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?

  • Mar 8 2012: I feel that sometimes people need to be told what is right and what is wrong. Though, nothing is ever that black and white. There are a few select things in life that seem like an absolute necessity and I feel that vaccination against a "killer virus" ,as you called it ,is that necessity. I completely agree with the argument that people need to be educated about such dangers but sometimes that isn't enough. When we say that people should be able to make their own decisions as to whether they want to protect themselves from such a virus or not; we think of the responsible people but, what about the rest of the population. What about those people who don't always make the correct decisions for their own well being? Should the rest just pay the price for others' mistakes? I personally believe that women or men should get vaccinated for their own selfish reason of protecting themselves not because they're being told to.
  • Mar 7 2012: All I know is that I do not want to live in a country where I have to accept that someone else will inject something in my body against my will. I think that's the least a government can do, to respect that people do not wish to get an injection, while if people do injections on their own incentive they'll go to jail for it. Are we children or adults? Because sometimes I can't tell the difference. If I need extra supervising the state can revoke my legal "license of age", but until that I think that I have a right to say no.

    Edit: And I'm not taking stance of whether a vaccine is good or not, merely on the topic about using force or making it illegal to refuse vaccine. The solution is quite obvious to me: use communication, not force.
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    Mar 8 2012: Not to open up a huge can of worms near the very end of this great conversation...but I feel like the decision on whether to obtain an HPV vaccine is something that women (and children along with their parents) need to decide on their own. While I know that this pertains to a matter of public safety, I feel the same way about the HPV vaccine as I do about abortion. It should be up to the individual (or in the case of a minor, the individual and their guardian). No one likes to be told what to do, and this is no different, so I think we should focus on educating the public about HPV and the vaccine and give them the information so they can make that decision for themselves.
    • Mar 8 2012: While I feel strongly that the vaccine should be mandatory if it is safe and healthy, I also totally understand why other people believe that it should be up to the individual to choose. In that regard I think educating young people about it would be a good way to encourage peoeple to receive the vaccination. I just struggle with the thought that peoples loved ones might die due to something that is treatable.
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        Mar 9 2012: I too feel that education should be our number 1 priority. People need to understand both sides of the story and decide for themselves. I wonder how much time and money that would take. would it be cheaper and safer just to mandate? By safer I mean, by the time we have educated people to the point of making a decision sometime in the future the virus might become an even bigger problem than it would have been. Just a thought. What do you think?
  • Mar 8 2012: I cannot believe how many people here are in favor of forcing people to get this vaccine. I have seen a few Ted videos and assumed that people following this site were free thinking individuals, but by many of the responses here, I must reconsider that thought. After reading these comments, it alarmed me enough to sign up to post on this topic.

    As a free person on this planet, no government or authority should have the right to do anything to me against my will, as long as I am living my life without compromising the liberties of any other people. Cancer is not a contagious disease, it is developed by one's own body. You cannot catch cancer like a cold. You develop cancer as the final stage of your body being polluted by toxins. There is no vaccine which can ever be made to prevent someone from getting cancer either by their own personal habits or by exposure to chemicals or other toxins which would cause someone to have any type of cancer, let alone cervical cancer.

    Follow the money when you want to see the meaning behind anything. The companies making vaccines, Merck in the case of Gardasil, are businesses that rely on sales to make profits to give to their owners and shareholders. To get their vaccines into the market, they pay enormous amounts of money to federal agencies for approval, which then offer government subsidies to have these same drugs given to the public. It is a huge conflict of interest and creates a financial windfall for these companies, as they practically have guaranteed sales of their products by political force.

    Gardasil was "fast tracked" and pushed to market before proper testing could be done and the results to girls given this vaccine may not be fully known for years to come. Please educate yourself by checking alternative, independent sources instead of being blindly fed by the salesmen of a product.

    http://articles.mercola.com/sites/articles/archive/2010/11/05/gardasil-vaccine-is-a-flop-for-good-reasons.aspx
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      Mar 9 2012: The cause of cancer is indeed extremely complex. Your risk for a particular cancer is affected by genetic as well as environmental factors. You are correct in saying that you can't "catch cancer like a cold" (although there have been some extremely interesting cases of directly communicable cancer in Tasmanian Devils http://www.cell.com/abstract/S0092-8674%2812%2900081-5)

      However, your risks for a particular cancer can be affected by viral infections. When a virus infects a cell, it can mess with cell cycle regulation, DNA-repair mechanisms, telomerase activity, etc. All of these effects push that particular cell in the direction of becoming cancerous.

      In the case of HPV, about 93% or even more of all cervical cancers are tied to HPV infection. In fact, "the presence of HPV in virtually all cervical cancers implies the highest worldwide attributable fraction so far reported for a specific cause of any major human cancer."

      Source: http://onlinelibrary.wiley.com/doi/10.1002/%28SICI%291096-9896%28199909%29189:1%3C12::AID-PATH431%3E3.0.CO;2-F/abstract

      This topic is biologically complex, so I understand why it may be confusing.

      Saying cancer is not communicable is mostly correct. Analogously, AIDS isn't communicable either. It is the viruses that causes these disease states that are.
  • Mar 8 2012: The medical benefits of the vaccine are wonderful and it makes sense for all women who plan on being sexually active to get vaccinated to avoid contracting HPV and cervical cancer. Quite frankly, the fact that 45% of college age women are infected with HPV is alarming, I had no idea that was the case. However, I thoroughly disagree that this vaccine should be mandated; I think a mandate is unnecessary. I believe the opportunity to protect oneself from cervical cancer is a large enough motivating factor that will prompt sexually active women to go out and get vaccinated. Do those who are in favor of mandating the vaccine have any evidence to believe that a significant number of women would choose not to protect themselves if there was a simple and easy way to do so?

    There are many women out there who choose to abstain until they are married, or at least until they find "someone special". If a woman and her sexual partner are both virgins at the time, and have not engaged in any sexual contact that would have put them at risk for contracting HPV, that woman does not need the vaccination. If there are ANY potential risks or side effects associated with the vaccine, a mandate would have put her at risk for no reason.

    Mandating this vaccine is unnecessary. Spreading awareness through our schools and in the community is sufficient to convince people to get vaccinated.
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    Mar 7 2012: for those who argue for the benefit of community over the individual, what do you think about the following argument?

    a human body contains a lot of parts that can be transplanted. one body can save two with kidney failure, one with liver failure, many with skin burns, one with heart failure, several who needs bone parts, bone marrow, blood etc.

    so wouldn't it be beneficial to sometimes get all such people together, kidnap a healthy individual, kill him, and transplant all the organs? one life versus 4-5-6 lives.

    what is the fundamental problem with that reasoning?
    • Mar 7 2012: I think that you illustrate the problem very well, Krisztián.

      It's a dangerous path to take, as if this is acceptable, then what's acceptable next? Then a 49:51 sacrifice ratio, and in certain situations even more, is acceptable "for the greater good". Another good thing about not vaccinating everyone is that -IF- the vaccine had unforeseen side effects it's good to not have given it to everyone. If the vaccine by accidental side effects reduces the fertility rate, for example, it's good for the community as a whole that not everyone was infected.

      I don't see what's wrong with the older reasoning by who to vaccine against things like the H1N1 virus, that we vaccinate people in the risk zone and people in 'public service', such as hospital personnel while the rest of us can take being sick for a few days if we get infected. If we aren't allowed to deal with the virus in a natural manner we will become 'addicted' to vaccine, which we already are, but in the cases of really harmful diseases such as polio, I do think that it's justified to create that addiction. But for a flue, not really, I'd rather be sick a few days than develop a vaccine addiction.
    • Mar 7 2012: I see two fundamental problems with Krisztián Pintér reasoning, the vaccines are not having a negative impact on the peoples lives. It can be much cheaper for society to rid itself of needing to protect against certain diseases.
      I do fundamentally believe in the greater good argument and I think those that do not should have to pay the cost of their position. H1P1 is a much more mild than if you refuse to get a vaccine for measles, as if you enter a hospital with measles have a high likelihood of killing someone that did not have the option to protect themselves.
      I have no problem with people refusing to vaccinate themselves or their babies as long as they are willing to pay for the loss of life they inflict on themselves and others.
      H1P1 that liability seems low so signing a waiver that you do not care seems reasonable if the price is affordable.
      The slippery slope argument of where do we stop seems to be the reverse of what we actually see. We generally don't vaccinate for disease, if we can control the spread from reaching us effectively. If you are traveling to China you get certain preventive measures that you are not required to get staying in the US. Most of the population does not have to pay that cost of either the vaccine or disease later.
      The cost of AIDS treatment vs a $400 mandatory vaccine, one patient if paying for the most comprehensive care could cover most a town. A comprehensive vaccination might be able to remove the cost completely and allow humans to spend their time on now more important problems.
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        Mar 7 2012: it was not a metaphor, it was a question about common good versus freedom. it is 100% sure that vaccination is bad for those that does not want it. otherwise they would not oppose it. the only question is whether their disutility is outweighed by the utility of the majority. hence my example.

        the real question is the following. if there is something that, on average, benefits society, how we make people do it? we convince? we pay? we ask? or we enforce? this is the real question. do we have a gun in the room or not? do we put people in jail, do we kidnap people and tie them up, do we beat someone? that is the solution we choose? in a so called modern, western, free democracy?
  • 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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    Mar 7 2012: While more scientific minds than mine must weigh in, the opposition I heard was not just that it was an imposition, but also that the virus was not as tied to cervical cancer as the company suggested, but rather they had found a possible link between the virus and women who had a genetic predisposition to the cancer. Additioonally, there was no evidence to suggest that giving the vaccine at such a young age would protect the women until an age when they would be most likely to develop cervical cancer.

    The reason why governor Perry made it mandatory was for political favors for himself, his chief of staff, and the Republican party in general. He had absolutely no concern for the science or for the overall health of women. This was so that Merck would have aincome source, nothing more.

    That's the social side of the issue, but U will defer to more knoledgeable people on the science/health issue.
  • Mar 6 2012: It's a tough call. Basically it comes down to a societal decision. I don't know much about epidemic rates and death rates pertaining to most diseases, so for comparison I looked up Influenza and HPV. About 4,000 women were estimated to have died during 2007 from cervical cancer that may (or may not) have been caused by HPV. In comparison, Influenza rates fluctuate broadly, with a rough average of 25,000 deaths per year, although it varied from about 3,000 to 49,000 deaths from the 1977-2007 flu seasons.
    http://www.cdc.gov/cancer/cervical/statistics/
    http://www.cdc.gov/flu/about/disease/us_flu-related_deaths.htm

    It is contagious through sexual contact only and is not-airborne, so should lowering the death rate then be the main criteria for forced vaccination? I don't know. What about a "vaccine" that prevents addictions? Or leaving vaccines, enforced ingestion of a medical prophylactic that prevents heart attacks (aspirin) or widespread fluoridation of water (dental cavities)? etc. etc.

    The question I have is, where is the bar that delineates societal needs vs. individual.?

    Also, we sometimes tend to find out biologically that there benefits to certain host-vector interactions that may have been missed (not that this is the case in HPV) for example, the initial realization the H.Pylori is the caustive agent behind stomach ulcers and gastric cancer, but may protect against asthma development.
    http://www.sciencedaily.com/releases/2007/04/070423185722.htm

    Another question I have pertains to the economics of forced medication and private corporations and corporations in general. It's one thing to have a vaccine produced in a taxpayer funded facility and distributed cheaply to all, but is it prudent to essentially force individuals to purchase goods (in this case a vaccine) from a private entity (Merck)? For example, big pharma has been paying billions in fines due to fraud but there is not much that can be done since they essentially monopolize needed drugs.
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      Mar 7 2012: You may have wandered into the realm of the 'slippery slope' fallacy, but I definitely agree. How the United States government approaches this problem will be historic and will most likely shape further legislation. At what point does the government's attempt at disease control lead to a totalitarian state?
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    Mar 6 2012: There is always the risk that you would replace the spreading killer virus by an iatrogenic effect that is equally effective at killing off those who are vaccinated.

    There is no research programme or legislation which mandates trials over a number of lifetimes. So there is no drug on the market which has been fully researched as to the effects over a long period on an individual, never mind on their offspring and subsequent generations. Until pharma companies can provide reassurance based on this sort of solid research, it seems reasonable to give the indiviual the choice of whether to accept the risk.

    Of course, drugs go out of patent and pharma companies drop them in favour or newer and more profitable formulations, so we are never going to have that sort of certainty. In other words, profit is put ahead of the wellbeing of the individual. And given that situation, why should the inidividual be denied choice as to whether they receive an experimental drug?
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      Mar 8 2012: You never can truly know all the side-effects a particular vaccine or medicine will have. However, this is not to say that the FDA doesn't have very rigorous standards before they approve a drug for the marketplace. Sometimes things do fall between the cracks, and adverse reactions that weren't statistically significant in trial studies become significant when administered to the public at large. When this happens, and it is serious enough, the FDA may revoke its approval of the drug.

      One way the US government tracks adverse reactions to vaccines is with Vaccine Adverse Event Reporting System (VAERS). http://vaers.hhs.gov/index

      That being said, "more than 35 million doses of HPV vaccine have been distributed in the United States as of June, 2011." As of yet, there does not appear to be any need for concern about ill-effects of the vaccine.

      Source: http://www.cdc.gov/std/hpv/stdfact-hpv-vaccine-young-women.htm

      Another thing to think about: If the rigors of drug approval are too high, then new drugs may NEVER make it to the marketplace. It may not be economically feasible for the companies to conduct the research. In addition, think of all the lives that are currently being saved by being vaccinated that would have died if the Gardasil vaccine was introduced in 100 years when they had more data.
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        Mar 8 2012: It's the incompleteness of knowledge which is the strongest argument for retaining the individual's right to refuse to take a risk.

        And of course, the statement that 'As of yet, there does not appear to be any need for concern about ill-effects of the vaccine' deserves challenge. It is classic research and marketing speak designed to divert attention from the fact that research is incomplete. As the old saying goes, absence of proof is not the same as proof of absence.
  • Mar 6 2012: it is really increddible how we do tend to impose things to everybody and how we are ready to adhere by certain things/ideas/solutions because that agency or corporation has supported it...
    it appears that the vaccine is not reliable and it was another way to make money for the pharmaceutical company marketing it and lobyying your government to approve it... they have tested it on human "cobays" young girls who were tricked into it by ignorant schools.... and not having enough information - but information as knowledge is dangerous for the companies in it for the money
    I understand (?!) that infant vaccines are given also by "choice" - I do not recall the doctor obliging me to vaccinate my son but I did it ...
    why now are we so in into a vaccine which has no guaranties that is working... - from 80% in the beginning they have revised this purcentage to less than 50%... the HPV is not an epidemic - not even H1N1 was not a pandemic as they wanted to frighten us - the same is now
    FEAR FACTOR - and this is reality and not a TV show...
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    Mar 9 2012: I would be very interested to see how many of the people who have been contributing to this conversation have since been swayed in their opinion? If you started out pro, did you go against? If you started out against, did you go pro? What was the most powerful piece of evidence that changed your mind?
  • Mar 8 2012: I haven't had any response to my earlier comment, so I thought I'd put a few links up before this discussion has closed. If anyone would like some further information on the Gardasil vaccine or vaccines in general, please check some of the articles listed from the search results in the link below:

    http://search.mercola.com/search/pages/Results.aspx?k=gardasil

    There are dozens of articles at the above listed link. Here are direct links to some of them:

    http://articles.mercola.com/sites/articles/archive/2008/10/25/prominent-scientist-warns-of-hpv-vaccine-dangers.aspx

    http://articles.mercola.com/sites/articles/archive/2009/08/08/Hundreds-of-Thousands-of-Reactions-to-Gardasil-Is-Your-Child-Next.aspx

    http://articles.mercola.com/sites/articles/archive/2009/02/24/spain-withdraws-gardasil-after-illnesses.aspx

    http://articles.mercola.com/sites/articles/archive/2010/04/17/time-for-the-truth-about-gardasil.aspx

    http://articles.mercola.com/sites/articles/archive/2010/07/20/does-gardasil-actually-increase-your-risk-of-cervical-cancer.aspx

    Besides these articles I've linked from Dr. Mercola's site, there are several other internal links within these articles to research, tests and statistics from studies not just in the United States, but in other countries as well, that contradict many of the claims being made in an effort to have this vaccine given.

    Please do not follow the herd, as sheep are usually sheared.
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      Mar 9 2012: I don't have enough time to go through all of these articles written by the singular author, Dr. Mercola, but I will address one point that is important to understand.

      Dr. Mercola cites information from the Vaccine Adverse Event Reporting System (VAERS), which is a reputable government agency cosponsored by the FDA and CDC. But, he does not put the information on the adverse effects reported in context. Just because an adverse effect is reported to a particular vaccine, this does not mean that they were caused by the vaccine itself. Investigators do follow up on the adverse reactions, but rarely find any cause-effect relationship.

      For example, if I took the Gardasil vaccine, then a few days later died in a fatal car crash, I may be included in the VAERS numbers. Maybe the vaccine did cause me to lose consciousness and swerve off the road, but this is all subject to speculation. People assume that the VAERS reports imply a causality, but this is not the case.
  • Mar 8 2012: I fully believe in the right for the government, to protect me from you killing me or crippling me with a disease. Polio is horrible beyond my imagination, and I am happy I don't have to put up with catching that in a very high likelihood. I believe my rights are better protected by such actions.
    HPV is a much less fatal or crippling disease for most people. Requiring everyone to take 3 shots to try to protect against it is within the governments powers but I don't believe they should do so yet. I do believe it is within the realm though of trying to make sure that people who want the shots should be able to get them. This means government could try to reduce the price of the vaccine, and perhaps provide a subsidy for women that cant afford to pay.
  • Mar 8 2012: I think the idea of making it mandatory to receive the vaccination is a good thing. I believe that it does involve giving up some liberties but it is for the good of society as a whole. I have heard though that there are some uncertainties as to how long the immunity last for? Obviously we will not know how long it will last for until a recipient of Gardasil has actually stayed immune for a given period of time. But if immunity lasts for an extended length than I personally deem that it is very important for safe and healthy vaccinations to be mandatory, this one included.
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    Mar 8 2012: I agree with the argument that unlike polio, chicken pox, measles or other diseases that have mandatory vaccines, the risk of contracting HPV is not the same from individual to individual. It doesn't really make sense to require 9-18 year old girls to get a vaccine in order to attend school (like MMR, polio, etc.) as a portion of those individuals might not be at risk for HPV at all due to lack of sexual activity. However, I disagree with arguments that are based in a fear of the unknown aspects of the vaccine. Yes, it is entirely possible that the vaccine has unforeseen affects, but as a whole the vaccine has proven effective thus far with few or little complications. It is this, almost irrational fear of vaccines and government mandates that causes people to abstain from shots that decrease infection rates, increase the herd immunity and thus the overall health of our country. As a child, I was very sick so the doctor suggested I get the chicken pox vaccine even though it wasn't required. However, since most children weren't vaccinated at the time, I still got chicken pox and rather severely at that. By refusing vaccines that are proven effective, you are potentially putting vaccinated individuals at risk. At the same time, other people are paying for vaccines that are benefiting your health (by decreasing your chances of coming into contact with the disease) without you having to contribute a cent. I believe personal liberty is very important, but not when it impedes the overall well-being of others.
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      Mar 9 2012: The type of cream you use for your hemorrhoids does not influence anyone but you. The choice for getting vaccinated does because the virus can be spread from person to person. This is not the case for hemorrhoids. I still believe people should enjoy their own opinion, but they should ponder the decision more extensively if the outcome effects anyone else other than themselves.
  • Mar 8 2012: In order to mandate this drug I feel as if you would have to mandate it to the entire population. Although there is no way to test a man to determine whether he does or does not have it, he is still a possible carry of HPV. If you do not mandate it for the entire population you are singling out half of the population that can carry and spread the disease. HPV is the primary cause for cervical cancer, but only covers 70% of the cause of it. The other 30% of this still goes on to cause cancer. On the other hand it protects against 90% of genital warts which is found on both men and women. The vaccination does not have as high a percentage of blocking cervical cancer as it does for genital warts. So although I agree that this vaccination should not be mandated for the purpose of taking away our rights to decide what we are going to do with our bodies, I believe that if it is mandated then it should mandated to the entire population.
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    Mar 7 2012: One of the things that concerns me about a mandatory vaccination is the expense. While I know that children can now stay on their parents' insurance until the age of 25, what about women (like myself) whose parents didn't have insurance? When I finished high school and moved away to college, I had to obtain my health insurance through my college, and while that was alright at the time, I know that people have had issues with that not covering some traditionally more basic needs, such as contacts and glasses for those with vision impairments. While I recognize the benefits of the vaccination, such as its high ability to protect and that it has been shown to be cost effective in the long run, I feel that mandatory vaccinations are a slippery slope. Additionally, cost effectiveness over a long period of time is certainly something for all individuals to consider with any vaccination, but that also requires someone to have the ability to pay the initial expense, which I don't believe is possible for everyone. Does anyone know if it's possible to get the price covered by an organization, or reduced rate through something like Planned Parenthood?

    I know that it have been mentioned here a few times already, but I agree that education is something that should be expanded upon. Many students have sex education courses and I don't remember hearing much in there about HPV. Also, if people are more educated on a subject, they may be more apt to talk about it and thus, we might be able to reduce some of the stigmas that exist in talking about sex and STIs.

    One last thing I'm curious about...the primary vaccine is established as being for women up until the age of 26. What is the reasoning for that upper age limit? As many women are dating over this age, and there is the unfortunately high rate of divorce, what possibilities other than safe sex practices and abstinence are there for this population?

    Thanks!
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      Mar 8 2012: I agree! I think if we are to consider vaccinating the masses we need to have the vaccine at an affordable cost for all. Here are the payment options I found: Girls ages 18 and under may qualify for the federal Vaccines for Children (VFC) program, which will cover the $120 for each injection.

      • Merck, the manufacturer of Gardasil vaccine offers a patient assistance program for young women, ages 19-26, based on financial eligibility.

      • Some private health insurance policies may provide coverage (private insurance clients will need to pay for the vaccine at the time of service and then submit a receipt for reimbursement from their insurance company).
      Source: http://www.plannedparenthood.org/ppsworegon/hpv-cervical-cancer-vaccine-29204.htm

      As for your question regarding the upper age limit for the vaccine, here is a direct quote from the CDC: "Both vaccines were studied in thousands of people from 9 through 26 years old and found to be safe and effective for these ages. The vaccine is not licensed in the United States for persons over age 26 years, as GARDASIL has not been demonstrated to prevent HPV-related outcomes in a general population of women and men older than 26 years of age".
      Source: http://www.cdc.gov/vaccines/vpd-vac/hpv/vac-faqs.htm

      It is interesting, Canada offers the same vaccine but their upper age limit for women is 45 as of April of last year. The difference comes from doing more studies with the vaccine up to that age limit.
      Source:
      http://www.newswire.ca/en/story/796529/health-canada-approves-gardasil-for-women-up-to-age-45
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        Mar 8 2012: It sounds to me like because they tested Gardasil on women ages 9-26, that's the ages where they were willing to ensure its safety. I'm sure that it's set up this way because of legal considerations, but I feel like it's a really random age to cut off the ability to obtain the vaccination. I don't have a lot of knowledge about human physiology, but I don't feel like there is much difference between 26 and 27. Give me another week or so and I'll tell you if 28 feels any different.
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    Mar 7 2012: If the disease can be avoided by lifestyle adjustments (malaria, jungle fever, aids, std's, etc) mandatory vaccination is not justifiable. If the disease is a threat to society and cannot be avoided by any means other than vaccination (mumps, measles, polio, etc.) then personal liberty must be set aside in favor of the greater good of society. For bad germs and viruses-- vaccinate. For bad choices--not a social/legal/government issue.
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      Mar 7 2012: For this reasoning to be true, we would have to agree that HPV can be avoided by lifestyle adjustments. If the lifestyle adjustment was abstinence, I would agree, HPV could be avoided and we should not vaccinate. However, people will not stop having sex. As my colleague Kevin pointed out in another comment: abstinence education is ineffective at changing sexual behaviors. Source:
      http://www.openeducation.net/2009/01/05/abstinence-only-sex-education-statistics-final-nail-in-the-coffin/

      HPV can take months or years to show up on a cervical screen, men can't be tested, it can be passed through oral intercourse, and condoms don't fully protect, thus having sex at all exposes you to the risk of contracting the virus. With a virus as prevalent as this one (20 million in the US, 45% of college aged women) the chances that someone will contract it at some point in their sexual career is very high.
      Sources:
      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1477576/?tool=pmcentrez
      http://www.cdc.gov/std/hpv/

      Therefore, I believe HPV is a threat to society as long as that society continues to have any kind of sex.
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        Mar 8 2012: If it is then vaccination should be mandatory. IF IT IS!
      • Mar 8 2012: "I believe HPV is a threat to society as long as that society continues to have any kind of sex."

        But 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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          Mar 8 2012: I am actually curious to see the statistic of what % of our population (either in U.S. or just in college) are abstinent until marriage. I disagree that the value would be substantial. If you would like to continue using that word, back it up with evidence. You are right that there is risk in taking the vaccine because we don't have any really long term data given that the vaccine is so new, but it's not ALL risk and no reward. The reward is preventing such a prominent cause of cervical cancer, various other cancers, and genital warts. I also wonder what the occurrence of HPV is at BYU, but BYU does not accurately reflect the rest of the nation. Lets talk about this more in class!
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          Mar 8 2012: A study conducted in 2002 showed that around 95% of people had engaged in premarital sex.

          Source: http://www.usatoday.com/news/health/2006-12-19-premarital-sex_x.htm

          You may say that this means that 5% of the population would not be benefited by the vaccine. However, their partner would have had to been abstinent as well. Just as a thought experiment, if mating is not assortative, then the chance of two people losing their virginity after marriage would be 0.05 x 0.05 = 0.0025 or .25%. So, hypothetically only a quarter of 1% of the population would be in this category. Of course, mating is probably assortative, with virgins more likely marrying virgins, but it is something to think about.

          Also, let's not forget about the high divorce rate in the United States. Even if you remained abstinent until marriage, and so did your life partner, you may still divorce and remarry. In addition, even life-long married couples do occasionally cheat on their spouses.
  • Mar 7 2012: Taking a vaccine that has only been tested for a relatively short period of time means that implementation of a mandate will not be met with open arms. Gardasil is still in its preliminary stages of study. Any vaccine should be tested for years before it is forced into people's systems. The claim that this vaccination has proved its effectiveness at preventing the spread of HPV is well-backed by scientific research so far, but it has been less than 6 years since Gardasil was first introduced. It simply has not been a long enough study to legitimize it as a mandatory vaccination for the American population. The current state of the vaccine is preferable to mandatory treatment specifically because of our inability to foresee the long-term consequences of injection. The most appropriate path is to increase awareness of HPV and the harm it poses to the infected, and to look into ways of cutting the cost of the series of injections. If more people understand the potential benefits to taking Gardasil, they may be more inclined to spend money on a vaccine that has untested long-term side effects. Essentially, I think that reducing the cost will equate to more people agreeing to join the inflow of test subjects for the potentially life-saving vaccination. I think it is important to consider weighing the urgency to prevent such an infectious virus and the potential risks of enforcing the injection of a relatively untested vaccine by citizens of the US.
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    Mar 7 2012: For those of you who are interested in more information regarding HPV in general and vaccines, Kevin and I have two Blogs posted on blog spot. here are the links:

    http://fullspectrumbiology.blogspot.com/2012/03/from-bed-to-streets-look-into-human.html

    http://fullspectrumbiology.blogspot.com/2012/03/understanding-vaccines-and-hpv-mandate.html

    We have a lot of embedded links which lead to great sources for a lot of the supporting evidence for both arguments.
  • Mar 7 2012: I am also torn on this issue. I think that if 35% of young women were infected with a disease that wasn't sexually transmitted, most people would want a vaccine mandated. However, this disease is transmitted by a life style choice. HPV affects a large percentage of the population because a large percentage of the population is sexually active with more than one partner. For the part of the population that isn't sexually active, even into adulthood, it seems unfair to mandate that they receive a vaccine that might be against their moral values. If we mandate a vaccine to the entire population including those that do not engage in the 'risky' behavior, where is the line drawn? About 34% of American adults are obese, which is a large amount of the population. Does that mean if a cure for obesity-related illnesses, like diabetes, were found that all Americans should be required to get the vaccine? A disease that is the direct result of a behavior is different from a disease that is spread by droplet or indirect contact. However, with HPV it only takes one time to contract the disease, making it different from obesity which is why I am torn. Ideally, people should be educated about HPV and make an educated choice if they want to get themselves vaccinated.
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      Mar 7 2012: You pose a great point: why should someone be forced to take the vaccine if they are not going to participate in sexual activities with more than one partner? This is one of the big points for the opposition. Because this virus is not something that can simply be coughed on you but has to instead be contracted by means of sexual activity, it limits who the susceptible populations are, i.e. the sexually active. However, with a virus as prominent as this one, we can imagine a situation in which a person who has been abstinent their entire lives until they chose to settle down with a partner, might contract the virus from that partner who has had sexual relationships with multiple people. Participating in sexual intercourse with that one person in, in effect, like having sexual intercourse with all their previous partners as far as the virus is concerned. It might be good for that person to protect themselves against possibly getting the virus one day down the road. Again, I totally agree that people need to be educating first before making any sort of decision on the issue. Maybe we should start with an opt-out vaccination? What do you think?
      • Mar 8 2012: I like the idea of an opt-out vaccination. If doctors were required to educate adults, especially parents, about the disease and the vaccine, then the public could make educated, personal choices. A mandate with the option to opt out is a fair government response to a disease such as this. The fact that someone can contract this from one isolated sexual encounter makes this disease a risk to almost the entire US population, so people should be educated and the vaccine made available. I am usually for freedom of choice and the government not making personal decisions, such as medical decisions, for the citizens. Because this disease is spread through direct sexual contact, and not in a faster more aggressive fashion, people should be given the choice to be vaccinated. Even if getting the vaccine seems like a no brainer, the fact that there is a choice is important to me.
        • Mar 8 2012: I agree as well I think that education of HPV is more important right now than mandating that everyone receive the vaccination. The choice to then decide whether or not you will get the vaccine becomes something that you have control over and are aware of. The fact is that people need to know what HPV can do to you and that once you get it there is no cure. Regular papsmears (which everyone should be doing) are then necessary to make sure that it does not develop into cancer. They also need to know that it actually takes a quite a bit of time to contract the virus and have it develop into cancer, so as long as they stay in control of the situation they can prevent the cancer themselves. Safe sex should also be promoted with this education even though you might still receive it from genital genital contact that is uncovered it would still be beneficial. Ultimately people deserve a choice in the matter just like they choose to have multiple partners.
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          Mar 8 2012: I fully agree with education being the most important part and not mandating the vaccination. To me it is a no brainer to get the vaccine, but in terms of fully eliminating cervical cancer, the vaccine is not sufficient. It will decrease it in great numbers but not remove it completely because although HPV is the main causes of cervical cancer, it is not the only one. Therefore, only those who fear the disease and worry about their future health should get the vaccine. Those that do not worry or see the benefit of the vaccine will be the ones who will most likely obtain HPV and bare the consequences. Yea, of course inaction can affect others, but everyone can protect against it in other ways and also detect the disease by doing annual exams. For this, I really believe it is a personal decision that can only be made when educated about the virus, associated diseases, and the vaccine benefits.
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    Mar 7 2012: I have read through the comments and I do agree with many of the conversations. I just wanted to reiterate that the vaccine requires three shots over a six month period and can cost upwards to $400 (which is not always covered by insurance.) This is a lot of money for the average American (especially during these rough economic times). It is understandable that people are concerned.
    In a recent NPR article called HPV Vaccine: The Science Behind The Controversy, the writer Richard Knox gives an overview of both sides of the controversy. Knox talks about how recent studies show that by the time girls reach 15 years old, nearly 10% of American girls are infected with HPV. Not to mention that by age 17, that number doubles to nearly 20%.
    Knox also interviewed Dr. Diane Harper, a professor at the University of Missouri-Kansas City School of Medicine. Harper is skeptical of the necessity for the vaccine. By Harper's calculations, the tried-and-true method of regular Pap smears is a more effective way to prevent cervical cancer. In the article, Harper says "Pap smear screening is far and away the biggest thing a woman can do to protect herself, to prevent cervical cancer."
    I believe both sides have their truths. I do think that this vaccine is expensive and maybe administered at too young of an age. But I also believe the researchers have a point. If we administer this vaccine at a younger age, quite possibly the antibodies in the younger individual may gain better immunity as compared to a older individual.
    Overall, this is a choice. A choice that should either be decided by the parents or by the individual themselves.
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      Mar 8 2012: As far as the cost goes, Srdjan wrote above that "girls ages 18 and under may qualify for the federal Vaccines for Children (VFC) program, which will cover the $120 for each injection." In addition, private insurers may also cover the vaccine as they do most vaccines recommended for routine immunization by the CDC.

      On the topic of pap smear screening vs. vaccination, one study shows that "the difference in screening coverage rates among countries affects the effectiveness of the vaccination program." The study also says that "the HPV vaccination program is cost-effective in only 46 countries where per capita GDP is high." I believe the USA would fall into the category.

      Source: http://www.ncbi.nlm.nih.gov/pubmed/18835313

      I believe the main motivation behind vaccinating the girls young is to protect them before they become sexually active, not because of age-related immune system decline (not to say that doesn't help!) Giving a girl a vaccine if she's already infected with that HPV strain has no upside.
    • Mar 8 2012: In regards to the cost of the vaccine: I think the primary cost that is associated with the vaccine is not the cost that the average American would have to pay. There are plenty of vaccination programs (Vaccines for Children program, Merck Vaccine Patience Assistance Program, Planned Parenthood, and many universities) that provide the vaccination for no, or a reduced cost. I think the main issue, and thing that would stop girls from getting the vaccination (if given the choice) is the stigmatism that is associated with young sexually active people. Although I feel that the shot should not be mandated, I do find it hard to believe that our government that would even potentially mandate this vaccination that prevents a STI that most public schools aren't even authorized to teach about. I feel strongly that the decision to have this shot, or not, should be left up to the individual because I feel that if they did receive the knowledge about the potential risks associated with various sexual diseases the individual would chose to have the shot, the real problem lies in that we are taught abstinence. If more of the focus of our sexual education programs was on prevention of STIs, and WHY we should care about preventing these, then maybe more people would understand why we want to protect ourselves from HPV and act accordingly. Maybe some of these people would chose abstinence, but those who do not would understand why it is important they receive this vaccination.
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    Mar 7 2012: Kevin,
    Thank you for the information on HPV and the studies cited. Also, I was being kind by not bringing his financial ties into the equation, but I have read about his link to Merck...he's the governor of Texas afterall, not that he is ever in the forefront of anything unless its to help his political aspirations.

    I'm having to go without internet presently, so when I have access I'm going to look into the info on Guardasil. I worked in the pharma industry for several years and enjoy perusing the published studies. I will leave it at that! Take care! Thanks again.
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      Mar 8 2012: No problem! Thanks for engaging in the conversation!
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    Mar 7 2012: I think an overlying risk associated with the spread of HPV is the concept of contact rate. When determining the threshold of how much of the population must be infected to stamp out HPV we have to determine the rate of spread. When comparing this virus with others such as Polio and Measels, we have very high contact rates due to the ease of spread. The spreading of HPV is limited to sexual encounters. So shouldn't a primary concern of ours be not to vaccinate this "infections disease" based on the assumption that everyone is sharing multiple partners, but to educate the masses into not engaging in dangerous promiscuous activities, but to use protection and reduce the overall amount of sexual partners?

    This seems like an easier and cheaper option than vaccinating the masses with a relatively expensive vaccine that we don't know all the facts about. Who knows how long Gardasil is effective or all of the potential side effects? It's just too early to mandate such a vaccine, we can educate people, advertise the potential benefits and let people decide. Forcing insurance companies to pay for the vaccine we don't fully understand and also placing the burden of our children dealing with unknown consequences of this vaccine are just unnecessary. Also, HPV rarely leads to an acute onset of cervical cancer, these cancers can be easily prevented during annual check ups.

    Another huge aspect to mandated vaccines is we can express our freedom of choice. Although many colleges require a meningitis vaccine, there are multiple cases in which an individual can claim religious views or other factors to a public health official and attend college without the vaccination.

    Until we discovered there are no potential biological side effects of the vaccine and that it lasts forever, we cannot mandate such a vaccine, and in the mean time, we are at a struggle with the social concerns surrounding the mandate on a sexually transmitted disease vaccination. If we have choice, we can refuse.
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      Mar 7 2012: While reducing the contact rate among people by telling them to abstain from sexual activity would be the most straightforward solution to the answer, I think we all know that people will keep having the same amount of sex regardless.

      We've seen how abstinence-only education is ineffective at changing the sexual behaviors of the youth, and I believe any education program we provide advocating for less sex amongst the youth will similarly be a failure.

      "The research group found that 'participants [in the abstinence-only program] had just as many sexual partners as nonparticipants and had sex at the same median age as nonparticipants.' In other words, abstinence education programs did nothing favorable – the result was the same as if there were no program being offered at all."

      Source: http://www.openeducation.net/2009/01/05/abstinence-only-sex-education-statistics-final-nail-in-the-coffin/
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        Mar 7 2012: I guess I should clarify: Our efforts should be into deterring the behaviors of unsafe sex, not sex entirely. Sex has become such a taboo in our society, and I believe this is (at least in some part) due to our abstinence education programs. Instead of urging our youth to abstain from sex entirely, we should educate them to make informed decisions toward engaging in sexual activities. We should urge them to get Pap smears before engaging in sexual activities if changing partners, and praise them for practicing safe sex, not punishing them for having sex in general.

        Last I checked a Pap smear can cost anything from 11 to 300 dollars. Lets find a way to lower this cost, make these tests more accessible, and teach our youth to utilize them. Instead of eradicating a single virus right now, lets also use this opportunity to teach our youth about safe sex so this lesson can extend to other STD's.
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          Mar 7 2012: When it comes to HPV, it's not so easy for someone to protect themselves if they still wish to have sex. Several months to years can elapse before the virus can be detected clinically (through paps). Source:
          http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1477576/?tool=pmcentrez

          This, combined with the fact that men can't be tested means that if anyone wishes to engage in sexual intercourse at all, they will still have the risk of getting the virus. Wearing condoms also reduces the risk of contraction, however it can be spread from contact by other genital areas uncovered. Abstinence is the only way to decrease the risk to 0%. Unfortunately for HPV there is no such thing as safe sex.
  • Mar 7 2012: A some what similar case came up with Typhoid Mary in some respects. The person did not believe it was important to limit the exposure to a disease and had to be forced to quit the jobs that she loved because she was a passive carrier of a disease. While this disease was fatal, HPV fatality markings are long after the virus is caught(I believe). It still shortens the lifespan. Part of the question I don't know the answer to is how many people would like to be protected by the herd of vaccination but can't.
    If the choice largely only affects you and you want to increase your chance of dying I do not think it should be mandated, but maybe the government should get you to sign a waiver that if you get cervical cancer it's on your own budget(in the US HMO's and medicare and medicad not required to cover your treatment.)
    If the choice affects others because of a large enough population can not protect themselves, then I think some degree of government direct control is beneficial and trumps the rights of the individuals to refuse. Banning travel made sense between black death infected towns, and the government is empowered with the right to take measures that sometimes seem draconian. Typhoid Mary was locked up in a mental hospital, to remove her and protect society from her even though she had done no crime.
    I believe that if people make free choices to get sick, when a cheaper preventive measure is easily and readily within their grasp and understood, they should bare part or all of the economic burden. We as a society should try to make cheap effective medical care available to as many people as possible as well. To often we think that we can make a bad choice and face limited or no consequences for that choice. To protect the poor, I think we should pass a law giving free access to anybody below the poverty line to get vaccinated.
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    Mar 7 2012: I heard it said that men can have HPV also, but they cannot be tested for it. Why can they not be tested for it?

    Also, the proposal that it be mandated for women is based on the fact that HPV causes a huge risk for cervical cancer, which men cannot get (for obvious reasons). People ask why not make males get it too, but I ask why not mandate it for all women. If a lot men get the vaccine and women still get HPV, then it doesn't help reduce cervical cancer risks, right? And therefore vaccination is less useful if the non-vaccinated women still get HPV and subsequently cervical cancer , right?
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      Mar 7 2012: For your first question regarding the test for men, here is a quote from the CDC: "Currently, there is no HPV test recommended for men. The only approved HPV tests on the market are for screening women for cervical cancer. They are not useful for screening for HPV-related cancers or genital warts in men."
      Source: http://www.cdc.gov/std/hpv/STDFact-HPV-and-men.htm

      We can think of a situation in which both men and women get vaccinated, that way the woman are protected against cervical cancer while the men are 1) stopped from giving it to them (for the most part) 2) protected against the majority of genital warts types.
      • Mar 7 2012: Getting back to the root issue of your question, do you think if such a vaccine for men were made, would it be more successful (than the current plan) to make it mandatory? Or, if it were required for both men and women, do you think we would be able to get past the women's rights issue and overlook the more general human rights issue?
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    Mar 7 2012: I know the concept of Herd Immunity in veterinary medicine is used as a protective measure. Herd immunity is the resistance of a group, community or population to the introduction and spread of an infectious disease, based on the collective immunity of the group. Since our cities are essentially herds of people, the resistance TO an infectious agent BY an entire group can be obtain by having a substantial proportion of the group being immune to the agent. So we dont need everyone to have the vaccination. Making it mandatory wont guarantee 100% vaccination because people will refuse and thats okay as long as a large proportion is immune. But again I'm no human doctor just an animal one in training.
  • Mar 7 2012: Not eating chocolate doesn't infect other people and give them cancer. Big difference.
    A lot of people are talking about abortion or contraception as examples of personal choice and using those instances for analogy here - but those choices don't affect other people in the same way that choosing not to get vaccinated does. HPV is a case when your choice not to get vaccinated can directly infect and even kill many other people, not just yourself.
    I totally agree that the cost of this vaccine is a problem, and that in needs to be dispersed in such a way that the cost to the individual citizen is reduced, but in the spirit of preventative medicine I am sure that this mandated measure would actually reduce the healthcare costs attributed to infection with the HPV virus and cancer for the infected individuals later in life.

    We should force as a final solution in a debate when the alternative is the infection and possible death of millions of people due to misconceptions and ridiculous fear mongering by the uneducated and misinformed.
    I completely agree, however, that education on the subject is by far the preferred method of prevention.
  • Mar 6 2012: I don't think that state-mandated vaccinations are really plausible in the case of HPV. As another commenter noted, the vaccine is distributed by a privately owned company. Unless the HPV vaccine can be distributed cheaply or be completely covered by insurance, I don't think it's fair to require vaccination of children.

    While I personally think everyone should get the vaccination, there will always be strong opposition to government-required vaccination, especially for a sexually transmitted infection.

    An interesting argument against mandatory vaccinations is the idea that the HPV vaccination will essentially give children and teens license to become sexually active due to lower risk of contracting an infection. Though I understand where the concern is coming from, I honestly don't believe that would be the case. Such a concern really speaks to the level of sexual education that children receive in school. How many school-age children will actually make the connection between the HPV vaccination and how it is contracted?

    In my opinion, a more plausible route for mandatory HPV vaccinations would come in at the university level. Many colleges and universities already require incoming students to be vaccinated for a number of diseases, so it should be easier for them to require another vaccination for a disease that easily affects the population of college campuses. If parents are really concerned about the susceptibility of their children before they graduate from high school, they can make the choice to get their children vaccinated earlier.
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      Mar 7 2012: As far as the sexual promiscuity argument goes, here's some preliminary data showing there is no link between HPV vaccination and increased sexual activity: http://www.nytimes.com/2011/12/27/health/research/no-link-is-seen-between-hpv-vaccine-and-girls-sexual-risks.html

      The problem with just waiting to give the vaccination to men or women when they have reached an older age is that around 50% of highschoolers have already had sexual intercourse. Giving a vaccine to someone already infected with HPV has no benefit. For the best outcomes, vaccination should be distributed to people before the onset of sexual behavior.
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    Mar 6 2012: For maximum coverage to stamp out a specific disease (e.g. small pox, polio) or infection - as high a proportion of the global population needs to be protected. Even in a small geographical area, like a US state, you'll never get 100% coverage, however hard you try. I think a coverage of at least 90% is needed to stamp out an infection.

    With regard to your HPV example, and many other STD's in my opinion, men should be protected as well as women. They are the primary vector by which the virus is spread. We need to protect the women our men will have sex with in the future too - men may not be directly affected by this virus, but their lives can be just as easily destroyed.

    Later in life, an unprotected (infected) man may have sex with a woman without this protection either from within their community or from an area / country without this protection, thus spreading the infection. Like wise, an unprotected (uninfected) man may have sex with an infected partner (male or female) and become infected. It would be tragic if either men later settled down and had a family - only to lose his wife / partner to cervical cancer.

    There is aslo the moral issue of making women the sole responsible partner in a issue where men play a critical role.
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    Mar 6 2012: This is a risk management.
    In risk management we deal with worst case scenario. These scenario is deemed the worst because it threatens lifes. All effort must then be directed to verify if that worst case scenario valid.
    If it is.. freedom is irrelevant.
    What good is freedoms when you're dead ?
    Much of the existing problems came from the failure to verify those worst case scenario.
    Freedom is still relevant.
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    Mar 6 2012: Mostly this relies on education and information. With a decent percentage of vaccined people, epidemics stop spreading. However, we live in groups, and while a single infected person can start a worldwide epidemic, through history we've long had quarantine and isolation wards. Forcing everybody comes down to dictatorship, with a terrifying perspective : what if a compulsory vaccine did start a massive scale death rate through reaction to the vaccine? Once again, there is no black or white solution to this, and people should be massively informed and educated prior to be massively vaccined, and not misinformed through some big lab propaganda or uneducated politicians.
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    Mar 6 2012: This falls into the category of freedom of choice. This deals with the female body and I feels that it is a personal choice the same as abortion. I fear that we are attempting to legislate choices that are personal decisions. I do not like tattoos and that is my choice. I do not force that decision on others. I do believe that they should go to professional that practice sanitary and safer conditions than a home application. I have seen tattoos that range from sublime to rediculious. Because it is invasive it carries the risk of passing deseases. The flu kills the yuoung and the old every year. The importance of the vaccine is well advertised. It is still a choice for everyone even those identified at risk.
    However, I support school required vaccinations. When close proximity groups are involved and some chance of exposure is present such as schools and prisons, etc ...

    Your subject and the examples are somewhat decieving. I was thinking epidemics and pandemics.
  • Mar 6 2012: :) Well, it's really quite simple.
    We never know what goes into a vaccine.
    If you research it, you'll find that the controversy of the issue stretches towards some outrageous claims, such as the fact that some of the main ingredients in many vaccines cause sterility, autism, etc.
    Whether or not these claims are true, it should be kept in mind that your everyday citizen isn't about to take a BA in chemistry, find access to a lab, figure out exactly what the vaccine is made of, and then take a decision. If a person firmly believes that vaccines can be worse than the actual disease, that person should definitely have the liberty to decline.
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      Mar 7 2012: But what if a person's individual decision to avoid vaccination hurts the community as a whole? Most economic models are based on the idea that when each individual does what they selfishly think is best, society as a whole is helped and profits maximized. However, sometimes individual selfish action can lead to devastating results. This is sometimes broadly described as the "tragedy of the commons." When people opt-out of vaccinations, they not only put themselves at risk but also the people around them.

      Additional Info:
      http://en.wikipedia.org/wiki/Tragedy_of_the_commons
      http://articles.latimes.com/2011/aug/05/health/la-he-vaccines-herd-immunity-20110801
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      Mar 7 2012: Also, we do know what is going into the Gardasil vaccine:

      edit: more direct link: http://www.merck.com/product/usa/pi_circulars/g/gardasil/gardasil_pi.pdf
      • Mar 7 2012: I do see your point 100%.
        I guess that the problem is that these people that refuse vaccines have no trust in the government or the associations that wish to make it mandatory.
        "The tragedy of the commons is a dilemma arising from the situation in which multiple individuals, acting independently and rationally consulting their own self-interest, will ultimately deplete a shared limited resource, even when it is clear that it is not in anyone's long-term interest for this to happen."
        I took this quote from the wikipedia link you offered.
        I think that this "tragedy of the commons" also applies to multi-billion corporations who deplete the world of resources such as oil, water, forests, etc etc etc. Maybe if the government did a better job at proving their allegiance to the community rather than the corporations and economic pig-heads that are benefiting financially from things such as pharmaceuticals and vaccines, those people would trust that the vaccines posed no real threat.
        Again, I'm no expert on the matter of vaccines, and I'm not saying that these vaccines necessarily are dangerous. I really wouldn't know. But a lot of people seem to be convinced that they are, and it wouldn't be ethical to force them into something they perceive as dangerous to their and their children's well-being. I don't see why the solution would be to make laws that everyone should be vaccinated. Why shouldn't the solution be that the government stops serving an elite portion of the population? Maybe then no one would opt out of such things.
        http://www.thrivemovement.com/drug-rx-money-making-killing
        http://www.democracynow.org/2004/12/31/confessions_of_an_economic_hit_man
        I'm sure that there are many things one can say to negate whatever is written in the links above. But regardless, if a portion of the population believes that this is what's going on, a portion big enough to affect the health of the entire community... there must be some sort of basis for the claims, don't you think?
      • Mar 8 2012: Hehe, surely it doesn't make it true, I didn't suggest that it did. I merely suggested that they're not going to think such a thing for absolutely no reason, there must be some sort of base upon which they made assumptions.
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          Mar 8 2012: While opting out of vaccines is a good example of the tragedy of the commons, it is an even better example of a positive externality and the free rider problem. In economics jargon, an externality is a cost (not monetary) or benefit that an individual experiences as a result of a purchase they did not take part in. In the case of vaccines, even if you choose not to get vaccinated for an infectious disease, you still receive a benefit every time someone else pays for the vaccine.
          Similarly, a "free rider" in economics is someone who consumes a resource without paying for it. In the case of vaccines, if you chose not to get vaccinated, you still get to consume the health benefit provided by the vaccine.
          I don't believe in an all powerful all controlling government. However, I believe that education is really important in order to quell some vaccine related fears. While this isn't necessarily true with HPV, there are people with compromised immune systems that are RELYING on a large number of people being vaccinated for diseases such as the flu, etc. so that they can avoid at worse a deadly infection and at best an expensive hospital visit. If we let people opt out based on conspiracy theories or even the basic human fear of the unknown, someone else's life could be jeopardy.
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    Mar 6 2012: question: if this vaccination is so good, why do you need to make it mandatory? chocolate is not mandatory, people buy it on their own.

    question 2: since when we use force as a final solution in a debate? what about this: if you don't agree with me that freedom comes first, i put you in jail. do you agree?
    • Mar 6 2012: My answer to your first question is that people have various reason to avoid vaccination, whether it is due to misinformation, belief frameworks based on past knowledge or lack of empathy and interest in well being of others. These beliefs exist despite vaccination being good.
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    Mar 6 2012: It was trialed in Canada first wasn't it?
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    Mar 6 2012: I don't know enough about HPV to know how I feel about a mandate as proposed by Rick Perry. I have read that the only way a child would be at risk is through sexual intercourse. I also am not sure about the claims for Guardasil being 100% effective in protecting sexually active women against contracting HPV, nor do I know the side effect profile of the vaccine. Because it is relatively new, only time will tell, and fortunately for me, my daughter has 14 years or so before this will be a decision in our lives. I say this primarily because by then I will have much more information on its use, and effects to make a sound decision on its benefits.

    If this was a question about vaccinations of children for diseases we have almost eradicated because we've had them in use and have outcomes data, I say yes they are important for the health of our communities against once deadly viruses. This, however, is very new. I also don't have much confidence in Rick Perry, so him being the person who brought this into the Texas legislature leaves me with more doubt than confidence. I can't help but wonder how Rick Perry, a staunch proponent of individual liberty, and of abstinence only sexual education for students because "abstinence is 100% successful in the eradication of teen pregnancies and stds" would advocate for mandatory vaccinations of teens against HPV, a virus that is only a risk for the sexually active? There is a reason, but I don't think it is what he presents solely to the public. What do you think?

    What do you think?
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      Mar 7 2012: The sexually transmitted strains of HPV, including the four covered by the Gardasil vaccine, can be transmitted through oral, anal, and vaginal sex.

      The claims about it's effectiveness are based on the high likelihood of antibodies against HPV in vaccinated women being present (around 99%). In addition, one study "in which vaccinated women were given a challenge dose 5 years after enrollment into the study demonstrated an augmented rise in antibody titer consistent with immune memory." This shows that the immunity against the HPV virus lasts at least for five years.

      Source: http://www.cdc.gov/mmwr/PDF/rr/rr5602.pdf

      Also, you're qualms about Rick Perry's motivation for proposing such a mandate may be well founded. He has received a lot of campaign donations from Merck, the manufacturer of Gardasil.

      Source: http://www.cnn.com/2011/09/15/opinion/krumholz-beckel-perry-pharmaceutical/index.html