Launched nine months ago with the blessing of the United States Federal Drug Administration, Merck's long-heralded remedy for cervical cancer has been predictably controversial. Any new vaccine is going to raise safety concerns, but one designed to prevent a sexually transmitted disease while targeting young girls, as Gardasil does, had family values groups on high alert. Any element of compulsion would be strongly contested.
And yet compulsory regimes were exactly what the drug giant lobbied strenuously for alongside its public advertising campaign ("You could be one less life affected by cervical cancer") late last year and through to February — when public reaction caused it to desist. Working through Women in Government, a group representing female legislators around the US, Merck persuaded a number of states to make vaccination a condition of attending school for girls aged 11 and 12. Around 20 states moved in this direction — with provision for parents to withdraw their daughters — but nearly all attempts have been stalled by opposition from parents.
Gardasil is controversial not only because it is new and untried on wide scale, but because it is different to other childhood vaccines. Most are aimed at diseases easily spread in schools: measles, mumps and whooping cough, for example. The genital human papillomavirus (HPV) that Gardisil targets is sexually transmitted. It is a disease eminently avoidable given a good human standard of behaviour. Gardasil therefore represents a new departure in medicine, where vaccines are used to protect people from the consequences of poor behaviour.
New, and yet not new. The great precedent for medicalising self-control is the contraceptive pill, and four decades of popping pills to avoid the natural consequences of sexual intercourse makes it easy for many people to accept the HPV vaccine as a legitimate insurance policy against self-harm.
Indeed, Gardasil is not even the first vaccine to be used in this way, as an article in the Washington Post points out. In the 1990s the United States added vaccination against hepatitis B — a disease that, in the US, spreads mainly through sex and shared hypodermic needles — to those already given to infants, even though children represented a small percentage of those infected. That move was advocated by the American Academy of Pediatrics, which said: "We are notably poor soothsayers in predicting which child will be put at high risk by future behaviour. Pediatricians must initiate, then, an insurance policy for young patients that matures in adulthood."
This time round the AAP is urging a go-slow approach — at least since the public backlash against Merck's strong-arm tactics became evident. The last thing health professionals want to see is entrenchment of the anti-vaccine mentality that has grown up around the MMR (measles, mumps, rubella) vaccine and its alleged links to autism.
One does not have to be a vaccine sceptic, however, to question the use of immunisation as behavioural insurance. Prevention is certainly better than cure, but when prevention means systematic short-circuiting of the human faculties of conscience and will it is a highly dubious approach. It is no longer just a matter of preventing a physical evil but of relativising a human good — not just any human good but the spiritual and moral powers that define humanity.
Where to from here? HPV is only one type of sexual disease — how many more vaccines are we going to need to make the world safe for irresponsible sex? Already there are trials under way for a genital herpes vaccine for women, which no doubt also means girls. From time to time an exasperated public health official calls for a contraceptive vaccine to use on teenage girls, and this type of contraception remains a goal of research in the field of population control. Research on an AIDS vaccine continues — with far greater justification.
But why stop at sexual behaviour? Alcohol and drug abuse produce nearly as big a social burden as sexual promiscuity. No wonder then that scientists in the US are said to be in the final stages of developing a vaccine against nicotine addiction, with cocaine and other drugs not far behind. If young people are going to experiment with these things, why not addiction-proof the kids when they are 12? All of them.
It is obvious that drug companies see vaccines as an ongoing source of bonanza. Not only Merck but GlaxoSmithKline and Swiss drug maker Roche expect to do well out of HPV vaccines internationally. After all, there is the whole male population to be immunised as well. Government mandated and subsidised programs for children and adolescents increase the scope for profit enormously. Yet they may do no more than replace one type of social burden with others.
Think of the cost. Gardasil alone costs $360 per course of three shots. Yet, according to a recent article in the New York Times, states in the US are struggling to fund the immunisations already recommended for children and doctors find it difficult to recoup their costs. If a child has all the recommended vaccines, these amount to as many as 37 shots and three oral doses at a cost exceeding $1600. Spending by the federal Vaccines for Children programme has grown from $500 million to $2.5 billion since 2000. 1.
Think more, though, about the cost of treating young people not so much like guinea pigs as like moral pygmies — half-human creatures who do not merit a serious effort at upbringing. Though some parents may believe otherwise, it seems likely that providing technical insurance against what boils down to deficits in character training and willpower will erode the whole idea of individual responsibility even further. Only a vaccine against life itself could prevent the harm from that.
Moral intelligence and — if that does not count in some quarters — economic rationality are against this trend. It should be nipped in the bud.
Carolyn Moynihan is Deputy Editor of MercatorNet.
1. "In need of a Booster Shot; Rising Costs Make Doctors Balk at Giving Vaccines," by Andrew Pollack, NYT, March 24, 2007