A new research finding on HPV is certain to add to the controversy about whether young women should be mandated to receive the HPV vaccine. Wait - did I say young women? It seems this new finding implicates young men. Dr. Laura Koutsky, a researcher at the University of Washington who led some of the original research and clinical trials that resulted in Gardasil, Merck's HPV vaccine, has discovered the presence of HPV under the fingernails of young men.
I'm going to be completely transparent here and say that when I first heard about states (including my own) wanting to mandate the HPV vaccine for school-age girls, I was none too pleased. Don't get me wrong, I'm not against vaccines in general. I have no problem vaccinating against chicken pox, tetanus, diphtheria, pertussis, flu, etc. for a couple of reasons. One - in most cases we're talking about airborne diseases, and two - we're not focusing on one sex or the other - both male and female children and adolescents receive them equally.
I DO have a problem mandating a new vaccine for girls only for a disease that until now was assumed to be contracted solely through sexual contact. Why? For a number of reasons. First, and perhaps most importantly, I believe this is a collaborative decision (read choice) for the parents, the physician, and the patient to make that should involve a very important discussion. By mandating this vaccine, we're removing a potential opportunity for parents to have the "sex talk" with their pre-teens. As dreaded as this talk may be to some parents, allowing families to make the decision about the HPV vaccine opens up an important opportunity to discuss: (1) how HPV gets transmitted (SEX); (2) how you can protect yourself (CONDOMS, ABSTINENCE, TALKING WITH YOUR PARTNER ABOUT PREVIOUS PARTNERS); and (3) the fact that this is just one STD of many (HIV, HERPES, GONORRHEA, CHLAMYDIA, to name a few) that the vaccine doesn't protect you from. My fear is that mandating this vaccine may facilitate parents avoiding "the talk" by giving them a false sense of security about their child's health.
Second, I feel uncomfortable mandating a vaccine that is so new to the market. Despite the best attempts at ensuring the safety of a product, there are enough cases of other products deemed to be safe in clinical trials that ultimately were found to cause severe adverse reactions, including death in some cases. Think Vioxx (another Merck product, by the way), Fen-Phen, and Rezulin among others. I'm uncomfortable with taking the decision-making out of parents' hands when we have no long-term data on the vaccine's safety. I think we need to trust parents and physicians to evaluate the data on their own terms and decide independently whether this is the route they want to choose for their daughters and patients. Not to mention, if there were significant adverse events associated with the vaccine over the long-term, is the government agency that mandated the vaccine going to take responsibility for any adverse outcomes? Somehow I doubt it.
Third (and this is the feminist in me talking) I just don't believe that we'd be mandating a vaccine for young men only. This is why Dr. Koutsky's finding is so important. One of the clear principles of epidemiology is to identify the source of an infection and at-risk populations in order to implement control and prevention strategies. With this principle in mind, scientific evidence that reveals the presence of HPV under the fingernails of young men suggests we need to be targeting young men in our control and prevention strategies - not just rushing to vaccinate all young girls and holding young boys unaccountable for their role in HPV transmission. While the HPV vaccine has some very positive potential, for now I'd like parents to retain the choice about whether to vaccinate until we see more long-term safety data on the vaccine and more research on prevention strategies for young men, including a vaccine for pre-teen boys. If and when such a vaccine hits the market, I'll be interested in seeing how many folks want to mandate it for boys.
I'm going to be completely transparent here and say that when I first heard about states (including my own) wanting to mandate the HPV vaccine for school-age girls, I was none too pleased. Don't get me wrong, I'm not against vaccines in general. I have no problem vaccinating against chicken pox, tetanus, diphtheria, pertussis, flu, etc. for a couple of reasons. One - in most cases we're talking about airborne diseases, and two - we're not focusing on one sex or the other - both male and female children and adolescents receive them equally.
I DO have a problem mandating a new vaccine for girls only for a disease that until now was assumed to be contracted solely through sexual contact. Why? For a number of reasons. First, and perhaps most importantly, I believe this is a collaborative decision (read choice) for the parents, the physician, and the patient to make that should involve a very important discussion. By mandating this vaccine, we're removing a potential opportunity for parents to have the "sex talk" with their pre-teens. As dreaded as this talk may be to some parents, allowing families to make the decision about the HPV vaccine opens up an important opportunity to discuss: (1) how HPV gets transmitted (SEX); (2) how you can protect yourself (CONDOMS, ABSTINENCE, TALKING WITH YOUR PARTNER ABOUT PREVIOUS PARTNERS); and (3) the fact that this is just one STD of many (HIV, HERPES, GONORRHEA, CHLAMYDIA, to name a few) that the vaccine doesn't protect you from. My fear is that mandating this vaccine may facilitate parents avoiding "the talk" by giving them a false sense of security about their child's health.
Second, I feel uncomfortable mandating a vaccine that is so new to the market. Despite the best attempts at ensuring the safety of a product, there are enough cases of other products deemed to be safe in clinical trials that ultimately were found to cause severe adverse reactions, including death in some cases. Think Vioxx (another Merck product, by the way), Fen-Phen, and Rezulin among others. I'm uncomfortable with taking the decision-making out of parents' hands when we have no long-term data on the vaccine's safety. I think we need to trust parents and physicians to evaluate the data on their own terms and decide independently whether this is the route they want to choose for their daughters and patients. Not to mention, if there were significant adverse events associated with the vaccine over the long-term, is the government agency that mandated the vaccine going to take responsibility for any adverse outcomes? Somehow I doubt it.
Third (and this is the feminist in me talking) I just don't believe that we'd be mandating a vaccine for young men only. This is why Dr. Koutsky's finding is so important. One of the clear principles of epidemiology is to identify the source of an infection and at-risk populations in order to implement control and prevention strategies. With this principle in mind, scientific evidence that reveals the presence of HPV under the fingernails of young men suggests we need to be targeting young men in our control and prevention strategies - not just rushing to vaccinate all young girls and holding young boys unaccountable for their role in HPV transmission. While the HPV vaccine has some very positive potential, for now I'd like parents to retain the choice about whether to vaccinate until we see more long-term safety data on the vaccine and more research on prevention strategies for young men, including a vaccine for pre-teen boys. If and when such a vaccine hits the market, I'll be interested in seeing how many folks want to mandate it for boys.
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