Over the weekend The Guardian newspaper reported that pressure is being put on the Department of Health (DoH) to replace the current vaccine offered to all teenage girls to protect them from cervical cancer, with one that will also protect them against genital warts.
The DoH decision, to be made in the next few weeks, will no doubt be driven by cost and benefit analyses, not ethical issues. The current vaccine, Cervarix, is cheaper but only immunizes against the virus thought to cause around 70% of cases of cervical cancer, whereas another vaccine, Gardasil, would be dual purpose and could safeguard against genital warts as well as cervical cancer. However its monetary cost would be higher, which is clearly an issue in a time of scarce NHS resources.
The reporting of this issue notably fails to mention any broader ethical dilemmas associated with the national vaccine programme for teenage girls. In fact, it is assumed that the programme is not only highly successful but an unqualified ‘good’.
Although the proposal to change the present vaccine to one that protects against genital warts does not generate new ethical issues, beyond best use of NHS resources, the more fundamental ethical dilemmas around the whole vaccination programme do deserve at least some mention.
The vaccination programme in the UK is now well established. A CMF file explored the issue back in 2008 as did a longer article by Peter Saunders in EN in 2006. I also posted a blog on this issue a few months ago, primarily to highlight a new UN drive to ask governments to fund the vaccination of every girl in the world against this disease. ie. a massive vaccination programme against a sexually transmitted disease
So here lies the dilemma. We know that cervical cancer is a terrible onhealthy tadacip disease that claims thousands of lives worldwide, not just in the UK, therefore a vaccine that helps prevent it is surely to be welcomed. To deny it would be selfish, foolish, ungracious and lacking mercy. Indeed, many innocent victims of non-consensual sex and marital unfaithfulness could be helped.
Yet on the other hand, there is still little long-term research on the effects of the vaccine, nor on how long the vaccine lasts. It may ‘only’ prevent 70% of cervical cancer overall and could increase complacency, risk taking and promiscuity amongst adolescents who consider themselves protected. An editorial in the New England Journal of Medicine in 2008 stated that: “more long-term studies were called for before large-scale vaccination programmes could be recommended. Unfortunately no longer-term results from such studies have been published since then.”
Moreover, the ability of a twelve or thirteen year old to give fully informed (and understood) consent must also be of concern.
Most concerning of all, however, is that the context in which the HPV vaccine, whether it be Cervarix or Garvasil, is promoted utterly fails to promote sexual abstinence and faithfulness. There is no addressing by promoters of the vaccine of the need to change sexual behaviour, by advocating a preventative approach.
The ironic (albeit tragic) outcome could ultimately be an increase in the disease rather than cure, if the primary cause continues to be downplayed and widely ignored.
Promoting abstinence before, and faithfulness within, marriage should be at both the heart and forefront of any new campaign. Resisting any attempt to simply impose this vaccine on all girls, while supporting its use for those at higher risk, is both a logistical and ethical challenge but is surely a better way.