Thursday, September 13, 2007

The ethics of the cervical cancer vaccine

No. 37, 18 June 2006

by Simeon Payne

On 8 June, the U.S. Food and Drug Administration (FDA) made medical history by unanimously approving the vaccine Gardasil. The vaccine should prevent the cancerous development of two strains of the Human Papillomavirus (HPV 16 &18), which is responsible for 70 per cent of all cervical cancer deaths.

Worldwide, 250,000 women die from cervical cancer each year, which after breast cancer is the second most deadly cancer afflicting woman. Of the 16 per 100,000 women who will be diagnosed with it this year, 9 will die.

Approval for Gardasil was given after its final Stage III medical trial which involved over 25,000 participants. This trial was a resounding success for Gardasil. No-one administered it developed cervicalintraepithelial neoplasia, the precursor to cervical cancer; whereas 12 of those in the placebo control group developed symptoms. The side effects were considered small.

Not only does Gardasil impress with what it can potentially achieve; it uses non-infectious virus like particles – a technology developed here in Australia by Dr Ian Frazer and his team at the University of Queensland. Frazer is now working on a vaccine for those who have already contracted cervical cancer. Other teams are working on vaccines to deal with the other cancer causing strains of HPV, and strains 6 & 11, which are responsible for non-carcinogenic genital warts.

Why be concerned about this scientific breakthrough? Shouldn’t all Christians rejoice at victory over such a terrible cancer? Prominent and vocal American Christians have expressed deep concern, and have actively campaigned against the therapeutic approval of this vaccine. Some Christians in Australia share their concerns.

There are two themes to their opposition. First, they are concerned that the vaccine will increase sexual promiscuity. They argue that vaccinated women, no longer fearful about receiving cervical cancer because of multiple sexual partners, would increase sexually promiscuous behaviour.

Second, they share an opposition to this and all vaccinations, based on an ideology that resists compulsory vaccinations. They often also promote a fear of vaccinations based on supposed negative side-effects of existing vaccines.

I do not share their concerns. I argue that, since all humanity bears the image of God, every person is intrinsically worthy of the highest medical care. As a cornerstone principle of a biblically based ethic, I argue that no human can or should ever be denied the best medical care, even if this is to reverse or protect against disease which is the result of sin. It is the biblical responsibility of all Christians to support any societal initiatives that reverse suffering. Further, on the basis of a neo-Kantian understanding of duty, I argue that it is the obligation of society (through government and medical servants) to avail any known or available medical technology upon its citizens that can be used for their good.

I am also concerned with the logic of those who resist this vaccine. It is true that the risk of getting the HPV infection is elevated in those who commence sexual activity at a young age and have multiple partners. But it needs to be stressed that there are documented examples of virgins and monogamous women who have received the HPV virus that causes cervical cancer. The virus can be contracted through child-birth, and indeed through any situation or procedure where viral and virginal contact occurs. A monogamous woman might also receive the virus as a result of her husband’s promiscuity. The argument that the virus would actually encourage women to become sexually promiscuous is demeaning and derogatory toward women.

Even if sexual promiscuity were the only factor of someone receiving the virus, I would still argue that we have a duty to avail the vaccine. I do not think people would rationally claim that, because they have been vaccinated, they will increase their sexual misbehaviour. At the moment babies receive the Hepatitis B vaccine to inhibit another cancerigenic virus. This virus is primarily transmitted by intravenous drug users. I have never heard anyone say that because they have been vaccinated for Hepatitis B, they will become a drug addict.

With compassion and a sense of duty we rightly treat those with heart problems, even when caused by gluttony. We do not allow those who have been in a drunken brawl to bleed to death from their injuries. The fact that a disease may be the result of an immoral act does not alter the fact that there is a moral duty to treat and prevent it.

Finally, I am concerned by those Christians who accept alarmist views of vaccination without critical discernment. All medical procedures entail elements of risk, but what must be considered is the balance of risk between doing and not doing. There may be some unforeseen adverse reaction, either directly or indirectly, but this risk must always be balanced with the risk of inactivity. In this case we are talking about the second biggest cancer killer of women, and our ability to reduce this by 70 per cent in the next generation.

We must also track the longitudinal health of those who have and will be vaccinated. On the balance of available information and reviews, I am satisfied that this vaccine should immediately be availed for use. I argue it is a parental ethical duty avail to their children all available vaccines. This is not an academic question for me as my nine-year-old daughter may be one of the first to receive this vaccine.

But a cost of US$400 it is unlikely to be made available to those who have the highest need for it: women in the third world. Perhaps we could campaign that our Federal Government not only subsidise our own daughters’ vaccinations, but those of our third world neighbours.

It goes back to the concept of duty: it is the duty of those with much to help those with little.

Simeon Payne is the Baptist Chaplain at the University of Western Sydney, a member of its Human Research Ethics Committee and guest lecturer in Scientific Ethics. The views expressed here are not necessarily those of UWS.

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Soundings is a publication of the Centre for Christian Ethics, edited by Rod Benson. Soundings welcomes submissions of up to 1000 words that seek to facilitate debate and explore issues of religion, ethics and public policy in Australia and internationally. Previous columns give a good indication of the topical range and tone for acceptable essays. Columns may be quoted or republished in full, with attribution to the author of the column, Soundings, and the Centre for Christian Ethics, Morling College, Sydney Australia. Views expressed in Soundings articles are not necessarily those of the Centre for Christian Ethics, Morling College or the Baptist Churches of NSW & ACT.

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