HPV vaccine: A debate involving politics and religion

“In religion and politics, people’s beliefs and convictions are in almost every case gotten at second-hand, and without examination, from authorities who have not themselves examined the questions at issue but have taken them at second-hand from other non-examiners, whose opinions about them were not worth a brass farthing.” Mark Twain – Autobiography of Mark Twain

In my short career as a columnist, I have thought that unless I want this column to have a very limited run, I should avoid politics and religion. However, the recent human papillomavirus vaccine controversy has caused me to challenge this assumption.

Immunization policy and the office practice of pediatrics straddle the yellow lines between science, religion and politics, with ethical behavior and moral reasoning establishing the roadway. Most practicing pediatricians have become proficient in navigating these highways, despite the inherent hazards involved. We do this because of the strength of the scientific evidence of vaccine efficacy and because of the special nature of our relationship with our patients. For some, a rigid policy of immunization practice provides both a logical and practical approach to care. One such example is an office policy of not seeing patients who are unvaccinated.

The true challenge of practice

For me, the balancing of my professional duties and beliefs to the care for individual patients and their families with their own thoughts and beliefs is the true challenge of practice. Sometimes, there is not enough common ground to maintain a useful relationship. But most of the time, the ongoing debate between us, physician and patient/family, is the soul of practice. The opportunity to teach, to learn, and to push the comfort zone of those with different feelings about vaccines exists in almost every office visit. For immunizations, this degree of involvement is worth the extra work. However, I can use help.

That is why when immunization policy hits the news cycle, I know that my office schedule has just been dealt a blow. When the news involves presidential politics and the intersection of public health policy, politics and religion, I know that someone has hit the cycle, and it hasn’t been a teammate. The HPV vaccine has already expanded my office day, as I appropriately extend discussions to male adolescents and their parents.

The news of a presidential candidate debate dominated by attacks on the HPV vaccine and public health policies involving its provision, only to be topped by Michele Bachmann’s statements over its danger and possible link to mental retardation, was a staggering moment. The potential of adverse long-term fallout for HPV vaccination and vaccines, in general, seems possible; if only the opportunity for a sensible discussion of sexual health, let alone immunization and public health in general, could have been seized.

The response from national organizations such as the AAP and public health institutions and advocates was as expected — immediate and rigorous in support of HPV vaccine. Press response generally took Bachmann to task for her most outlandish statements — but the anti-governmental tone and the reliance on hot-button words, such as intrusions and mandates, was not generally attacked, nor was a reasoned response enunciated that could focus the debate in a more helpful way.

A solid argument

One response does stand out. That was of Michael Gerson (no relation, much better writer), an editorialist for The Washington Post. In an opinion column (“A dose of reality for the HPV debate,” Sept. 15, 2011), this conservative writer voiced an effective rebuttal to those challenging the HPV vaccine and brought a thoughtful approach to vaccine policy by challenging the moral confusion and public health illiteracy expressed by opponents.

Dejected by the lost opportunity and the preadolescent knowledge and judgment displayed in the debate, Gerson provides a concise review of the nature of HPV infection. He castigates Bachmann for pandering to antivaccine paranoia — “one of the most direct and practical ways that a public official can undermine the health of his or her fellow citizens.” More importantly, he takes on two of the major conservative and religious objections to HPV vaccine policy: 1) the idea that taking away medical consequences of sexual intimacy — in this case, HPV disease and cervical cancer — encourages sexual experimentation; and 2) the issue of parental rights and the notion that an ethical context exists in which these rights are different for a vaccine against a sexually transmitted illness than one transmitted by other forms of contact.

His approach to the first is to acknowledge the difficulty in proving or disproving such a link, but discounting the commonsense likelihood of any such connection. More striking is his denunciation of the moral argument, allowing the moral bewilderment of a political candidate, but not of a parent. He reminds us that Christianity teaches that moral rules are for the benefit of the individual, not to punish them with preventable death. The ethical and moral failure to prevent transmission of HPV disease is, thus, unconscionable.

To the second issue, Gerson plainly states the public health case for vaccination and denies special consideration for pathogens spread by sexual contact. Vaccines decrease disease in a population, thus insuring improved health for everyone, not only in the vaccinated individual — no matter by what means the disease is transmitted.

“The decision to vaccinate — for HPV or any infectious disease — is not just a personal, family choice. It is also a matter of public health. And it is not unreasonable for public authorities to strongly encourage responsible parental choices,” Gerson wrote in his editorial.

I couldn’t agree more.

William T. Gerson, MD, is Clinical Professor of Pediatrics at the University of Vermont College of Medicine and a member of the Infectious Diseases in Children Editorial Board. Disclosure: Dr. Gerson reports no relevant financial disclosures.

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