I was raised in a religion with strict standards regarding sexual purity and virginity. It was the expectation of my parents and my church that daughters would be virgins on their wedding day and monogamous with one man for life. Although I have since left that culture and chosen a different path, I have deep empathy for how fundamental these values are to my friends and family who remain followers of such religions.
So I watched with curiosity as the national debate regarding the human papillomavirus (HPV) vaccine unfolded in 2006. HPV is a sexually transmitted virus that causes cancers of the cervix, genitals, and throat and is spread by sexual contact. These cancers can be devastating and fatal. This relatively new vaccine protects against the most dangerous strains of HPV and was heralded by the medical community as a tremendous advancement in the fight against cancer. But there was a catch.
In order to be effective, the HPV vaccine must be administered before a person is infected. The Centers for Disease Control recommends children receive the HPV vaccine at age 11 or 12 — which requires parental consent. Enter the opposition.
On one side of the debate were public health experts, lauding this new medical breakthrough as a powerful preventive measure against a devastating type of cancer. On the other side were concerned parents and members of certain community or cultural groups, fearful that the HPV vaccine was a stamp of approval for sexual promiscuity in teenagers. Even I was surprised at how political and nasty the national conversation quickly became.
Michael Douglas put a face on the HPV discussion recently when he revealed that his throat cancer — which took an enormous toll on his health and his family — was caused by HPV. In fact, 70 percent of oropharyngeal cancers are caused by the sexually transmitted virus which is easily spread through oral sex. Partly because vaginal fluids carry a higher virus load than the surface of the penis, HPV-related throat cancer has risen dramatically in middle-aged heterosexual males over the past 30 years. It was a brave disclosure by Mr. Douglas, and it reinvigorated the debate over parents’ rights to decline vaccination for their child on religious or moral grounds.
The vaccine’s opponents do not dispute that the vaccine works — there is ample evidence that it does. Rather, the issue at hand is one of personal beliefs. Do parents have the right to deny their child a vaccine against HPV, thus ensuring potentially dire consequences for unapproved sexual activity? And even if children plan to remain virgins until marriage and monogamous after, should they be punished with cancer if they decide in the future to choose a different path? We know that 65 percent of teenagers are already sexually active by age 18, and the HPV vaccine must be administered before becoming infected with the virus. If parents don’t allow the vaccine during childhood, and the child becomes sexually active during the teenage years (as most do), then the opportunity for prevention may have passed.
If we have a vaccine that prevents cancer, why would anyone opt out for his or her child? It’s a baffling question for those of us in public health and has spurred accusations of cruelty and ignorance toward such parents. But I propose a softer approach.
Placing the HPV vaccine debate within the historical context of other medical developments that challenged long-held religious and cultural dogma provides perspective on just how long it takes for a medical advancement to gain popular acceptance.
Take, for example, sperm. The belief that women were responsible for the sex of their offspring caused calamity for thousands of years. Henry VIII had his second wife beheaded for failing to produce a son. When it was discovered in 1905 that sex determination lay in the XY sperm of the male, and not the female’s egg, did society applaud and promptly change their beliefs? On the contrary! Over 100 years later, brides are still cheerfully encouraged to “give him a son” and sometimes persecuted when they do not. The dogma was so deeply ingrained in us that 100 years of knowing better hasn’t abolished it.
So I personally propose, even as a staunch vaccine advocate, an attitude of patience and empathy with those parents who are struggling with the HPV vaccine on the ground that it will be the moral downfall of their children. And I commend the brave parents who have chosen to vaccinate their children against HPV despite being members of groups who oppose it. For although they hope their child will subscribe to the virtuous virginity their religious faith expects, they also recognize that failing to do so should not be punishable by disease and death.
I believe controversy over the HPV vaccine will diminish over time — although hopefully it won’t take 100 years. My personal perspective is that withholding health care from a child to induce moral chastity will some day sound as archaic to us as beheading one’s wife for failing to produce a son.
Or at least we hope so.
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Charity Thoman, MD, is a deputy health officer in Santa Barbara County's Public Health Department.