Across America people are divided about the legality of abortion, when, how and if sex education should be taught in public schools, pre-marital sex, gay marriage, and the government’s role in health care for the individual and the public at large. In this environment, it is easy to see how two republican candidates for president can disagree about mandating the HPV vaccine for school entry.
Although the HPV vaccine was mainly developed to prevent cervical cancer, it also prevents genital warts, anal cancer and might prevent penile cancer and some types of oropharyngeal cancer as well. There is no way to have an educated discussion about the vaccine without talking about teen sexuality and sexual practices. As patients get closer to thirteen and fourteen, I feel comfortable discussing their sexual development without parents present. However, before that time, I think it is important that parents take a more active role in initiating that discussion and the HPV vaccine provides the perfect opportunity for me to encourage that dialogue even if it is just puberty 101.
The vaccine can be given as young as nine years old, but it is recommended at 11-12 years of age for girls and may be given to boys (the CDC and AAP do not yet officially recommend it for boys). The emotional and physical maturity of the child at this age is variable but generally boys are a little less developed. In addition, the unique values of each family, broaden or limit the scope of the discussion along with the gender of the parent at the visit.
Most parents have heard of the vaccine. If a mother has had a history of abnormal pap smears, she might quickly say, “Oh yeah. We talk all the time. We want that vaccine.” While another mother may respectfully say, “No thank you. She is too young,” and agree a year or two later when we discuss it again. A dad might defer his daughter’s vaccine saying mom will bring her back another time. Pre-pubertal boys whose minds are on baseball cards and video games can barely look me in the eye to talk about school let alone sex. Their mothers usually just make the executive decision with little fanfare.
To assert that this vaccine is just like any other childhood or adolescent vaccine is purely academic and not at all practical. My two daughters will get the HPV vaccine. But what about my autistic and delayed son who is unlikely to ever have a sexual relationship? If Ohio mandated the vaccine for school admission, I would opt out for him.
Since the vaccine was licensed in 2006, about half the states introduced legislation to mandate the vaccine for girls but only Virginia and D.C. succeeded and they both allow parental opt-outs. Unlike most other vaccines that are mandated by daycare centers and schools, the disease that HPV prevents cannot be spread or contracted in the school environment.
I think the HPV vaccine is safe and provides both personal and public health benefits. Although I do not think it should be mandated by schools, I do recommend the vaccine for girls and boys. Next post I’ll discuss the details of the human papillomavirus, how it is spread, the diseases it might cause, and the vaccine’s role in prevention. That way you can make the best decision for your own children with your doctor.
