January 1, 1970 (Vol. , No. )
Taralyn Tan Ph.D. Curriculum Fellow Harvard Medical
Human Papillomavirus (HPV) has been a media darling (if a sexually transmitted, cancer-causing virus can really be a “darling,” that is) since the Gardasil vaccine came onto the scene years ago. Since then, HPV – or rather, HPV vaccines – have basked in headline infamy and controversy due to the usual suspects – you know, safety issues, ages during which they should be administered, etc. Last month, two bills in the New York State legislature promised the most blockbuster media backlash to date. Akin to an epic movie that boasts action and romance, Senate bills No. S04779 and No. A778 together proposed not only mandated vaccinations to both young girls and boys in order to attend school (A778), but also advocated the administration of vaccines against sexually transmitted diseases to children under the age of 18 without their parents’ consent (S04779).
Senate bill No. S04779 has been put on hold, according to an email sent by New York State Senator Eric Schneiderman to a researcher for Merck’s Gardasil vaccine, yet the issues that it raises will almost certainly persist in future discussions of vaccinations against sexually transmitted diseases. The crux of the matter lies in the conundrum: parent thinks child is not having sex, sexually active child wants to keep it that way, and therefore child may not seek treatment or preventative measures for sexually transmitted diseases if parent will find out. Bill No. S04779 simply tries to provide said hypothetical child with an out – the parent doesn’t have to know. To a certain extent, this doesn’t sound like a bad idea…until one considers the other side of the coin. A sexually active child is still a child, after all, and especially since the wording in bill No. S04779 doesn’t stipulate a minimum age, who can say that a thirteen- or fourteen-year-old will understand the risks or other considerations in relation to any medical care, including vaccines?
Thus, in terms of providing sexually-related medical care to underage minors without their parents’ consent, we remain at an impasse. It’s not an issue that we can sweep under the rug, either, as (quite sadly, in my opinion) adolescents seem to be engaging in sexual activities at younger and younger ages. I certainly don’t have answers, but I do believe that any suggestion to keep parents in the dark in order to better provide medical care must be accompanied by a great number of checks to ensure that the minor has access to a number of resources and can truly be determined to be in a position to give an informed consent. (The question remains, however, whether a child’s consent can ever be considered “informed.”)
As for the other bill, which proposes a mandated HPV vaccine for children in order for them to be able to attend school, the controversy stems from a different, but not altogether unrelated consideration. Namely, one is only at risk of HPV if one is sexually active. Therefore, why the need to require that all school-aged children receive it? The way I see it, the answer to this question is that here we have an example of a perfectly adequate strategy to avoid the entire “hiding medical information from parents” situation in the first place! If an HPV vaccine were mandated, then parents would once again be the consenting party, and even if their ten-year-old children aren’t sexually active at the time, there is a fairly good chance that they will be by their early twenties, which is the upper age limit for the vaccine.
People who resist this proposition cite the safety issues involved with the vaccination, and therefore believe that it is an abhorrent idea to require sexually inactive children who don’t “need” the vaccine to receive it. In response to that, I say, haven’t we had enough vaccine superstition for a while? From the retraction of a previously published 1998 study in The Lancet that linked the measles, mumps, and rubella vaccine to autism, to the recent rulings by the “Vaccine Court” that the vaccine preservative thimerosal cannot cause autism, the past number of months have exposed (to some extent) the degree to which society engages in vaccination witch-hunting. In the case of HPV vaccines, I think that we need to stop being so paranoid, as (at least the first one, Gardasil) has been well studied and thoroughly evaluated. (My only concern would be that before we start vaccinating young children, we should perhaps have a better idea of the half-life of the vaccination, and whether booster shots would be needed.) I have no doubt that the American public will ultimately come to its senses, and an HPV vaccine will join the ranks of the other mandated vaccines. It’s unfortunate, though, that unsubstantiated safety concerns persist for such a long time after vaccines are developed.