Thursday, November 20, 2008

HPV vaccines for all!

Saw this bit on Jim Pickett's LifeLube about a study showing that one of the HPV vaccines is efficacious in preventing genital warts in boys.
Hopefully, approval will be coming soon, and our backwards policy of vaccinating only girls will be expanded to include boys as well.

Why is vaccinating only girls a backwards policy? Because girls usually get HPV from boys (and men), not other girls. Think of boys like mosquitos. Seriously. If you do nothing to keep the mosquitos from getting infected, they're going to keep poking their noses in, and passing the infection along to anyone who's not protected.
If you reduce the infection rate in the mosquitos too, then the probability you'll get infected drops dramatically, even if the vaccine didn't quite work for you.

So the whole vaccination policy in the US (for girls and boys) is exclusively oriented towards self-interest, which isn't at all efficient or cost-effective.

Implications for the coming HIV vaccine
Imagine, if you will, an HIV vaccine comes along. If our vaccination policy then is oriented exclusively to self-interest (and I'm pretty sure it will be), then vaccines will be 'targeted' towards 'high risk' groups. This targeting will result in extremely inefficient vaccination rates (as we have already seen from the experience with the HBV vaccine).

First, most people not at 'high risk' won't be protected.

Second, a large proportion of 'high risk' people won't get the vaccine because nobody likes to think of themselves as 'high risk'. And it's easy to justify why I'm not nearly as high risk as other people I know. Also, insurance companies will set up a screen for who is high risk enough to get the vaccine paid for, which worked against the interests of getting HBV vaccine out there.

Third, targeting HIV vaccine to 'high risk' people will further the stigmatization of these groups, even if they do get the vaccine. "Why did you need it?" is a question that not only insurers will ask, but also others in a person's life, and most distressingly, each individual themselves. Each shot will be literally a stigmata of risk identity.

So, is there any way we can turn vaccination policy around in this country, returning to the more successful strategies of universal vaccination that we saw with smallpox and polio?

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