There has been a lot of recent news about a possible HPV Vaccine mandate in several states. For those of you who do not know what I am talking about, HPV is the Human Papilloma Virus that has been linked to cervical cancer. It’s a virus that a lot of sexually active adolescent girls in high school and college have been found to have. It’s relatively asymptomatic and is transmitted through sexual activity, and thus a lot of women are carriers of it. Given these associations, the vaccine for HPV has generated a lot of excitement because it prevents a cancer that is related to sexual activity.

The vaccine was approved by the Food and Drug Administration in 2006 and was met with a lot of fanfare and a recommendation by the Centers for Disease Control to routinely give it to young girls. Thus about 16 million doses of it have been given since its approval.

But in the last year or so, there has been a backlash against the vaccine. This is largely due to the fact that mandatory vaccination is being put on the ballots in several states. These efforts have been supported by its manufacturer, Merck. This corporate push, in combination with a general anti-vaccine movement, have stirred the controversy around the vaccine, which goes by the trade name “Gardasil”.

Thus far, there do not appear to be any major side effects from the vaccine other than some patients had allergic reactions and some fainted after taking the vaccine.  Many parents have been hesitant to give the vaccine to their young daughters who are not yet sexually active.

In general I do not think anything should be mandatory in medicine with a few exceptions. The main exception is the situation where failure to mandate intervention will threaten the greater health of the community. This is a concept called community beneficence. The best analogy is that of a disease such as smallpox in which transmissibility is an issue and vaccination is the only way to protect people. In that situation failure to vaccinate will lead to the spread throughout the entire population. Given that HPV is a sexually transmitted virus, I do not think a mandate is necessary. Those who want the vaccine can take it. It should not be forced on anyone.

One thing that people do not understand is that vaccine creation is an expensive and corporate driven endeavor. It costs tens of millions of dollars and at least a decade of research and experiments as well as a very strong lobby to create a vaccine. In the history of vaccines, vaccines have only been created because their was a large public health demand and threat or because there was a select population or lobby that pushed the vaccine’s creation.

One example of the latter is the Lyme Disease vaccine – a totally useless vaccine for anybody that lives outside of Connecticut or the woodsy Northeast, but one that nevertheless was created and targeted for those wealthy populations that wanted it. Undoubtedly it was a profitable endeavor for its creator. Undoubtedly it did not really do much good for 99.9% of the population.

The HPV vaccine isn’t as ridiculous as the Lyme Disease vaccine. HPV is associated with cervical cancer transformation, and cervical cancer is a big cause of morbidity and mortality among women. However, it’s difficult to say that the mandate is not profit driven by Merck or that the lobby for this product is not lining the pockets of legislators who are mandating its use.

Thus far the mandate has only been passed in Washington, D.C., and Virginia with HPV vaccination being a requirement for school attendance. However it is being considered in almost every other state.