Last week I took my daughter to the pediatrician to receive her MMR vaccine (measles, mumps, rubella). The trip to the doctor’s was spurred by two factors, the first was age, my daughter was now at the recommended age for receiving the vaccine but the second was the fact that she was about to enter daycare and state law requires the shot as a condition of enrollment. Vaccine laws vary but state, but every state requires the receipt of multiple vaccines before a child may enroll in school and these requirements appear to be highly effective at ensuring school age children are vaccinated. Given this fact, I have been struck by a number of the aspects of the Gardasil debate.
Gardasil is the vaccine given to prevent HPV, the Human Papillomavirus, the virus responsible for the majority of cervical cancers. Both the CDC and the American Academy of Pediatrics recommend the vaccine and nearly every state as well as the District of Columbia has considered making it a requirement of school attendance. However, currently, only one state, Virginia, actually requires girls to receive the vaccine. The result of leaving the vaccine optional almost certainly means fewer girls will receive the shot. Whether this is a good or bad thing depends on your point of view about the vaccine. Although rare, serious medical conditions have been linked to the HPV vaccine. In addition, the strongest opposition has come from religious groups concerned that the HPV vaccine will lead to sexual promiscuity among young women.
However, what I find particularly interesting about the debate surrounding the HPV vaccine is that fact that although it is optional for the majority of Americans, it is mandatory for those seeking to become Americans. As of July 1, 2008, all women seeking to obtain permanent residency in the United states are now required to receive the HPV vaccine. Some commentators have argued, here, that this disparate treatment is problematic because it indicates a lesser regard for the health and welfare of immigrant women and therefore must be repealed. I wonder however, if such disparate treatment should lead to the opposite conclusion, i.e. that the vaccine should be mandatory for US citizen women as well. If the federal government believes that the HPV virus is such a danger that it would withhold citizenship in order to ensure vaccination doesn’t this imply the severity of the problem and the drastic steps that must be taken to halt its spread? How can we be concerned about the potential for immigrant women to become infected with HPV but not have the same concern for US citizen women. Either HPV is a problem requiring outside intervention or it isn’t, I don’t see how we can have it both ways.
Posted by Marcia Zug on September 3, 2009 at 12:19 PM
Comments
Is there a medical reason why this vaccine is aimed only at females and not males? I understand that males don’t suffer from most of the effects of HPV, but obviously a disease that spreads sexually will have male and female vectors.
Why the disparate treatment by sex?
Posted by: Shane | Sep 4, 2009 5:13:36 PM
Requiring vaccinations for diseases that might otherwise spread in school seems fair enough, but IIRC that is not how HPV is spread. So it seems to me that making an HPV vaccine mandatory for school enrollment would be détournement de pouvoir, i.e. abuse of power, and as such unlawful. Whether the same logic applies to naturalisation, I’m not sure.
Posted by: Martin Holterman | Sep 4, 2009 11:56:13 AM
According to Elizabeth Sheyn, who wrote the article linked to above, the mandatory requirement was a surprise. Merck, the drug manufacturer which has lobbied extensively for mandatory vaccines at the school level did not lobby to make the vaccine mandatory for immigrants and was not aware of the mandate until after it had passed. Shyn similarly states that the CDC never expected that its recommendation would turn into a mandate. However, I have not seen an explanation for why this additional step was taken. I can only guess that it was based on a concern regarding the seriousness of the disease and a belief that the naturalization process would be a way to vaccinate a group that would not be reached even if/when a mandatory school vaccine is passed.
Posted by: Marcia Zug | Sep 4, 2009 11:42:02 AM
Remember that we require applicants for citizenship to pass a test. People who are born citizens are not required to know anything, even though knowledge of US history is arguably a good thing.
We can put requirements on potential immigrants that cannot be placed on citizens. Its as simple as that.
Posted by: Al | Sep 3, 2009 8:41:53 PM
From what I have read, the push to make the vaccine mandatory (in any situation) comes almost exclusively from the manufacturer. It is not contagious to schoolchildren the way that MMR are, so the pediatric and CDC recommendations are aimed more at parents than schools. So why is it mandatory for all immigrants but only for one state’s schoolchildren? Because lobbying a single Congress is cheaper and easier than lobbying all 50 state legislatures. Higher success rate, too. It has nothing to do with health.
Posted by: Suzanna Sherry | Sep 3, 2009 4:07:10 PM
I agree that there is a problem with the disparate treatment of the two populations of women. It seems as though there must have been some reason given for requiring those wishing to become citizens to have the vaccination, and I wonder if while researching this, you’d come across the reason given? A distinction, if you will?
This is nonsense, but an example would be if HPV from other countries is of a different strain. Then there might be a reason. I’m not a doctor, but I think that it’s unlikely that that is the case. So what was the reason for the distinction?
Posted by: GJELblogger | Sep 3, 2009 2:26:42 PM