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Srdjan Kamenko

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When it comes to vaccine intervention for disease control, should personal liberty go before the benefit to society?

This question is extremely important when one considers current news on the Human Papillomavirus vaccine. The main vaccine, Gardasil, has been widely used on women ages 9-26 since its introduction in 2006. The vaccine first made waves in 2007 when Texas governor Rick Perry issued an executive order to mandate the vaccine for all young women in Texas. Even though it was met with much opposition and ultimately failed, the question still remained: should we have a mandatory HPV vaccine for all women? The two sides of the argument clash, each bringing significant evidence to bear on the issue. Mathematical models indicate that with a vaccine as effective as this one (about 100%), mandating the vaccine will stamp out the virus types targeted by the vaccine. HPV is the most common STI with 45% of college age women currently infected. Freeing society of such a dangerous virus, the number one cause of cervical cancer, is a highlight of the pro-mandate argument. The opposition suggests that personal liberty is at stake, and that parents should have the choice to vaccinate their children if they believe the vaccine is worth it for them. What do you think? Is it reasonable to limit personal liberty for the good of the community in the face of a spreading killer virus?

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  • Mar 7 2012: On a personal level, I believe all women should get the HPV vaccination. However I do not think a government mandated order for this is necessary, women should do it if they feel comfortable or inclined. The way I see it is that if there is a possible solution/prevention method why wouldn't anyone want it? No matter how little data there is about the future of the disease there is plenty of supporting facts about the benefits this vaccine can have for women in the present. The statistics and trials of long term effects of the vaccine will need time, that is just an inevitable part of any new pharmaceutical product on the market. Why not get what is available, protection that is experimentally proven to work in the short term, and contribute to the long term analysis of the product for your daughters generations that her's after that. While I do feel strongly about women taking the initiative to protect themselves, I do not think it is reasonable to legislate medical choices.
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      Mar 7 2012: Why not? People have sex whether the government and its citizens want to accept it or not. Should not the government take practical view on the subject and protect its citizens by mandating that the population be guarded from these adverse effects of HPV? I understand if they hold off until HPV either gets worse or the vaccines are proven fully effective, but for now, their interests (when it is a wide spread health issue) should always be for safety of the public as a whole, which in this case, is to vaccinate.
      • Mar 7 2012: I agree that the government's main priority should be public safety, and that mandatory vaccination is really the only way that the government can ensure public safety. Also, like Hillary, I think that all women should be vaccinated for HPV. However, HPV is transmitted through sexual activity, which is a lifestyle choice, and I think it would be unfair for the government to try to interfere with the decisions that people make for themselves and their families.
        Until the vaccine is proven to be wholly effective (or the rate of infection becomes staggeringly high), I think the government should really seek to inform the public about the risks that HPV poses and strongly recommend that children are vaccinated before sexual activity begins. If people understand what the vaccine offers and the risks that refusing vaccination poses, they can make better choices.
        • Mar 8 2012: I don't think sexual activity is a lifestyle choice - being CELIBATE is a lifestyle choice. Having sex is one of the fundamental features of all organisms on this earth. Protecting people from contracting this sexually-transmitted disease is the same in my mind as protecting them from the measles or hepatitis.
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          Mar 8 2012: I think it is very interesting what Ashley presents about HPV infection not a a lifestyle choice. I think many could agree that one could abstain from having sex for x reasons and thereby not transmit the disease. But, unless a person abstains from sex all their life , then there will most always be a risk. And since reproduction is part of a biological process for which all organisms participate in, then I can see the point of view for those that say the vaccine should be mandated.
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          Mar 8 2012: Ashley, I agree that sexual activity is not so much a lifestyle choice as it is the way we reproduce as a species and something that we are biologically inclined to do. However, each person is going to go about sex in a different way and this is, to some extent, a choice. For example, some people wait until marriage to become sexually active and then sleep with the same person for the rest of their life. These people are most likely at a lower risk for HPV and therefore vaccinating them is costing the health care system money without any large benefit to herd immunity or the spread of the disease. However, people who have more sexual partners in their lifetime are going to be at a higher risk of both contracting and spreading the disease and are good candidates for vaccination. I'm not entirely sure how I stand on a mandate of this vaccine. It proves an interesting topic for debate because unlike other diseases with vaccines we have mandated, HPV does not pose an equal risk to every individual.
        • Mar 8 2012: Science never says things in absolutes. If it did then they would have said anti-biotics prevent bacterial infections, and while they do in a lot of cases, somethings changing the game like anti-biotic resistant bacteria. Science understands it is wrong sometimes or situations change to shift the data. When handling science they always leave room for doubt or new evidence. If you wait for something to be 100% proven, it will never happen so cost occur, so products will never hit the market.
          Pundits have an advantage of betting against the field, if they are right in the modern market they get jobs being the soothsayers of our communities. Too many are using the fact that science always leaves room for freak occurances to say don't do the societally protective thing. I think when we decide to trust these people we should see how much stake in themselves they are willing to bet their view is right. That way there is a down side to their bad bets.
          Just out of curiosity is there any market out there on the HPV vaccine effectiveness in stopping cervical cancer? Briefly check in-trade and didn't find one.
      • Mar 8 2012: I do agree that it is in the best interest of any government to protect it's citizens any way possible, but if this means imposed in a forcible manner it will not be well received nor is it constitutional. It is a relatively new disease to have gained huge momentum in the last decade, and the statistics surrounding this infectious disease and its mode of transmission are frightening. 93% or even more of all cervical cancers are tied to HPV infection. By the time girls’ reach the age of 15 nearly 10% of American girls are infected with HPV, by 17 the percent doubles to 20%. About 4,000 women were estimated to have died during 2007 from cervical cancer that may have been caused by HPV. About 45% of college aged women are said to have HPV. After reading these, and letting them sink in, how are you feeling? shocked? nervous? A whirl of emotion, im sure. Now if we use this tactic to educate young women then they can either make the decision to protect themselves or not. It is ultimately up to the individual.
        • Mar 8 2012: It is important that this information be conveyed to the public, not as a scare tactic, but as an educational tool to incite further investigation of the individual on the subject. Merely telling women that they have a 1 in 5 chance of contracting HPV by the age of 17 is not enough. A well-rounded conversation (much like this TED conversation) should be the venue for people to make educated decisions regarding their bodies. It is understandable to want a mandate for HPV vaccination, but you are right, the decision should ultimately be in the hands of the individual.

          This issue makes me think about the regulations we have on tobacco. As much as some of us may find it disgusting, as well as a health risk to both the smoker and those around him, it is up to the smoker whether or not he wants to smoke. Compare the questions: Should we ban smoking altogether? Should we mandate vaccination? Both questions yield risks whether they are answered yes or no. Are either of them worth limiting the freedoms of the individual?
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          Mar 9 2012: Smoking has been banned in dozens of types of public establishments (restaurants, bars, schools). This has limited the exposure of people to second hand smoke. It seems that as far as the government is concerned it is not up to the individual to choose where they want to smoke because of the risk to others. In the case of smoking, the government has weighed the cost of limiting personal freedom vs. the benefit to society and have found that the benefit is greater! Smoking is a good analogy because it shows that in some cases the benefit to society comes before personal liberty.
    • Mar 8 2012: I agree. I feel that this should not and does not need to be a mandated vaccination. If sexual education were provided then young girls would be able to make a decision on their own, and given the correct information I feel that girls would see the clear advantages of receiving it. If sex was not so stigmatized in our system, than maybe it would be easier for girls to receive the information that they need. After learning about how HPV is spread, how cervical cancer can affect us, and how preventable it all is it seems obvious that one would want to protect themselves against this virus. Although having a mandatory vaccination may be in our best interest, it ultimately should be our own decision, and right, to receive it, or not.
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        Mar 9 2012: Do you think educating everyone to make the choice on their own would take too much money and time? Maybe if we started vaccinating the masses now we can catch the virus before it gets any worse. It might also be cheaper for simple vaccination vs. education programs. It is hard to boil things down to cost, but some people have raised the cost effectiveness as an issue for the use of the vaccine, saying the vaccine is too expensive. Is the alternative any cheaper?
    • Mar 8 2012: I completely agree. MMR, small pox, chicken pox, these vaccines are mandated because people cannot make a lifestyle choice to prevent contracting these infections. HPV? That can be avoided through abstinence or by engaging in monogamous sexual activity with a partner who has not put themselves at risk for HPV by having previous sexual contact. If some one is going to put forth the effort to make that lifestyle choice, the HPV vaccine is unnecessary.
      • Mar 8 2012: I totally agree. If it is possible for some people to not be at risk for HPV, it does not make sense to mandate everybody to get the vaccine. Only something that truly affects everybody should require a government mandate, in my opinion. Information about HPV should be available for those who do not choose to engage in abstinence or monogamous sexual activity, and ultimately they should be able to choose whether or not they want to protect themselves from it.
      • Mar 8 2012: Don't you think that there are actually very few people who remain in monogamous sexual relationships throughout their lives? Plus I don't know why we aren't considering that people lie all the time without being mindful of others' health and safety. We all should know by now that there are very few instances in our human race when people have learned from their historical mistakes. Though, I find the idea of mandating such a vaccine quite radical, hearing the statistics of how many women are infected just between the ages of 18-24 is very disturbing. With such rising numbers of infected individuals we should definitely consider the possibility of this particular vaccine mandate.
        • Mar 8 2012: I think you are looking at a particular scenario where one person would just trust another person that he or she was committed to them. There are actually plenty of people who are monogamous through their lives, whether that is for religious reasons or personal reasons.

          I'm going to quote my response to Srdjan.

          "There is a substantial, and I mean SUBSTANTIAL, amount of people who actually choose not to have sex until they are married, at which point both husband and wife are losing their virginity for the first time. Quite often, they have not engaged in any other non coital sexual activity that could have resulted in the contraction of HPV either. As long as they are monogamous, HPV is not a threat to them. If there is any potential side effect whatsoever with this vaccine, how can we justify administering it to them? It's all risk, no reward for those individuals.

          And again, there is enough people who make this lifestyle choice, which makes this a very relevant concern. For example, I wonder what the occurrence of HPV is at a school like BYU, which has an honor code that calls for its students to be abstinent."

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