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Clash over use of cancer vaccine

The shot is effective against cervical cancer, but some worry it could promote sexual activity.

November 07, 2005|Rob Stein | Washington Post

A new vaccine that protects against cervical cancer has set up a clash between health advocates who want to use the shots aggressively to prevent thousands of malignancies and social conservatives who say immunizing teenagers could encourage sexual activity.

Although the vaccine will not become available until next year at the earliest, activists on both sides have begun maneuvering to influence how widely the immunizations will be employed.

Groups working to reduce the toll of the cancer are eagerly awaiting the vaccine and want it to become part of the roster of shots that children, especially girls, receive just before puberty.

Because the vaccine protects against a sexually transmitted virus, many conservatives oppose making it mandatory, citing fears that it could send a subtle message condoning sexual activity before marriage.

The vaccine protects women against strains of a ubiquitous germ called the human papilloma virus. Although many strains of the virus are innocuous, some can cause cancerous lesions on the cervix, making them the primary cause of this cancer in the United States. Cervical cancer strikes more than 10,000 U.S. women each year, killing more than 3,700.

The vaccine appears to be virtually 100% effective against two of the most common cancer-causing HPV strains. Merck, whose vaccine is further along than GlaxoSmithKline's, plans to ask the Food and Drug Administration by the end of the year for approval to sell it.

Exactly how the vaccine is used will be largely determined by the Advisory Committee on Immunization Practices (ACIP), a panel of experts assembled by the Centers for Disease Control and Prevention in Atlanta.

Officials of both companies noted that research indicates the best age to vaccinate would be just before puberty to make sure children are protected before they become sexually active. The vaccine would probably be targeted primarily at girls but could also be used on boys to limit the spread of the virus.

"If you really want to have cervical cancer rates fall as much as possible as quickly as possible, then you want as many people to get vaccinated as possible," said Dr. Mark Feinberg, Merck's vice president of medical affairs and policy, noting "school mandates have been one of the most effective ways to increase immunization rates."

That is a view being pushed by cervical cancer experts and women's health advocates.

"I would like to see it that if you don't have your HPV vaccine, you can't start high school," said Dr. Juan Carlos Felix of USC, who leads the National Cervical Cancer Coalition's medical advisory panel.

Conservative groups say they welcome the vaccine as an important public health tool but oppose making it mandatory.

"Some people have raised the issue of whether this vaccine may be sending an overall message to teenagers that, 'We expect you to be sexually active,' " said Reginald Finger, a doctor trained in public health who served as a medical analyst for Focus on the Family before being appointed to the ACIP in 2003.

Conservative medical groups have been fielding calls from concerned parents and organizations, officials said.

"I've talked to some who have said, 'This is going to sabotage our abstinence message,' " said Gene Rudd, associate executive director of the Christian Medical and Dental Assns. But Rudd said most people change their minds once they learn more, adding he would probably want his children immunized. Rudd, however, draws the line at making the vaccine mandatory.

"Parents should have the choice," Rudd said.

Alan Kaye, executive director of the National Cervical Cancer Coalition, likened the vaccine to wearing a seat belt. "Just because you wear a seat belt doesn't mean you're seeking out an accident," Kaye said.

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