'Reasons of Conscience' and the HPV Vaccine

Hooray for Texas!

The state became the first on Friday to mandate the new HPV vaccine for 11- and 12-year-old girls entering sixth grade. HPV, or human papillomavirus, is a sexually transmitted infection that causes cervical cancer. It is the most common STI in the country. A total of 20 million people in the United States are affected, including one in four 15-to-24-year-olds. Each year, 4,000 U.S. women die of cervical cancer.

Texas' Republican governor, Rick Perry, signed an executive order requiring the vaccine beginning in September 2008. Insurance is expected to cover the vaccination for many women and girls, and free shots will be made available to those who would otherwise be unable to afford them. Parents have been permitted to opt out of vaccinating their daughters "for reasons of conscience, including religious beliefs." What reasons of conscience would argue against potentially saving a woman's life?

The conservative and religious groups who have been mollified by this clause worry that the vaccinations will lead to increased promiscuity among teens by creating the false impression that sex is either safe or condoned. (They raise, by the way, the same argument against comprehensive sexual education.) Because of a moral condemnation of a related behavior — premarital sexual activity — these groups would leave women unprotected from a health risk that now can be mostly eliminated. In this mindset, disease becomes almost deserved, a sort of divine punishment.

These religious and conservative groups' reasoning has some serious flaws. Men can carry HPV, but no vaccine has yet been developed for them. Therefore, even a woman who has had only one sexual partner may still be at risk for contracting HPV and later developing cervical cancer. And, the unfortunate truth remains that not all sexual encounters are chosen. Should a rape victim be condemned to cancer for an attack that she could not repel?

With the new HPV vaccine, we have the ability to prevent a cancer that kills thousands a year. We can vaccinate all American females as young girls, before they are likely to be exposed to HPV, thereby preventing cervical cancer. If more states follow Texas' lead, then insurance companies will be required to cover the vaccination, which ranges from $350 to $400 for the full course. If inoculation is done through the schools, there is a better chance of individuals complying with the vaccine's three-shots-over-six-months regimen.

Because this cancer affects a sexual organ and is caused by a virus correlated to sexual behavior, however, moral disapproval suddenly becomes a factor. What we have here is a medical issue — a question of health — that has become confused with the societal debate about appropriate sexuality.

Sexuality is, or should be, a private matter. Health is a public one. Disease has serious implications for individuals and society. On the personal side, there is pain and suffering and loss of loved ones; on the societal side, there are costs for medical treatment and from loss of worker productivity. We inoculate against smallpox, measles, rubella and other epidemics. Why not inoculate against cervical cancer-causing HPV, since we've learned that it is just as preventable?

The most infuriating aspect of this debate is that opposition to the HPV vaccine shows just how far we, as a society, still have to go in order to overcome the gender divide. Feminists raised their voices 30 and 40 years ago for women's equality. They were successful enough that today's women are able to take their privileges — the ability to go to college, to both hold jobs and have kids, to expect not to be discriminated against, to control our own bodies and destinies — for granted. But when we find a radical breakthrough in women's health controversial simply because its working mechanism suggests that women have sex, we're right back at square one of the horrible and yet-to-be-defeated sexual double standard. But this time it's not our reputations; it's our lives.

In the case of the HPV vaccine, "reasons of conscience" dictate mandating the inoculation for all women. Thank you, Governor Perry, for setting an example that others should be proud to follow. You've protected not only the health but also the civil rights of half of your constituents. Emily Stolzenberg is a German major from Morgantown, W. Va. She can be reached at estolzen@princeton.edu.