Everything Not Forbidden Is Compulsory

When we last checked in on Gardasil, a vaccine against viruses that cause cervical cancer, the issue was whether the treatment would be allowed at all. HPV viruses are transmitted sexually, and the shot is most effective when given to girls aged 10 to 14; opponents argued that it might encourage preteen promiscuity.

Now the issue is whether the vaccination should be required. Since Gardasil was approved, several states have been mulling mandates for middle-school girls to get the shots. In Maryland, the legislator who sponsored such a bill has just withdrawn it from consideration.

So far, the loudest opposition to these bills has come from religious-right groups like Focus on the Family, which "supports widespread (universal) availability of HPV vaccines but opposes mandatory HPV vaccinations for entry to public school" because "the decision of whether to vaccinate a minor against this or other sexually transmitted infections should remain with the child's parent or guardian." The drive to require the shots has largely come from the pharmaceutical company Merck, which—surprise!—manufactures the vaccine. The larger medical community has been cooler to the idea, as the Baltimore Sun reported Monday:

The American Academy of Pediatrics, for instance, is urging a go-slow approach, with an initial focus on raising public awareness of HPV and more monitoring of the safety of the vaccine, which had minimal side effects in clinical trials but hasn't been observed in larger-scale rollouts.

"A lot of us are worried it's a little early to be pushing a mandated HPV vaccine," said Dr. Martin Myers, director of the National Network for Immunization Information. "It's not that I'm not wildly enthusiastic about this vaccine. I am. But many of us are concerned a mandate may be premature, and it's important for people to realize that this isn't as clear-cut as with some previous vaccines."

He added, "It's not the vaccine community pushing for this."

The stakes here weren't quite as high as the rhetoric on either side might suggest. Without the Maryland bill, the vaccine will still be available on a voluntary basis. With the bill, parents could receive a religious exemption from its requirements; and if you aren't religious, you could still probably get the exemption if you want it, since the only thing you need to do is sign a form. So the vaccinations would have been more a default setting than an absolute mandate.

But the stench of corporate welfare is still in the air, and so is the smell of social engineering. The terms of the debate have shifted; the issue now is not whether the government should deny us a vaccine that could save lives, but whether it should push it on people who don't want it. You can count me with the fundies on that one.