District's HPV Proposal Tinged With Ugly Assumptions

By Courtland Milloy
Wednesday, January 10, 2007

Let's say you have an 11-year-old daughter in D.C. public schools. She'll be a sixth-grader next year. You are reminded that she must be immunized before she will be allowed to return to school. She'll need the usual vaccinations against measles, rubella and chickenpox. But this time, there's another disease on the list, one that the D.C. government is strongly urging your daughter be immunized against: the human papillomavirus, or HPV, which is sexually transmitted. After all, your daughter is 11 and probably black, so the assumption is she'll be having unprotected sex in no time -- but don't take offense.

Surely the HPV Vaccination Reporting Act of 2007, which was introduced before the D.C. Council yesterday, is for her own good. HPV causes cervical cancer in about 10,000 women in the United States each year and kills about 3,700. The rate of the disease in the country is 8.8 per 100,000 females, according to the American Cancer Society. But it is up to 13.5 per 100,000 in the District.

Only the most progressive and caring elected city officials -- in this case, two nice white people -- would propose a program to vaccinate against sexually transmitted disease girls under 13 in a predominantly black school system. After all, if the girls' parents can't protect them -- and, God knows, they can't protect themselves -- then somebody's got to do it. There is no vaccine for the boys who infect the girls, so just forget about them.

"With January being National Cervical Cancer Awareness Month, now is the perfect time for the District to lead the nation in the fight against what is in essence a preventable disease," said D.C. Council member David A. Catania (I-At Large), a truly well-meaning, if naive, co-sponsor of the legislation. Forget about taking time to educate the public about HPV or exploring any adverse side effects of the vaccination. Let's go right at these presumed-to-be-promiscuous, 11-year-old black girls.

Even experts on the ethics and politics of compulsory HPV vaccinations disagree. In a recent issue of the New England Journal of Medicine, author James Colgrove writes: "Bioethicists, who generally hold the values of patient autonomy and informed consent to be preeminent, tend to be skeptical about compulsory vaccination laws. . . . Because HPV is not casually transmissible, they argue there is less compelling rationale for requiring protection against it than against measles or pertussis; in the absence of potential harm to a third party, such laws may be considered unacceptably paternalistic."

Oh please. If the parents were doing their jobs, then there would be no need for a paternalistic government. Isn't that right, D.C.? Some of your elected officials certainly seem to think so.

A large body of evidence demonstrates that school-based laws are an effective and efficient way of boosting vaccine-coverage rates, Colgrove writes. "Requiring HPV vaccination by law will almost certainly achieve more widespread protection against the disease than will policies that rely exclusively on persuasion and education." He quotes Beverly S. Hammerstrom (R), the Michigan state senator who introduced legislation similar to what was proposed in the District yesterday: "The only way to ensure that as many girls as possible receive the HPV vaccine is to require it before they enter middle school."

So forget about the ham-handed way the legislation was proposed in the District. Your tissue-paper feelings just don't matter.

And please don't bring up that old paranoia about government agencies conducting medical experiments on black people. The Tuskegee syphilis experiments are old news. Besides, all of those black guinea pigs are dead and gone. Same for Norplant, the birth control drug judges offered mostly to black, female convicts in lieu of jail time. That practice was found to be unconstitutional -- eventually.

And don't worry about the safety of the vaccine. As Colgrove notes: "During the past two decades, in the face of a sharp increase in the number of recommended pediatric vaccines, unproven theories alleging connections between vaccines and illnesses such as autism, diabetes and multiple sclerosis have been spreading. A social movement involving diverse participants has challenged the safety of vaccinations and mounted attacks in courtrooms and legislatures on compulsory vaccination laws."

Just remember that the District's HPV program would be administered by the D.C. Department of Health. That's run by black people. So you know black adolescent girls will be treated with dignity and respect. Just because the city's health officials have made a monumental mess out of its handling of the AIDS crisis only means that they have plenty of mistakes to learn from.

And if they say the vaccine for HVP is safe, you can bet your life on it.

E-mail: milloyc@washpost.com

© 2007 The Washington Post Company