Post-Genomics Blog

Forging a connection between research and clinical applications.

New vaccines preventing cervical cancer and new controversies

I will focus here on cervical cancer, a disease that kills only women, for which a promising new vaccine is on the market. This disease kills perhaps 300, 000 women each year, mostly in developing countries. These deaths are unnecessary, and may now be reduced—if the vaccine is deployed and used by women, and that is where the ethical issues come in.

It is impossible to develop cervical cancer without first being infected by HPV. Thus, if a woman is not infected with HPV, she will not develop cervical cancer. Second, not all women who are infected with HPV will develop cervical cancer

The cervical cancer vaccine
A study in the US has shown that after four years a vaccine targeting HPV was still protecting women. The HPV vaccine has the potential to dramatically lower deaths from cervical cancer. Merck’s vaccine called Gardasil was already appoved by the FDA on June 8th and the other is GlaxoSmithKline’s vaccine called Cervarix which will be probably approved by next year.

Conservative objections
The vaccines are most effective when given before women are sexually active. There is opposition from some in the U.S. who think that the vaccines may encourage sexual activity in teens by promoting the view that premarital sex is safe. Others in the U.S.A. are concerned that abstinence programs may be attacked if this vaccine is promoted. The fact that Gardasil can be administered to preteens before they become sexually active is the cause of great controversy for Christian groups. They assume that this type of vaccine will promote a view—either implicitly or explicitly—that it is appropriate for children to engage in sexual activity before marriage.

This argument for rejecting the cervical cancer vaccine is equivalent to saying that seatbelts in cars are bad, because they will undoubtedly cause people to drive faster and have more wrecks. I wonder, then, how many vaccine opponents would be willing to support a law outlawing seatbelts as well?

Other ethical issues
There are still many unanswered questions and they are very important. How should the vaccine be advertised and promoted in USA and by whom? How can the vaccine be promoted elsewhere, particularly in developing world countries where the cervical cancer exerts its greatest burden? There are a slew of other important, unanswered questions that I can only posit for this audience’s deliberation. Should sexually conservative parents be held morally or legally liable if they resist inoculation, or would a majority of U.S. citizens find the idea so repugnant that Gardasil would be restricted to consenting adults only? What say, if any, should minors have in determining their sexual health, especially when their wishes run counter to their parents’ beliefs?

Even if it could be agreed upon that every young woman should be vaccinated, and parental permission should be required unless the girl requests the vaccine on her own initiative, who will pay for it?

The right thing to do is to ensure that all young women are vaccinated. We need to push politicians now to make sure that the money for these vaccines will be available. If insurance companies do not have to pay, and public health departments cannot afford to, then all other moral issues surrounding the vaccine will become insignificant. My advice: stay tuned, as this controversy is not going away anytime soon.

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