Girls, boys, bioethics, chastity, and the HPV vaccine

The HPV vaccine would be less controversial if it were being given to boys instead of girls. How bad bioethics mates with bad psychology to produce bad politics.

Following the counsel of the Advisory Committee on Immunization Policy, the Centers for Disease Control recommends the Human Papilloma Virus (HPV) vaccine for girls and women 11-26. (After that, it’s mostly too late; an astonishing 70% of sexually active Americans are reportedly infected already.)

What happened to the boys and men?

Males mostly don’t get especially sick from HPV infections (except for the occasional case of penile warts, which sounds pretty uncomfortable) but they’re part of the transmission chain. The goal of any vaccination effort is to stop epidemic spread by getting to the point where the average person newly infected will infect less than one addditional person during his or her lifetime.

According to my friend Gary Emmett, a pediatrician who chaired the committee that wrote the HPV Vaccine Information Sheet for CDC, the critical level of protection against HPV could be achieved by getting about three-quarters of the girs immune, or alternatively by getting half the girls and half the boys immune. (Not everyone who gets the vaccine winds up immune, so the proportions getting vaccinated need to be a little bit higher. Since the main problem other than money is convincing the parents, the unisex route seems obviously more feasible: it’s alwyas easier to get a majority than a super-majority.

Of course doing it that way would require more shots, which means spending more money. (Not much additional social cost is involved, since most of the price of the vaccine is royalties and profit margin, but it’s still a budget issue.) Apparently, though, that’s not the reason the CDC and its advisers decided on “girls-only.” The big argument was that, since individual males don’t personally benefit much from immunity to HPV, it would be ethically questionable to subject them to the discomfort and risks of vaccination.

Words fail me (almost). Shouldn’t we properly assume that sex is, or ought to be, accompanied by affection, and that someone having sex ought therefore to be assumed to benefit by protecting his partner from a possibly fatal disease? Even if that weren’t true, is it really ethically dubious to ask people to make tiny sacrifices for the public health, even in cases where they personally don’t benefit?

(I’ve suggested before that bioethics ought to be a felony, except as practiced by Hilary Bok and whoever she chooses to license. It seems to me that this case nails down the case for that proposal.)

In this case, silly ethics meets poor psychology and worse political strategy. The current plan says to parents “We expect your 11-year-old princess to be sexually active soon.” It thus fits nicely into the culture warriors fantasy world in which secularized Hollywood Jews are out to debauch everyone’s virgin daughters.

If the HPV vaccine were being given to boys instead of girls, there would be much less of a fuss about it. For reasons presumably well-grounded in evolutionary psychology, male chastity is simply not as emotionally compelling an issue as female chastity. (That’s why Joseph Andrews is such a funny send-up of Pamela.)

Many parents (especially, I would guess, fathers) who feel threatened and insulted by a proposal that their prepubescent daughters be immunized against a sexually transmitted disease would be rather pleased than offended by the suggestion that their sons will soon be in need of protection from their own overpowering virility.

So it looks to me as if “girls-only” is a mistake not only ethically but operationally and politically. Unfortunately, it seems to be too late to do anything about it.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: