Virgin Vaccine
Has the Religious Right really changed its mind about preventing HPV?
by Cristina Page
June 28, 2005
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.
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.
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."
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."
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.
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."
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."
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©2006 Cristina Page and Nerve.com