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Blind Faith

The right is still fighting the HPV vaccine.

Last year, when news broke about Merck's successful trials of Gardasil, a vaccine intended to prevent cervical cancer, pundits braced for an all-out culture war. The vaccine blocks the Human Papilloma Virus (HPV), a common sexually transmitted disease that causes cervical cancer--which in turn kills several thousand Americans (and hundreds of thousands worldwide) every year. Merck's vaccine had been shown to be completely effective against most strains that cause cervical cancer, with few side effects. But the Christian right seemed to view the vaccine as a license for promiscuity. The Chicago Tribune reported that "conservative groups promoting abstinence say they will fight recommendations that children get shots," while the Los Angeles Times warned of a "clash between health advocates ... and social conservatives."

In fact, the dispute over the vaccine has remained relatively low key, prompting Merck to claim victory. Deb Wambold, a spokeswoman for the pharmaceutical giant, told me, "We have been meeting extensively with groups like the Family Research Council to provide data, answer questions, and address concerns. And we feel confident that we were able to show them the value of the vaccine as a public health tool."

But Wambold shouldn't be so confident. Instead of campaigning aggressively against the vaccine, Christian groups have adopted a subtler rhetorical strategy: saying simply that they favor "choice"--that is, allowing parents to decide whether the vaccine or abstinence is right for their children. This strategy is no less pernicious for being polite. And it could go a long way towards undermining the vaccine's potential benefits.

Consider the statements of conservative groups on the subject. On the one hand, they are careful to praise the vaccine. The Family Research Council said it "support[s] the widespread distribution and use of vaccines against HPV." Focus on the Family announced that it "supports and encourages the development of safe, effective, and ethical vaccines against HPV and other viruses ... [and] supports the widespread (universal) availability of HPV vaccines." And a spokeswoman for Christian Medical %amp% Dental Associations told me her group "fully supports wide availability of the vaccine for those who want it."

At the same time, these groups pointedly oppose the vaccine becoming mandatory. "Because parents have an inherent right to be the primary educator and decision maker regarding their children's health, we would oppose any measures to legally require the vaccination or to coerce parents into authorizing it," said the Family Research Council. Focus on the Family "opposes mandatory HPV vaccinations for entry into public school. The decision of whether to vaccinate a minor against this or other sexually transmitted infections should remain with the child's parent or guardian." And the Christian Medical %amp% Dental Associations believe the vaccination should "absolutely remain a choice, not a requirement."

But social conservatives have it wrong. To effectively combat cervical cancer, the HPV vaccine should be mandatory--or as close to mandatory as such things can be. In practice, this would mean adding the vaccine to the roster of immunizations that states require before students can enroll in school--a list that includes inoculations against other public health threats such as Hepatitis B, which also can be transmitted sexually.

Religious conservatives are posing the debate as a choice between abstinence and safe sex. "We feel people should have the choice of abstinence as a means to avoid HPV," a spokeswoman for Christian Medical %amp% Dental Associations told me. "Our concern is this vaccine will be marketed to a segment of the population that should be getting a message about abstinence," says the Family Research Council. And in theory, that's fine. But, like communism, certain ideas have a hard time succeeding in the real world. Studies show that not only do abstinence programs have little to no effect on rates of sexual activity, they also tend to mislead or withhold information about practicing safe sex. That's why people who pledge abstinence are less likely to have safe sex and avoid STDs when they do find partners. So while, in theory, the choice of abstinence over Merck's vaccine would be fine, in reality, it too often would mean a choice to expose oneself to HPV--and the risk of cervical cancer.

And because HPV is so widespread--absent a vaccine, 80 percent of Americans will contract it at some point in their lives--the stakes in this discussion are high. It's true that most of the hundred or so strains of HPV are innocuous, so the fact that over 20 million Americans have it at any given point is not necessarily cause for alarm. It's also true that the annual number of cervical cancer cases is relatively small--10,400, a third of which are fatal. But each year, 4.7 million American women require one or more follow-up appointments for an abnormal pap result, and at least 3 million of these cases result from having HPV. The cost of these appointments to the individual (and to our already overburdened health care system) quickly adds up. A 2003 Stanford study suggested that the cost of inoculating people against the disease would be far smaller than the current cost to the health care system associated with HPV.

Since the disease is so common, many fail to bring it up with their partners. Those who refrain from intercourse can still get HPV from other sexual activities. And even those who remain fully abstinent until marriage could contract it from their spouses. In short, HPV is a significant public health threat. It therefore isn't enough to back the vaccine's "availability"; one has to support the strongest possible steps to inoculate the entire population.

The future of Merck's vaccine is now largely in the hands of the Advisory Committee on Immunization Practices (ACIP), a branch of the Centers for Disease Control. (The FDA is expected to approve the vaccine sometime this year.) Doctors follow the ACIP's vaccine guidelines very closely. Thus, in order for a vaccine to make immunization schedules on a large scale, the ACIP has to make an official recommendation. If a vaccine fails to pass muster with the ACIP, it runs the risk of being overlooked by the broader medical community.

It's not clear whether most religious groups would support or oppose an ACIP recommendation that the vaccine be distributed universally and added to regular immunization schedules. But even if they would back such a recommendation, the real fight comes after, when state governments would face a decision about whether to require that students be vaccinated. And Christian conservatives can be expected to oppose those moves vigorously. This may strike some as implausible. "I don't think anyone wants to stop a cancer vaccine," says Alan Kaye, chairman of the National Cervical Cancer Coalition. If only he were right.

Steven Groopman is a reporter-researcher at The New Republic.

By Steven Groopman