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August 27, 2006

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A shot in the dark

By Paul Schratz

There has often been something of a moral quandary for parents over the issue of vaccinating their children.

They weigh the benefits of keeping their children healthy against the possible health risks involved with vaccinations and the problematic background of some vaccines.

In the end, most parents opt to vaccinate. Now, however, the dilemma is becoming more difficult with the introduction of a new drug that raises a host of questions.

The vaccine, called Gardasil, is aimed at preventing the spread of human papillomavirus (HPV), which causes cancer of the cervix, a disease that infects 1,300 women a year in Canada, claiming the lives of nearly 400 of them.

Those hundreds of deaths make HPV a legitimate public health issue, but the speed and ferocity with which Gardasil is being thrust on Canadians is truly breathtaking. Most of the provinces are now launching HPV vaccination programs, some starting as soon as September. In the U.S., several states have tried to make the vaccinations mandatory.

Not since the Salk vaccine was introduced in the 1950s to combat polio has a drug been rushed into mass use so vigorously, and for a disease that is nowhere near as serious a public health risk. Cancer of the cervix, while a very real health concern, is not among the 10 most common cancers for women, or among the 10 most common causes of cancer-related deaths among women.

There remain questions about the safety of the drug and whether mass inoculations are warranted, following reports of illness and death after vaccinations.

In addition, some experts fear vaccinations could give women a false sense of security, leading them to neglect other forms of prevention and screening, such as regular pap smears.

The main concern, however, is the way the vaccine is being pushed on young girls as young as 9, to tackle a virus that is primarily spread through sexual contact. As one consultant advised the B.C. Cancer Agency, this is not a vaccine against cancer, but a vaccine against a sexually transmitted disease, implying a presumption of promiscuity among children.

The risk is that the vaccine will become yet another easy solution for parents who are uncomfortable with or opposed to teaching their children about restricting sexual activity to marriage, just as they deal with other sexually transmitted diseases and pregnancy by throwing pills and condoms at young people.

Moira McQueen, executive director of the Canadian Catholic Bioethics Institute, said vaccinating against HPV is not like vaccinating against a disease like measles for which there are no other preventive measures.

"Itís completely dependent on young girls being sexually active," she said in an interview with Canadian Catholic News. "There is a rush to vaccinate people who do not need to be vaccinated." HPV and other sexually transmitted diseases "are preventable if abstinence is followed," she said.

The drug is being all but imposed on children over the concerns of parents, large numbers of whom tell surveys they oppose Gardasilís mandatory use. While parents who object strenuously enough may manage to opt their children out of vaccination program in jurisdictions trying to impose it, how many parents have the level of commitment needed to oppose a process that everyone else is going along with? Most will simply acquiesce.

One must also question the motivations behind those responsible for the rapid introduction of this vaccine. Not surprisingly, Merck & Co., the manufacturer thatís been lobbying for mandatory vaccinations of Gardasil and has been successful in getting provinces to buy into large-scale public vaccination programs, is eyeing huge profit growth this year.

The B.C. government is wisely waiting one year before introducing the vaccination program in its schools. It should wait even longer. Gardasil may have appropriate uses, but the urgency with which itís being promoted through a near-mandatory vaccination program is bad policy on many levels.


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