This week the Food and Drug Administration approved the first vaccine specifically designed to prevent cancer. Merck's Gardasil thwarts cervical cancer by blocking infection by the human papilloma virus, which is spread through sexual contact. Gardasil also blocks precancerous lesions that can cause infertility.
To reach maximum effectiveness, the drug should be administered at a young age -- ideally between nine and fourteen -- to assure protection prior to sexual activity and to take advantage of the robust immune response among pre-teen girls.
Given that a half a million women in the U.S. are diagnosed with cervical cancer annually -- and some 4,000 die from it -- the approval of this drug is phenomenally good news. It is even better news for the developing world where cervical cancer is far more common than it is here. So it's all systems go, let's get all young girls vaccinated so we can wipe out cervical cancer in the U.S., right? Not quite.
The potential obstacle for widespread application of this new, life-saving vaccine is a concern that giving it to pre-teen girls will somehow be interpreted as a green light for early sexual activity.
Some religious-right groups including Focus on the Family and the Family Research Council, while not opposed to the approval of Gardasil, are adamantly opposing including Gardasil on the list of mandated inoculations required for public school attendance (such as diphtheria, mumps, and pertussis).
Opponents argue that the disease is not communicable like mumps and measles and should be fought through "proper behavior" (meaning postponing all sexual encounters until marriage to a similarly inexperienced and uninfected man and remaining monogamous thereafter). As a spokesman for Focus on the Family put it, "We support the widespread availability of the vaccine, but we do oppose the mandatory vaccines for entry into public schools...This is a disease that is completely sexually transmitted...we believe that that parents should have the final say on whether to vaccinate their children."
Even the most libertarian among us must agree that certain public health mandates -- such as laws requiring water chlorination and regulations demanding pre-school vaccinations -- have virtually wiped out life-threatening communicable and infectious diseases. These interventions represent "public health" at its best. If we gave everyone the choice of whether or not to vaccinate their kids, we would have disease profiles approaching those of the Third World.
The argument that cervical cancer is "different" because it is largely sexually transmitted and therefore it can be prevented through strict sexual abstinence is just plain naive. Even the relatively small percentage of women who do remain sexually inactive until marriage will run the risk of exposure from their husbands.
The use of Gardasil is a medical matter -- not a moral one.
The mere fact that ten- or fourteen-year-old girls are inoculated with Gardasil has nothing to do with their propensity to commence sexual activity. Those decisions are culturally and religiously based -- and can be very much influenced by parents -- with or without Gardasil. Clearly there are myriad reasons for young, immature youth of either sex to postpone sexual relationships. These include the risk of numerous sexually transmitted diseases (from which Gardasil offers no protection), negative emotional effects, and distraction from high priorities like education, not to mention the very real risk of unwanted pregnancy. What parent could possibly argue that a vaccination at age ten would increase the odds of promiscuity when there are so many other real-life reasons not to become sexually active at a young age?
We should be able to alleviate ethical concerns by taking three complementary steps. First, make it well known that the new vaccine, when used appropriately, will virtually eliminate cervical cancer. Second, stress that the reason it must be given early in life is that inoculation at that point provides the best chance of lifetime protection (we do not know if booster shots will be necessary later in life). Third, completely separate the medical matter -- preventing cancer -- from moral matters regarding pre-marital sex.
Perhaps Merck can circumvent this controversy: while promoting the inclusion of Gardasil as a standard or required form of vaccination, they might also work with family-focused groups who oppose sex outside marriage to co-develop educational tools for discouraging premature sexual relationships -- citing medical, emotional, and practical reasons for doing so.
Protection from cervical cancer and youthful sexual abstinence can happily coexist.
Elizabeth Whelan, Sc.D., MPH, is founder and president of the American Council on Science and Health (ACSH.org, HealthFactsAndFears.com).
