Government's priorities questioned, as panel tells boys to get HPV shots

Washington D.C., Oct 28, 2011 / 04:07 am

The Catholic Medical Association is reacting with skepticism to a government panel recommendation that all boys be vaccinated again the sexually-transmitted Human Papillomavirus (HPV).

“It's really debatable whether this is a good use of public money, and whether it's really a good strategy for reducing cancer rates or HPV infection rates,” said John Brehany, Executive Director and Ethicist at the Catholic Medical Association. Brehany was responding to the Oct. 25 announcement of the decision by the Center for Disease Control's Advisory Committee on Immunization Practices.

“I'm very suspicious of this recommendation. They claim to have looked at the numbers, and to have some valid public policy goals, but I think it's quite debatable – and almost certainly not a good idea, from a cost-benefit perspective.”

Dr. Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases, called the recommendation “another milestone in the nation's battle against cancer” in a press conference on Tuesday.

The CDC will likely adopt the recommendation, for boys ages 9 and up to receive the Gardasil vaccine, after its own review within the next 12 months.

“The greatest impact can be had when the vaccine is given at ages 11 or 12 where there is a better immune response compared with older ages,” said Schuchat. “The vaccine is most effective when it is given before there is exposure to the virus which occurs through sexual contact.”

Schuchat said the suggestion partly aims to keep men from giving HPV to women, who can suffer various female cancers as a result. But it could also help prevent certain types of cancer more often associated with HPV transmission between men.

The Catholic Medical Association does not oppose the Gardasil vaccine, which it says is “safe, effective, and … can be ethically acceptable” in certain circumstances with informed parental consent.

But Behany thinks that society would be wasting scarce resources by treating HPV in men as a public health priority.

“It's true that if more boys are immunized, probably fewer girls will contract HPV,” he said. “There's some truth to that.”

But as Schuchat admitted in Tuesday's press conference, the panel made its recommendation in part because of the “pretty poor uptake in girls,” who frequently choose not to receive Gardasil or fail to complete the series of three shots at a cost of $130 each.

“Girls were the target audience – and the audience for which the best public policy case could be made,” Brehany argued on Thursday. “Why would you dive in with boys, before you had really addressed how you're going to do this effectively with girls?”

He noted that a 2009 study, published in the British Medical Journal, found that giving boys the HPV vaccine would not be cost-effective in terms of its impact on the general population.

That study, he said, found that “including boys raised the cost, to much more than is usually though to be acceptable for the health benefit.”

The medical ethicist said that doctors “could debate the best way to prevent HPV infection among women,” a question that is both morally and technically complex.

“But to recommend routine HPV immunization among boys, that's much less debatable,” Brehany said.

“They'll say, 'Well, it will do some good.' Yes, you'll do some good, but you''ll spend a ton of money that probably should be spent on other things.”

“And you may send some bad messages, too: 'Hey, kids, you got this immunization. You're safe.' You can introduce even more problems there.”

If Brehany questions whether the plan to vaccinate boys will help ensure females' safety, he has no doubt that it represents a poor use of resources when it comes to men's own health.

“Routine immunization of boys, with a three-dose regimen at $130 dollars a dose, to help prevent certain cancers mostly associated with male-to-male sexual contact, is an imprudent and bad public policy decision,” he stated. 

And with health care costs and public debt both on the rise, the head of the Catholic Medical Association believes public officials must weigh their decisions carefully.

“Individuals have limited funds, and so do governments. When you force them, or induce them, to spend money on things for which the benefit is low, they are not going to be spending money on some other things.”

“States are going broke paying for Medicaid, for example. They are proposing to cut, or severely limit, the days of hospitalization per year that Medicaid patients are eligible for.”

“Let's say someone were to make it a state policy, that Gardasil were mandated for children,” Brehany speculated. “They'll pay Merck $100 a dose, and they're not going to have money for other things.”

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“When people are saying, 'You don't get to go in the hospital,' or 'You get only so many days of dialysis,' then you'll have to look at all the other things we're spending money on – like Gardasil for boys. What do you really get for it?”