New HPV Vaccine Stirs Debate:
Herd Immunity and Health Care Costs
When a federal advisory panel voted unanimously on June 30 to recommend that all girls and women ages 11 to 26 received a new vaccination, it re-kindled a simmering debate about the role of vaccinations in public health, disease management and health care cost containment.
Because vaccinations generally prevent disease, they help restrain the cost of health care for LIUNA health and welfare funds. However, this new vaccine is different in some regards from those of the past. It is important that fund trustees and administrators learn what they can about it so they can handle questions and make the right decision regarding coverage for their participants.
The new vaccine, Gardasil, targets four strains of the human papillomavirus (HPV), the most commonly transmitted sexual disease, which causes 70 percent of cervical cancers and 90 percent of genital warts in women. In the United States, about 20 million women and men carry the virus and another five million become infected each year. Most women with the virus do not develop cancer, but about 10,000 each year do and 3,700 die. Worldwide, about 233,000 women die each year. The cancer is far less deadly in the U.S. because millions of women have annual Pap smears to test for early signs and tens of thousands undergo further testing to check positive test results.
However, the vaccine is the most protective if it is started before a young woman becomes sexually active, and therefore, the advisory board recommended that all girls get the three-course vaccination beginning at age 11. This recommendation is the basis of the controversy.
Some religious and social conservative groups do not believe that the vaccine is the best way to protect against the danger of HPV. Instead, they urge sexual abstinence. However, even they acknowledge, for instance, that a young woman might marry a man who, unbeknownst to him, carries the virus and, in that case, abstinence until marriage would not have protected her. Thus, Focus on the Family, writes on its website that it “supports widespread (universal) availability of the HPV vaccine but opposes mandatory HPV vaccination for entry to public school. As in all areas of sexual health and education, Focus on the Family upholds parents’ right to be the primary decision maker and educator for children.”
The distinguishing vaccination issue here is “sexual health and education.” None of the other recommended childhood vaccinations – such as diphtheria, hepatitis, polio, mumps, measles and rubella – are related to sexually transmitted disease. Though some parental organizations have criticized these traditional vaccinations on grounds of health risk – a few children have adverse and, occasionally, fatal reactions – states have nevertheless made them mandatory for school attendance. Apparently, there is little health risk associated with the HPV vaccine.
The mandatory requirement for most childhood vaccines ensures that so few unvaccinated hosts remain that the disease eventually dies out and disappears. Known as “herd immunity,” this is what eventually eliminated smallpox on earth and is close to doing the same with polio.
Without a requirement that all girls and young women – and, eventually, boys and young men, too – be vaccinated, HPV cannot be eradicated.
In addition to improved, long-term health prospects for women and men, the introduction of the vaccine and the eventual elimination of the virus would produce a huge health cost savings for U.S. society as a whole. First, it will greatly reduce the number of cancers and the cost of their treatment. Also, while the current Pap smear test program could not be eliminated – the current vaccine combats only about 70 percent of the virus strains that cause cervical cancer – the vaccine will greatly reduce the enormous number of false positive results that must now be followed up with additional, expensive test procedures.
The federal panel’s June 30 recommendation all but commits the federal government to provide HPV vaccination to the nation’s poorest girls, ages 11 to 18. The Department of Health and Human Services must affirm the recommendation, but that is routine. It is expected that private health plans will begin covering the vaccines as well. That leaves unprotected the daughters of the so-called “working poor,” those without insurance but earning too much to qualify for Medicaid. In pursuit of herd immunity, many states provide vaccinations for this group, but state budgets have been strained in recent years and Gardasil is quite expensive by traditional vaccine standards.
Gardasil is not a “live” vaccine, so no one can catch HPV from the vaccination. Other pharmaceutical companies may soon have similar vaccines approved.
LIUNA health and welfare funds will now have to determine if they will pay for the HPV vaccination. Those with wellness programs may choose to cover it under childhood vaccinations. Laborers and their family members who are interested in this option should talk with their local fund. More information on HPV is available from the Centers for Disease Control.