Tuesday, September 23, 2008

hpv vaccination: the day I embraced Dawkins

Today, through John Smeaton's blog, I found a blog written by Radagast, Senior Teacher in a faith school. He expresses deep concerns about the forthcoming vaccination of young (and I mean young) secondary schoolchildren, predominantly girls, against human papillomavirus (hpv) - which can cause cervical cancer in the 10% of women who don't spontaneously clear the virus.

Minima has now moved up to secondary school and, despite wars and rumours of wars, loves it. But, now having two girls liable to be considered by the education authorities as liable for the vaccination, this was the part of Radagast's post, entitled Cerevix and sexual freedom, that caught me:

To vaccinate my child against a disease that she is most likely to get from taking multiple sexual partners seems to me to capitulate to a culture in which the image of the human person has become grossly distorted. It is to admit and promote the idea that sexual activity between young people before marriage is inevitable and unstoppable despite being potentially harmful. It is to accept the lie that sexual freedom means being able to act without consequences...
The thing is, for parents to be armed with the necessary knowledge to make a choice, they need proper information, and that was not what was on offer on BBC Radio 4's Case Notes, of which a transcript has been posted on the show's website. What first made me feel uneasy was Professor Jack Cuzick of the Wolfson Institute of Preventive Medicine minimizing the range of hpv types that could be harmful:

there are well over a hundred different types now, so it's kind of a stamp collecting activity that people continue to identify new and rare types but in fact there are only a few that really matter.
The number of types of hpv that can cause cervical cancer is variously reckoned between 30 and 40. In their paper on the subject, for example, Muñoz et al put the number of potentially carcinogenic types at 30 in 2003.

Let's look at Muñoz' conservative data in the light of the protection that Ceravix is projected to provide - ie, against hpv types 16 and 18. That leaves: types 6, 11, 26, 31, 33, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 66, 68, 70, 72, 73, 81, 82 and the incongruously-named CP6108.

When Dr Mark Porter started discussing the risk of a mutation of the hpv virus arising through natural selection, I was gripped by a biting sense of irony. I've been introduced in depth to the theories of Charles Darwin through Richard Dawkins' exegesis of them, precisely because I oppose Dawkins' conclusion - itself a statement of faith - that embracing the theory of evolution leads ineluctably to atheism.

A not insubstantial portion of The Selfish Gene is given over to Dawkins' espousal of the Evolutionary Stable Strategy (ESS), a statement of game theory whereby the different elements of a population will remain at constant proportions if all other factors remain constant.

And there's the rub: although Ceravix is manufactured in order to take the two allegedly most carcinogenic hpv types out of the picture, it is suspected by Case Notes' participants that "we don't really need to worry about that". In a sense I agree - the risk of a mutant version of type 16 or 18 seems to be small against the risk of one or two of the other 28 types establishing a new Evolutionary Stable Strategy by becoming the new bullies on the playground. The naïveté is stunning: can you imagine taking out the two biggest gangsters in the city and expecting all of the 28 remaining contenders to play nice?

The NHS certainly isn't playing nice in its resources for the campaign. A leaflet for 12-13 year olds advises them, on the subject of consent:

You may be given a consent form that your parents should sign giving permission for you to have the vaccination. It’s important that you return the signed form before your vaccination is due.

If your parents are not sure that you should have the vaccination you should still return the form and speak to your nurse, doctor or other healthcare professional. Having the vaccination now will help protect you against the most common causes of cervical cancer for many years.
The gist of this appears to be that if a girl of 12 or 13 is not allowed by her parents to have the injection, it can still go ahead. Working in the addictions sector, however, we were clear that in English law a child of 12 was a totally different creature from one of 13, in that we were not allowed to give any service whatsoever, either concerning drugs or sexual matters, to a child under 13 without the explicit consent of the parent or guardian because, in English law, consent given by anybody under the age of 13 is meaningless.

So how is a child of 12 or 13 supposed to make a decision about how she will behave as a young woman of 16? As Radagast says: "the assumption that girls will probably become sexually active at the age of 16 is made without considering the possibility that some girls and young men might not." Indeed, the default assumption is that girls will be sexually active at or before the age of 16. The present administration seems to contain many individuals who are threatened by the ability of a young woman to choose chastity, even though if this is not an option, then the concept of sexual freedom itself is a fiction.

Perhaps the fevered compulsion with which this strategy is being pursued signals a quiet admission of defeat in another aspect of "reproductive rights": research reported in the New England Journal of Medicine concludes that when condoms are used during intercourse 100% of the time women have a 20% risk of contracting hpv (by my calculator - work it out yourself: all you need to know is that for these purposes "patient years" means the number of patients in a trial multiplied by the amout in years that the trial lasts). Which raises the old chestnut of the effectiveness of condoms against viral particles - but that's for another day.

I hope that my girls will feel confident enough to speak to their Mum and/or me about this. We'll pray about it, as we have before about matters relating to their developing bodies, as well as looking at the biological facts. They have already told me they don't want the vaccination, when they've heard the subject on the radio. I'm proud of them - but we can't be with them every step of the way to stop them making a mistake or acting under the influence of alcohol or going starry-eyed at a nasty piece of stuff. But to think that a vaccine effective against two types out of thirty of one particular STD is going to protect them from any of that is like allowing them to think that a suit of armour made of tissue-paper (or latex) will protect them from the slings and arrows of outrageous fortune.

Anyway, it strikes me as astonishly sexist that women should be left to worry about the unintended effects of sex. Men should take a share of the load if they want a sexual relationship with a woman when they're not sure if she's "the one". For example, circumcision has been shown to lessen the risk of cervical cancer, without altering the balance of power in the virological gangland. Who's first, lads?


  1. The governor of the state of Texas has tried to make this vaccine mandatory. i.e., he enacted the law, but there is your typical Texan opposition. We have not vaccinated our 12-year-old daughter.

  2. Well done! The CDC report states,

    "Abstaining from sexual activity (i.e., refraining from any genital contact with another persons) is the surest way to prevent genital HPV infection. For those who choose to be sexually active, a monogamous relationship with an uninfected partner is the strategy most likely to prevent future genital HPV infections."

    In the UK, I think there is a second agenda of getting people used to medical/surgical interventions that the gov't deems necessary. Any chance of shipping some Texans over here?

    All the best

    Frugal Dougal


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