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The Virgin Vaccine

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The past few weeks have brought the political equivalent of a UFO sighting, a rare opportunity to witness a spectacular, possibly staged, event. The Religious Right appears to have made an about-face on a sexual-health issue, a turn all the more extraordinary because it affects teens. Just months ago, the Christian Right opposed the new breakthrough vaccine against the most common sexually transmitted disease, the human papilloma virus (or HPV); today, they embrace it. It's a display that reproductive health advocates find entrancing — and not entirely credible.
   On June 8th, the FDA approved Merck's Gardasil, which is 100% effective at immunizing against the two HPV strains that cause 70% of all cervical cancers. In the months preceding the FDA approval of this groundbreaking cancer-prevention method — this is one of the world's first cancer vaccines — the Religious Right seemed prepared to (characteristically) camp out on the wrong side of history.

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Their argument against the vaccine was familiar: it threatens to seduce unmarried people into thinking that sex is not so risky. Ipso facto, the pro-life movement opposed it. This might be a technological advance so stunning it promises to save hundreds of thousands of lives every year, but spokespeople trotted out arguments best summarized by Bridget Maher, of the Family Research Council, who told New Scientist magazine in April 2005, "Giving the HPV vaccine to young women could be potentially harmful. They may see it as a license to engage in premarital sex."
   Just last year, pro-lifers used the very same promiscuity forecast to derail the application to make emergency contraception available over the counter. "We are very concerned that no data is available to suggest what impact this decision will have on the sexual behavior of adolescents," wrote forty-nine pro-life members of Congress to President Bush. Their successful campaign revealed a startling paradox: pro-life political forces are willing to forego the best chance at dramatically reducing the nation's abortion rate if they perceive the slightest possibility that sex will become less risky.
   

To shamelessly oppose a cancer vaccine is to play the bogeyman a little too well.

Initially, the script for the Right's opposition to the HPV vaccine seemed like it would play out the same way. The opening act was the December 2005 announcement by Merck that it would be best to inoculate girls against HPV while they're still virgins, probably at age eleven or twelve. The reasoning was simple. By current estimates, each year about 10,000 American women will get cervical cancer, and 3,700 will die from it. The vaccine will significantly reduce the threat of the disease. (Imagine the public frenzy in support of an avian flu vaccine if 3,700 Americans a year were to die from an outbreak.) However with HPV, as with abortion, prevention is simply not on religious conservatives' to-do list. As Jim Sedlak, vice president of the American Life League, wrote on the group's website, "It appears that Planned Parenthood wants this new HPV vaccine so it can continue leading our children into a destructive lifestyle while giving them a 'shot' to avoid some of the complications of that lifestyle."
   But to shamelessly oppose a cancer vaccine is to play the bogeyman a little too well. "The Religious Right just didn't see much fun in setting themselves up as the piñata on this," says Kirsten Moore, of the Reproductive Health Technologies Project, a group that helped bring emergency contraception's over-the-counter application to the FDA. "The press was desperate for a cat fight, and our opposition didn't take the bait."
   In the course of the past few months, one by one, conservative groups began to come out in favor of the vaccine. But their new message feels like a well-worn page from the Bush playbook: Say you're for it but work furtively against it. Focus on the Family hailed the vaccine as "a tremendous breakthrough in science that will likely save millions of women's lives around the world," but said it would oppose mandatory HPV vaccinations. Likewise, The Family Research Council may now "support the widespread distribution of vaccines against HPV," but "would oppose any measures to legally require vaccination."

Women's health proponents expect the Religious Right will battle the HPV vaccine state-by-state.

   According to Dr. Gregory Zimet, chair of the vaccine committee at the Society for Adolescent Medicine, this is the Right's attempt to repackage its original agenda. "The softening of their position came, at least in part, from the recognition that being labeled as pro-cancer didn't really fit well with their attempt to present themselves as pro-life," said Zimet. "Many of them are now saying, 'We've never been opposed to it,' even though I looked at their websites a year and a half ago and they were. What they've done is said, 'Of course we're not opposed to this vaccine that can save the lives of our daughters, our wives and our mothers — but we just don't think it should be forced on people.' So, I think partly [the new message] is cover and partly it may be a warning — as they say, a shot across the bow." It will be up to the states to decide whether the HPV vaccine is, like inoculations against polio and diphtheria, required for a child to proceed through school. "As states begin to consider the potential for mandating a vaccine like this," says Zimet, "They are forewarned that these groups will put resources to fight it."
   The Advisory Committee on Immunization Practices (ACIP) is a fifteen-member panel that advises the CDC on which vaccines should be recommended nationwide. Their decisions have a significant effect on whether private insurers will pay for the vaccine. ACIP also recommends whether a vaccine should be included in the Vaccines for Children program, run by the CDC. (This is crucial if poor people — those most at risk for sexually transmitted diseases — are to get the vaccine. The Vaccines for Children program supplies vaccinations to Medicaid, the uninsured and some underinsured patients, but only if the CDC designates it as recommended.) The ACIP meets June 29th to make recommendations to the CDC on the HPV vaccine. The CDC traditionally follows the ACIP's advice. Also traditional is for states, individually, to adopt ACIP advice and require a vaccine for public-school admission.
   And here is the area in which many are bracing for a fight. Women's-health proponents expect the Religious Right to battle the HPV vaccine state-by-state in an attempt to convince parents and legislators that mandatory vaccination amounts to a confiscation of parental authority. As the Family Research Council spokesman explained, "There is no justification for any vaccination mandate as a condition of public-school attendance."

        
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      But the "no mandate" strategy feels like a ploy. After all, every state, with the lone exception of Mississippi, allows parents to opt out of vaccinating a child. "There has never been any vaccine that has been mandated. But using that term generates a tremendous amount of sympathy," explains Dr. Juan Carlos Felix of the University of Southern California, who leads the National Cervical Cancer Coalition's medical advisory panel. In forty-five states, a parent can simply cite personal, philosophical or religious reasons for not vaccinating a child and still gain admission to public school. In the remaining four states, a child can be exempt from vaccination if a parent cites religious reasons.

For parents who don't wish to inoculate their daughters against the primary cause of cervical cancer, opting out is already possible.

The new "no mandate" language is, perhaps, a leap forward from the prevention-equals-promiscuity rhetoric of a few months ago. But for those who have watched as seemingly minor objections — such as whether emergency contraception would be abused by eleven year olds, a key argument mounted by the Right — stop public-health advancements in their tracks, wariness is the order of the day. The true confirmation of the Right's professed willingness to welcome the vaccine will be whether groups like the Family Research Council accept that their concern over school mandates is unwarranted. It bears repeating: For parents who don't wish to inoculate their daughters against the primary cause of cervical cancer, opting out is already possible. (As for Mississippi's lack of a vaccine exemption, let's synchronize our watches and see how fast one appears once the Religious Right comes knocking.)
   Meanwhile, leaders of conservative Christian organizations plead sincerity. They claim the shift in their position results from research and genuine reflection about the benefits of the vaccine. As Dr. Gene Rudd of the Christian Medical Association explains, "I know a lot of groups had questions earlier on, but they were going through that evolution, trying to figure out what it was, and what their position was going to be. And I just think the mandate is still in that little limbo because some of these groups haven't worked their way through the thought process. I think, in the end, they are going to say 'Hey, mandates with exemptions will solve the problem.'"
   If indeed Dr. Rudd is correct, the HPV vaccine could spur another breakthrough: it may cure a little of the malignancy that now characterizes this culture war. "It would be very good news if these groups said mandates are okay," explains Deborah Arrindell, vice president of health policy at the American Social Health Association, an organization that leads education campaigns about HPV and the new vaccine. "I am hoping they will join us. All people from all religious perspectives can join together to get all people protected. If the issue is that they are being mischaracterized in the press — and instead there is support from all faith-based communities and political parties for the vaccine — that would be good news."

A key appointee from the Religious Right will help decide the future of the HPV vaccine.

   Proponents of the HPV vaccine are, at this point, keeping their fingers crossed. They must still surmount several hurdles even before they face mandate fights in state legislatures. First is the ACIP meeting in late June, where a key appointee from the Religious Right will help decide the future of the HPV vaccine. In 2002, Tommy Thompson, then Secretary of the Department of Health and Human Services, asked Focus on the Family for a list of candidates to appoint to key posts concerning sexual health matters. Focus on the Family assigned the task to Reginald Finger, its medical advisor. In 2003, with the HPV vaccine on the committee's horizon, Finger was appointed to the ACIP. He previewed the perspective he will bring to the decisive June ACIP meeting in a quote given to The Hill a few months ago: "If people begin to market the vaccine or tout the vaccine [so as to suggest] that this makes adolescent sex safer, then that would undermine the abstinence-only message."
   Generally, public-health experts, including Dr. Rudd at the Christian Medical Association, believe that the ACIP will recommend the vaccine. But as Bill Barker, a representative of Advocates for Youth, cautions, "[I was] very involved with the emergency contraceptive, [and] it didn't seem like the Bush appointees were going to have an impact then either. In fact, we were hearing from all our friends and experts at the time, 'Don't worry about it. The FDA is going to do the right thing.' So, there are definitely concerns. We don't want to get caught again thinking that everything is fine, and put our advocacy efforts in the background. We want to make sure we don't get this ripped away from us right at the end."
 

        

©2006 Cristina Page and Nerve.com
ABOUT THE AUTHOR:
Cristina Page is author of How the Pro-Choice Movement Saved America: Freedom, Politics and the War on Sex.