“More than 80 percent of all sexually active people in the U.S. have one or more viral strains of HPV,” said Dr. Arthur Caplan, director of the University of Pennsylvania Center for Bioethics, during a fact-filled Thursday discussion.
Caplan explored the ethical debate behind the controversial HPV vaccine, which treats HPV viruses linked to causing cervical cancer. Male and female students, science and non-science majors alike, packed into Shanklin Hall to discuss whether or not the groundbreaking vaccine should be mandatory for both men and women in the United States.
There are about 100 strains of the HPV virus, which is highly contagious and spreads through skin-to-skin contact. However, only seven of those strains are believed to cause forms of cervical and anal cancer, while two strains cause genital warts.
Although cervical cancer is not a major killer of women in the U.S., $1.7 billion is still spent every year on screening and treating the disease. However, most of the cases occur worldwide, with 80 percent in Africa and Asia. Caplan argued that if HPV vaccines are or are not approved in the U.S., it would influence decisions taken in other nations regarding approval of the vaccine.
“It shouldn’t matter that there are ‘relatively few’ deaths in the U.S.,” said Jess Mack ’07. “If the U.S. has the ability to influence which vaccines other countries approve, then we should use our power for good. Not evil like we usually do.”
Two pharmaceutical companies, Merck and Glaxo, have developed versions of the vaccine. Merck’s version, Gardasil, only treats two strains that cause cancer, as well as the two strains that cause genital warts. It has been approved in the U.S. and European Union, and it costs $360 for three shots, or $120 per dose. Glaxo’s version, Coravix, only works against two cancer-causing strains, but the company argues that its vaccine is more effective.
“Vaccines have always been misunderstood,” Caplan said. “They’re more expensive for patients, and they haven’t made a lot of money for pharmaceutical companies. They’re just not glamorous!”
Because the vaccine is most effective when it is given before women are sexually active, the issue then becomes when exactly women should be vaccinated, and whether men (who are also susceptible to genital warts) should also be encouraged to receive vaccinations, as Caplan explained.
In particular, supporters of abstinence programs such as the Family Research Council, a Christian organization, are concerned with the availability of the HPV vaccine, especially with ways it may be promoted and advertised.
“People were saying, ‘Maybe we don’t want to push this vaccine aggressively since it’s linked to an STD,’” Caplan said. “They’re saying, ‘We don’t want to vaccinate them, we want them to not respond to sexual activity.’ This wouldn’t be happening this way if this was a primarily male disease. That’s part of it.”
Many students agreed with Caplan’s assertion.
“As with all major industries in the United States, the healthcare industry is predominantly male run and thus operates in the interest of males,” said Anthony Nikolchev ’08. “Caplan made it clear that if this was a cancer that affected men, the vaccine would be much more discussed and prevalent.”
Besides controversy over whether the vaccination could be interpreted as encouraging sexual activity, there is also controversy over whether the vaccine should be mandated or not. Merck is currently engaging in intense state lobbying efforts and trying to get a government mandate for the vaccine. However, as Caplan explained, a ‘mandated’ vaccine could actually mean many things: something that is required, forced, encouraged, or covered financially. Insurance companies will not cover the HPV vaccine unless it is placed on the list with other mandated vaccines such as the smallpox vaccine.
“I get an uneasy intuitive feeling against mandating a vaccine for a virus that affects both men and women, and yet is only approved for women and thus only mandated for women,” Nikolchev said. “It also unfairly burdens women to feel like it is their responsibility to protect [themselves] against this disease, and it reduces the male’s responsibility as the carrier.”
Some students left the lecture inspired to receive what Caplan called a forerunner of vaccines to come.
“I had actually just asked my doctor over spring break about the vaccine, and she had told me to wait because there was still a lot of talk going on about it,” said Kaitlyn Krauss ’08. “I was really moved by the lecture, but I also feel wary of Merck and pharmaceutical companies in general. [But] considering how safe the vaccine is, I think I will get it.”
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