The American Cancer Society estimates that approximately 3,670 women in the United States will die from cervical cancer this year, with about half of all diagnosed between the ages 35 and 55. Around the world, that number soars to about 270,000. Cervical cancer is an anomaly among human cancer types due to the fact that the progression of the disease is actually kick-started by a virus. Human papillomavirus is sexually transmitted and is directly responsible for an estimated 70 percent of all cervical cancer cases. There is now an effective vaccine to prevent up to 70 percent of cervical cancer cases in the United States. Surely one would expect this vaccine to be welcomed with open arms by both the general public and legislators alike, but this is not the case. The state of the issue is such that the hurdles are political, not technical. In other words, for the first time in history it is possible to prevent a great deal of cancer deaths using a vaccine, and society hesitates.
One of the reasons why cervical cancer is so devastating is that, unlike many other cancer types, it regularly occurs in midlife. Similar to breast cancer, many of those affected may have families that are dependant on them, and may not have yet accomplished what they wish to accomplish in life. It is because of this that cervical cancer also carries with it severe emotional and social impacts.
The HPV strains in question are fairly common. A recent article in the New York Times reports that ‘at least half of sexually active men and women acquire genital HPV at some point in their lives.’ The first vaccine developed to combat HPV is known as Gardasil. Produced by Merck, it protects against the strains of HPV that are attributed to 70 percent of cervical cancer and 90 percent of genital warts. However, the vaccine only works against preventing infections, not combating current ones. The FDA recommends the vaccination of young girls before they become sexually active, or before they would come in contact with the virus.
But the preventive solution is unpopular with some, including the Texas legislature, which in February issued a political backlash against Governor Rick Perry’s mandating the HPV vaccination be included with other required vaccinations for middle-school girls. The debate brought to the surface several major objections to the vaccine.
The first objection is monetary. At $360 per person, immunization using Gardasil would be fairly expensive. The very notion of a monetary objection to saving innocent lives and preventing human suffering is preposterous in itself, but if one completely severs emotional attachments to the debate and only considers numbers, it is still in the best interest of legislators to back the vaccine. The March 2007 issue of the American Journal of Obstetrics and Gynecology published an article on the economic burden of HPV that included the compilation of nine studies on the subject. It was noted that ‘the annual health care costs of human papillomavirus-related conditions in the United States range from $2.25-$4.6 billion (2005 US dollars).’ To further put this in perspective, the journal notes that the burden of HPV is second only to HIV among sexually transmitted diseases.
It is likely that the large scale production of the vaccine may bring down the cost to Medicare providers. In addition, prices will likely drop with the production of competing vaccines, such as Cervarix by GlaxoSmithKline. The Philadelphia Inquirer reports that they are currently seeking FDA approval for Cervarix and that the vaccine might be on the market as early as October. Cervarix could offer improved benefits in its own right, but the common thread between the two vaccines is that they are both preventive, not therapeutic. In order to be effective, the vaccines must be administered to girls before they become sexually active or acquire the virus.
The second major objection comes mostly from the religiously charged right. The assertion is that immunizing young girls against HVP would encourage sexual promiscuity. This makes as much sense as claiming that wearing seatbelts will encourage reckless driving. The fact that HPV is the root cause of cervical cancer was not in the public spotlight until recently, and most young girls probably still have no idea what HPV is. It is likely that HPV was not a determinant before, so it is not logical to claim that a vaccine against it will actually increase promiscuity in the future. One could even argue that the increased emphasis on preventing sexually transmitted diseases and the discussion it entails might foster a more conscious youth and, thus, wiser personal decisions about sex. After all, cervical cancer is nothing to laugh at.
Vaccination against HPV should be mandatory and should be subsidized by the government. The monetary cost of vaccination will drop. It’s just a matter of time. HVP and cervical cancer, like tetanus, smallpox, chickenpox and hepatitis, is a disease that is preventable via vaccination. Like HIV, a person can have HPV for years or decades before symptoms arise, and during this time they can still pass it on to others. In the interest of public health, this should be regarded just as any other vaccine. But perhaps we should consider the alternatives. It would be inconceivable to simply let people die from a disease that is preventable, and to do so in the hopes of fostering more informed decisions about sex. By all means, there are much better ways to influence behavior than by consciously deciding to not prevent a lethal disease.
Ryon Graf is a third-year biological sciences major.