Too Many Parents Are Blowing It: Kids Need The Nanny State To Require The HPV Vaccine
The news is good, but it could be so much better. The journal Pediatrics recently published a study that compared the prevalence of the human papillomavirus (HPV) in American girls and young women in the years before and after the HPV vaccine was first recommended in 2006.
CONCLUSIONS: Within 6 years of vaccine introduction, there was a 64% decrease in 4vHPV type prevalence among females aged 14 to 19 years and a 34% decrease among those aged 20 to 24 years. This finding extends previous observations of population impact in the United States and demonstrates the first national evidence of impact among females in their 20s.
[snip] Although rates of HPV vaccination have been increasing in the United States, coverage is still low; in 2013, a national survey found that 57% of 13- to 17-year-old females had received at least 1 dose and 38% had received 3 doses. [NOTE: The recommendation is for a 3 dose course]
This is incredibly important because HPV causes some really nasty forms of cancer. For women, just about every case of cervical cancer -- which, according to the CDC, "usually does not have symptoms until it is quite advanced and hard to treat" -- results from HPV. Over 4,000 American women die from it every year. Overall, 18,000 women and 9,000 men get cancer of some kind from HPV (others include cancer of the vulva, vagina, penis, anus, and back of the throat).
Additionally, more than 400,000 American women are diagnosed annually with pre-cancerous cervical lesions resulting from potential HPV infections. These women may undergo multiple cervical biopsies, and many require the removal of a portion of their cervix. This can increase the risk that they will deliver prematurely in the future. Premature birth is the number one risk factor for infant death, and one of the leading causes of brain damage and numerous other health problems in children. Oh, and don't forget that HPV can also lead to genital warts. Lovely.
Additionally, only about 20 percent of boys aged 13 to 17 are immunized. This matters both for their own health, and because boys and girls spread HPV through sexual activity. The previous two words are the ones that largely explain why vaccination rates in the U.S. aren't higher.
First, doctors aren't recommending the vaccine strongly enough. Here's what a University of North Carolina study found:
Background: Low human papillomavirus (HPV) vaccination coverage stands in stark contrast to our success in delivering other adolescent vaccines. To identify opportunities for improving physicians' recommendations for HPV vaccination, we sought to understand how the communication context surrounding adolescent vaccination varies by vaccine type.
[snip] Conclusions: Our findings suggest that primary care physicians perceived HPV vaccine discussions to be burdensome, requiring more time and engendering less parental support than other adolescent vaccines. Perhaps for this reason, physicians in our national study recommended HPV vaccine less strongly than other adolescent vaccines, and often chose to discuss it last.
One young woman's story exemplifies this problem. When Vanessa Laven was a college student and resided in the suburbs near New York City -- not exactly the most conservative of areas -- she made an appointment with her gynecologist and asked for the HPV vaccine. What did her physician say? You don't need it. Why? Because, he said, she's a "good girl" from a "good family." She didn't get the vaccine, and now has to live with the consequences of that paternalistic advice.
"It was totally about sex," said Laven, now 29, living in Minneapolis with her husband, and, sadly, positive for both HPV and the precancerous cell growth associated with it. "The discussion of the vaccine was tied up with some old-fashioned notion of virtue."
Then there's the parents. Some parents in this country are simply opposed to vaccines in general, as Mickey Mouse and the rest of us learned the hard way about a year ago. But the specific resistance to HPV vaccination goes far beyond that general anti-vaccine hysteria. As with Vanessa Laven's doctor, it's about sex.
There are some parents who think that their teenagers -- and this applies even more so with girls -- won't have sex and shouldn't have sex and sex is bad and how dare you bring up sex? These are many of the same people who think sex education should consist of teaching abstinence only because anything else will give kids the "wrong idea," and will somehow encourage them to have sex by making it less dangerous. Apparently, these parents think HPV vaccines are just as threatening to their morality as students learning to put a condom on a banana. And they're right -- but not in the way they'd expect.
Research shows that young people who get comprehensive sex education are "not more likely to become sexually active, increase sexual activity, or experience negative sexual health outcomes." The same is true for those who receive an HPV vaccine. A study from the Journal of the American Medical Association (JAMA) found: "Human papillomavirus vaccination was not associated with increases in [sexually transmitted infections] in a large cohort of females." Finally, the HPV vaccines are safe. There have been no documented side effects beyond "brief soreness and other local symptoms at the injection site. These problems are similar to those commonly experienced with other vaccines."
I know, I know, how can science compete with what people know in their gut? All kidding aside, what kind of person says: I know this vaccine might save my children's lives, but -- without any basis in fact -- I think it might encourage them to have sex at a younger age, so I won't let them have it. That's a kind of insanity that I -- a parent of two girls myself -- simply cannot fathom.
There's a pretty high likelihood that, at some point in their lives, my daughters will be sexually active. When that day comes, I couldn't live with myself if I had done anything to increase the risk that they'll die from it. That may not be the way some parents think of their actions, but that is the reality.
As a society we are reluctant to increase the reach of government, to expand its authority in ways that interfere with liberty. That's a sound instinct in general, as government should step in only when actions by private citizens prove ineffective or harmful. And that is the case here. Liberty is one thing, but parents denying their children potentially life-saving medical care is another. The vaccination needs to take place before the onset of sexual activity, as it will not help a person who has already been infected with HPV. That's why the medical community, through the Advisory Committee on Immunization Practices (ACIP), recommends vaccinations begin at age 11-12.
If parents won't get their kids vaccinated on their own, we have to require it for the sake of their children, just as many states do for multiple other vaccines. The least we could do is offer it in schools, like other countries do. Rwanda has a 93 percent HPV immunization rate for girls. Why don't we?
We cannot allow Victorian attitudes held by adults about sex to put their children's health and lives -- disproportionately female lives -- at risk. Call it the nanny state, call it big government, whatever. But let's also call what the anti-HPV vaccine parents are doing to their kids by the right name: child abuse.
A version of this post originally appeared on Daily Kos.
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