The Right Thing for all the Wrong Reasons

Here in Texas there is nothing more divisive in the world of public health than the issue of the Executive Order for mandatory HPV vaccination of girls prior to entering sixth grade.

People are against it because Governor Perry has personal connections to the lobbyist from Merck, the manufacturer of Gardisil, the vaccine for HPV. People are against it because the three shot series retails at $360. People are against it because it only received FDA approval last June. People are against it because HPV is a sexually transmitted disease and vaccination against it may lead to promiscuity. People are against it because the order itself over steps the bounds of what a Governor's Executive Order should concern. People are against it because they just don't like things that are mandatory.

But that's just people.

Welcome to Texas, the gerrymandering capital of the universe. A place where the Democratic minority is not beneath hiding out in a Holiday Inn in Oklahoma to block a vote. Seriously. A place where we can hold our heads high and esteem to become the next Tom Delay, George W. Bush, or Enron-like executive. A place where it's okay to go out to shoot fowl and hit your hunting buddy instead. No fowl, no foul? We used to be our own frickin' country! Don't Mess With Us. We really don't like litter.

But behind all this smoke about nepotism, unsafe vaccines, superseding parental judgement, creating a generation of promiscuous little girls and executives using power they don't actually have, there is truth. And if you stop listening to all the loud voices you might actually hear it.

Gardisil prevents 70% of all cervical cancer. It has been endorsed by both the CDC (Centers for Disease Control and Prevention) and ACIP (Advisory Committee on Immunization Practices), part of NIP (the National Immunization Program.) It is now part of the Children's Vaccination Program, which means that CDC/ the Federal Government purchases it in bulk at a substantial discount and provides it to state immunization programs at that same discount. Any child eligible for Medicaid or SCHIP (State Children's Health Insurance Program) or who gets vaccinated through public clinics or VNA (Visiting Nurses Association) programs will get the vaccine either for free or at the substantial discount. And, many private insurance companies have already started covering it.

As for the whole mandatory thing, in every state, including Texas, there is a means by which a parent can refuse vaccination (specific vaccinations or all of them). They are just required to contact the state health department and fill out some paper work, sometimes they need a notary signature (which you can get at any bank), sometimes not. Some states require a reason, like a religious belief, some don't. But even those that do, are, for the most part, not allowed to investigate what the parents religion is or whether the parents' religion/faith really does have an issue with immunization. Back in Massachusetts, we used to refer to "the Church of No MMR" because of the number of parents who sought exemptions from the measles, mumps & rubella vaccine on religious grounds. The truth, of course, was that they had bought into a very well publicized, but terribly incorrect, theory that MMR (or one of its components, thermisol) caused autism.

As for vaccinating children against a sexually transmitted disease... Guess what?! We're already doing that! Hepatitis B has been out of the blood supply since the late 1980s. Every organ donor is tested for it before their organs are given to someone else and if they are HepB positive, they're organs and tissue will not be used. Which means... You got it! The only way to contract HepB (unless you're a healthcare worker or first responder) is from sex with an infected individual or sharing needles. Every state in the union vaccinates newborns against this virus. Where's the uproar that we're condoning unprotected sex and intravenous drug use???!! Among toddlers, even! What's to stop 3 year olds from developing a heroin habit, I mean, aside from their lack of mobility. (It is kind of hard to drive the car from the carseat in the back...) And perhaps underdeveloped fine motor skills required to cook the spoon, tie the tourniquet, fill the dirty syringe, find a vein and inject.

Now I don't really care if the Governor overstepped his bounds. I'm actually required by law to professionally agree with him. Not the point. If parents are going to leave their daughters unprotected just because they don't like the governor telling them what to do, what does that make them? Adolescents. Now trust me on this one, because I have decades of experience. No matter how many times you don't do something just because an authority figure (say, hypothetically, your mother) tells you to, you will never "train" that individual to stop telling you what to do. It's a battle you can't win.

But just for fun, lets consider an alternate reality where HPV is something different. Let's say, just for fun that it caused disease in males. If it could be weaponized, we would have already tested it extensively, more than anyone would ever need, since we'd have vaccinated all our troops. Anthrax, anyone? Or what if it caused testicular cancer instead of cervical cancer? (And let's be honest, no father wants to admit that his 11 year old little girl even has a cervix...) Would there be the same uproar? Remember, boys can't be promiscuous, that's a trait reserved for females. Boys are just being boys. The pro-vaccine clamor would quickly outweigh the cautious. We would have Lance Armstrong and ever other uniballed man on earth out fighting for this cause. It would be a no brainer.