Thursday, April 19, 2007

Great conversation, poor in bed

Mandates cause outrage among politicians and the public. So do sexually transmitted infections, such as the papillomavirus (HPV), which causes genital warts and cancer.

But a possible bill by state Sen. Lena Taylor, D-Milwaukee, which would mandate the vaccination of young girls against HPV, has started a festering but needed conversation about public health and sexuality.

HPV is the most widespread sexually transmitted infection in the United States, affecting about 50 percent of the population, according to the Center of Disease Control. The vaccine, Gardasil, targets strains that cause up to 70 percent of cervical cancers and 90 percent of genital warts.

Despite the benefits of decreasing infection and cancer, criticism of a mandate has come from doctors and public officials. They argue that the public needs more education about HPV and that Gardasil needs more testing and is too expensive. It costs roughly $360 for three shots, and some insurance companies do not cover it.

“This is something that’s not on people’s radar,” James H. Conway, a pediatrician at the University of Wisconsin–Madison, says in the Milwaukee Journal Sentinel. “We can’t get to the point where we’re forcing people into doing something without educating them about why they’re doing it.”

I agree that much of the public needs more time to understand HPV and the immunization before it’s mandated. Also, people need the resources to get the vaccine, whether insured or not.

Fortunately, countywide efforts in Wisconsin are making that possible. Public Health- Madison & Dane County has been offering Gardasil free of charge to young uninsured girls since April 1.

“No one is turned away,” says Jeneile Luebke, the Immunization Specialist for Public Health. She notes that uninsured girls aged 9 to 18 can get vaccinated, and exceptions are made for girls whose insurance doesn’t yet cover the HPV vaccine.

So far, Luebke says that funding for the vaccinations has been adequate, and the public is receptive. But she notes that the budgets are stretched thin, forcing the county to shift funds to cover the more expensive HPV vaccine.

“[President] Bush cut the budget of the national vaccination program by 16 percent this year,” Luebke says. “The state has to make up for that.”

HPV vaccine programs are also facing some challenges from socially conservative groups such as the Family Research Institute and the Abstinence Coalition. They charge that the vaccine sends a message that teenagers are expected to have sex, making it more permissible to them.

“Any time there is a mandate, there’s a backlash,” Luebke says of such groups, countering that even if a woman is abstinent until marriage, she can still contract HPV from a husband who has previously had sex.

County vaccination programs like that of Dane County rightfully engage Wisconsin residents about the problems associated with HPV and provide intervention.

Sen. Taylor’s proposed bill is founded on the best intentions. Combating HPV must be part of the public sphere, but awareness of the vaccine and its use will take some time.

Forcing good policy will hinder its acceptance. Instead, resources should be used to support county vaccination programs and combat virulent strains of flawed ideology.

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