The HPV Debate Needs an Injection of Reality

Most cervical cancers can be prevented with regular pap smear tests, which find precancerous growths that can be excised. Most of the women who get cervical cancer haven't had the test done in at least three years. It stands to reason that, without a mandatory vaccination, many of the girls who don't get vaccinated will belong to the same groups that fall through the cracks of the patchy U.S. health-care system.

During a recent radio interview about this issue, I was dismayed to hear callers claim that proposed HPV mandates would make their children "guinea pigs" in a contemporary Tuskegee -- a reference to the notorious experiments in which black men with syphilis were studied but not given penicillin. I responded by asking whether it was better to be neglected by the medical mainstream than to be enrolled in a measure that covers all girls -- rich, poor, black, white, Hispanic and Asian.

Sadly, as long as the HPV vaccine is not required, the people who need it most probably won't get it. "Those who are well-informed with good families, parents involved with their children, will go ahead," said Hall, who is with the University of Rochester Medical Center in New York. "Those who are not as well informed or involved in the care of their children will not get the vaccine."

So why, given all these arguments, do I think that requiring HPV vaccination for school-age girls is a mistake at the present time? The most obvious reason is that when a vaccine is mandated, it must be available for free to those who can't afford it. But state health officials are already struggling to provide for existing mandated vaccines such as DTP (diphtheria, tetanus and pertussis), MMR (measles, mumps and rubella) and chickenpox. They simply don't have the money to buy the HPV immunization for girls whose families can't afford it.

Second, the vaccine, while promising, has no track record. Merck's hepatitis B vaccine was licensed in 1986, which allowed plenty of time to observe its efficacy and safety before it became mandatory -- and forestalled the "guinea pig" argument. While the hepatitis B vaccine proved quite safe, there's no guarantee that the HPV immunization won't provoke a rare side effect.

But there is a third, less tangible reason for holding off -- one that has to do with the kind of public perceptions that are essential to successful vaccination programs and are magnified in this era of instant blogging.

With only Merck and a few activists pushing the HPV vaccine, it lacks credibility. This has opened the door to critics of immunization in general, who are gaining support among people who fear an HPV-vaccine mandate.

Our rickety pediatric vaccination system is a three-legged stool whose stability relies on the participation of drug companies, which need a profit incentive; the government, which buys about half of all childhood vaccines; and parents, who are called on to submit their children to vaccination not only to protect them but to diminish the spread of disease.

In failing to include two legs of the system, those pushing for immediate mandatory vaccination are risking its collapse. The HPV vaccine may do great things, but we shouldn't rush it.

arthurallenw@aol.com

Arthur Allen, a Washington writer, is the author of "Vaccine: The Controversial Story of Medicine's Greatest Lifesaver" (WW Norton).