Mandatory Medicine?

I spent this past weekend in Cambridge, Mass., where I spoke about covering reproductive health issues at a conference called Women, Action, Media. During the question and answer session at our panel (which also featured Emily Douglas of RH Reality Check, Kiki Zeldes from Our Bodies, Ourselves, and Jessica Gonzalez-Rojas of the National Latina Institute for Reproductive Health), the audience really wanted to talk about Gardasil, Merck’s HPV vaccine. Gardasil provides protection against cervical cancer, and is currently recommended for girls and women between the ages of 11 and 26. Some school systems and states have tried — and failed — to mandate the vaccine for middle-school girls. Opposition to mandatory vaccination comes from both the left and right; conservative parentsoften fear that vaccinating their daughters against an STI tacitly condones sexual behavior, while many on the left are skeptical of any new drug pushed by a pharmaceutical company after only short-term trials.

But the controversy hasn’t stopped the federal government from requiring Gardasil vaccination for immigrant girls and young women applying for U.S. citizenship, a policy opposed by the Latina Institute. In addition, Merck iscurrently pushing the FDA to approve the vaccination for boys and young men, and for insurance companies to cover vaccination for women into their thirties.
I have been optimistic about Gardasil (I’m vaccinated) and enthusiastic about giving the series of three injections to boys. Nevertheless, a policy of mandatory vaccination for immigrant girls and women, but no one else in our society, raises my eyebrows. And HPV/cervical cancer is not the only public health issue currently subject to a debate about mandatory medicine. A rash of states are now requiring HIV tests for pregnant women, a policy I support, since, with the proper precautions, the rate of HIV transmission between mother and child can be cut to 2 percent. Now Rhode Island is debating allowing doctors to test any patient for HIV without his or her explicit consent, as part of a battery of blood tests. The ACLU opposes the proposed legislation, as does Gay & Lesbian Advocates and Defenders, aBoston-based group. They are concerned about patients’ rights to refuse treatment and to keep their HIV status confidential. Yet in the past, the public health effects of mandatory testing have been strikingly positive.
The Providence Journal reports:
…when the law was amended regarding pregnant women the participation rate jumped from 52 to 92 percent. …Rhode Island’s rate of children born with the virus dropped from sixth-highest in the country to nil…
That’s pretty powerful evidence in favor of testing. Are you convinced?

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