One of my clients is extremely opposed to vaccinations. I'm not. It's a point on which we agree to disagree, with an arrangement that I don't have to directly put my name directly to anything opposing vaccinations. I think she is mistaken and using faulty logic to reach her conclusions about vaccinations, but I also know that her thought process is not going to be swayed. Plus, she who pays the bills makes the rules.
Personally, though, I put vaccinations right up there with sanitation and contraception as one of the great advances in science and medicine. However, vaccinations, like peanut butter ball mix, are so mundane that we don't appreciate just how sci-fi they are. Our planet is crawling with tiny, deadly things that straddle the border between lifeform and not-life. These things can kill us in dozens of ways that bypass our biological defenses. To protect our young from these maybe-alive things that we don't completely understand, we give our children substances that artificially enhance their immune systems, starting in infancy, and continue taking these substances at regular intervals throughout life to keep up the immune system enhancements and deny these maybe-lifeforms a host population. Does that not sound like the start of a plot to an episode of Stargate, or any of those sci-fi dramas that rely on dropping Earthlings onto other planets inhabited by aliens who are pretty much humans with SFX makeup?
In the unlikely event that I ever have fledglings of my own, you can bet your bippy those kids are going to be vaccinated against everything we have vaccinations for, even chickenpox. I don't, myself, even remember getting the chickenpox, though the blood tests indicate I did at some point before I was 18. I do, however, know or know of two people who nearly died from the same virus I can't remember.
My hypothetical fledglings are also definitely getting the HPV vaccine. Here in the U.S., we've more or less tamed cervical cancer. Women still get it and die from it, but not at nearly the rates they did before Paps became ubiquitous. Without the widespread screening, cervical cancer is right up there with giving birth on the list of Things That Kill Women Young, but the U.S. has been so good with paps for so long (possibly related to my prior post about GPs holding our contraceptives hostage until we pay the annual ransom of cervical cells) that mothers in my generation don't remember what a killer it is. Both HPV and chickenpox vaccinations run into the problem that the parents deciding to vaccinate their kids don't know how dangerous the viruses can be.
The HPV vaccines protect against the viral strains implicated in most, but not all, cases of cervical cancer, so having the HPV vaccine isn't a get-out-of-pap-free card. Here in the developed world, we'll still need to get regular paps to find the sliver of cases of cervical cancer that aren't attributed to the strains of HPV in the vaccine, and I wouldn't expect that the number of deaths from cervical cancer to go down too much once we deploy the vaccine. There will be side effects to the HPV vaccine; there are side effects to anything we do, including eating a bean burrito. The benefits aren't likely to be huge. Why, then, risk getting the HPV vaccine?
Because it's not about us. In the U.S., we have readily available gynecological care and fairly widespread screening for cervical cancer. On a global scale, this is unusual. In many parts of the world, gynecological care is all but nonexistent, and what is available is usually focused on keeping women alive during and after childbirth. Cervical cancer screenings are way down the list of health priorities, below things like malnutrition, malaria and the large collection of fatal diseases caused by contaminated water. However, the fact that cervical cancer isn't on the radar doesn't mean it doesn't kill women in those parts of the world. A lot of those women could be saved, to raise the children they manage to survive the births of, with widespread deployment of HPV vaccines.
However, the developed world has some bad history with the populations that would be most well-served with widespread HPV vaccinations, starting with that whole colonization thing, and going downhill from there. Some of these places have resisted efforts at universal polio vaccination, mistrustful of the motivations of those offering polio immunizations. In some places, folks have raised concerns that the polio vaccinations are a cover for population-control measures. Given some of the attitudes toward the developing world by the places on the planet that generally develop vaccines (including the kind of insulting subtext to the terminology "developed/developing" and "first world/third world"), one could understand where they're coming from.
So, if we show up with an HPV vaccine and want to inject it into all of their virgins, while at the same time saying that we're not giving it to our own little girls...that just isn't going to go over well. We need to adopt the HPV vaccine in the U.S. as a measure of good faith for those who don't have the backup detection methods we have. Getting the vaccine in the U.S. may not reduce death rates from cervical cancer here, but it can go a long way in the places that will benefit directly from the vaccine more than we will.
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