for HPV. It can be transferred by birth. Two centuries ago, maybe a vaccine would make sense, but if you give the treatment to someone who has HPV, the chances of getting cancer are ridiculously higher. It’s a tragedy that your daughter passed away, but the vaccine, as it exist now, would have only killed her sooner.
To “Genuinely Concerned” Not only is your whole statement unfounded but, it is also just plain stupid. As a doctor and a patholigist I can say you do NOT know what you are talking about. Your comment about the yougd girl is not only mean spirited but lacks any compassion. You should be asking God for Mercy for your own attitudes.
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