Many good things came about as a result of the Lance Armstrong Foundation's LiveStrong Presidential Cancer Forum in Iowa. Discussions on cancer research funding and how government can play a role in America's quality of life came to the forefront. Perhaps one of the most important aspects of the forum for those who advocate for reproductive health, however, was the injection of the human papillomavirus vaccination into the national conversation.
Genital HPV infection is a sexually transmitted disease that is caused by human papillomavirus, a group of viruses that includes more than 100 different strains. The disease is spread by genital contact. All types of HPV can cause mild Pap test abnormalities which do not have serious consequences. Roughly 10 out of the 30 identified genital HPV types can lead to development of cervical cancer.
In June 2006, the first vaccine developed to prevent cervical cancer and other diseases in females caused by HPV was recommended by the Centers for Disease Control and Prevention. The vaccine protects against four HPV types, which altogether cause 70 percent of cervical cancers and 90 percent of genital warts. The vaccine was subsequently approved by the Food and Drug Administration for use in girls and women between the ages of 9 and 26. The vaccine is given through a series of three shots during a six-month period.
While there is no doubt the vaccination could save the lives of girls if it is provided before they become sexually active, social conservatives have argued that immunizing teens could encourage sexual activity and provide a false sense of protection against other STDs.
"I think we can reassure [those who worry about promiscuity] that there isn't a cause-effect relationship," said Dr. John Seffrin, chief executive officer of the American Cancer Society, following the conclusion of the LiveStrong forum held in Cedar Rapids this week. "To put it in another way, the threat of getting cancer has not prevented people from engaging in sexual activity. More importantly, we've found that if you want people to take up an effective measure, you don't ram it down their throat. You provide it and educate people."
The six presidential candidates who attended the forum — both Republicans and Democrats — agreed with Seffrin that it is better to continue to educate the public in lieu of creating a mandate for the vaccination.
"While I don't think you can force people to take any type of treatment like that, I think you certainly should make it a covered [by insurance] treatment," said Republican presidential candidate Mike Huckabee. "It has a great potential to virtually eliminate cervical cancer among women so it would be a dramatic improvement if people did it. I'm always hesitant when the government decides it knows more than a mom or dad for their teenage girl. I think that's overstepping the role of government."
Huckabee, former governor of Arkansas, added that polio and small pox have been nearly eliminated because of government-mandated vaccinations.
"It certainly makes sense to receive the HPV vaccine," he said. "More importantly, it makes sense to make sure that it is covered under insurance policies."
The other Republican contender who appeared at the forum, Sen. Sam Brownback of Kansas, was the only candidate to be questioned about use of the vaccine by MSNBC's Chris Matthews, who joined cycling champion and cancer survivor Lance Armstrong as co-host.
"Should we require vaccinations for cervical cancer among school girls?" asked Matthews.
"I don't think so," said Brownback.
Matthews followed up, "You just made the point that early detection equals early action. So why do you demur on this thing?"
"You have a number of people who are hesitant about this at this point in time," said Brownback. "I want to watch it for a little bit. I think it is great that we have this vaccine that prevents the HPV — the human papillomavirus. I think it is excellent. I think if people want to take advantage of that, they should. But for us to step out at this point in time and require that at a federal government level … I'm hesitant about doing that at this point in time. I am, however, delighted we have this available because HPV has spread broadly in the population. It is the lead cause of cervical cancer and here's a way we can head it off in a lot of places."
Brownback added that he views the differences of opinion on the vaccination and the debate on the perceived risks and known benefits as a cultural divide between the two political parties.
"I want this vaccine available to people," he said after leaving the stage. "I want it easily accessible and available and cheap so that people can have access to it. I'm just not ready to have the government mandate and/or require it."
Remarkably, this issue may be one of the few in which both Democrats and Republicans can find common ground.
Former Sen. John Edwards of North Carolina said on stage that he would like to see preventive health care mandated by the federal government. In a press meeting following his appearance, I asked if the Democratic candidate's stance included the HPV vaccination.
"You're too deep in the weeds for me," Edwards said. "What I was talking about out there was yearly check-ups and other generalized things that relate to physical health."
In a follow-up email, his campaign stated, "Senator Edwards believes that it is promising and parents should discuss it with their children's doctors, but it should not be mandatory yet. Conservatives are wrong to argue that the use of the HPV vaccine will increase teen sexual activity. There is no evidence this is true. However, we should also resist the rush by drug manufacturers to make this vaccine mandatory. We need more experience with the drug to ensure it's safe and to promote public acceptance before we mandate this costly step. States like Utah, New Hampshire, South Dakota, and Washington have provided voluntary free vaccines and/or educational materials with great success."
Rep. Dennis Kucinich, D-Ohio, is the only candidate in the presidential race who advocates a single-payer universal health insurance system. As a part of that system, the HPV vaccination would be fully covered for all parents who elected to have their daughters protected.
New York Sen. Hillary Rodham Clinton and New Mexico Gov. Bill Richardson were the only candidates who did not make themselves available to the press following their public remarks at the forum. Their campaigns, however, did respond to requests on their stances on the HPV vaccine.
In New Mexico, Richardson took steps to increase access to the HPV vaccine by increasing funding to the state's Department of Health to provide the vaccine on a voluntary basis. He also required all insurance companies to cover the vaccine. According to his campaign, this would also be his policy if elected president.
Clinton's campaign provided text from a November 2005 statement in which their candidate called on the head of the U.S. Health and Human Service Department to ensure decisions about the vaccination were based on science and not on ideology or politics.
"Safe and effective vaccines save lives; there is no evidence that they promote or discourage sexual activity," she wrote in a letter to HHS Secretary Michael Leavitt.
Seffrin says the American Cancer Society remains very excited about the HPV vaccine.
"In October we'll be having a medal of honor ceremony where two scientists — both involved with the development of this vaccine — will be honored," he said. "What's important here is that will allow us first-hand knowledge that we can eradicate cervical cancer mortality in the world. It's another example that if we want to bring diseases like cancer under control, we need to go through prevention. We not only think it works, we support people taking advantage of it as soon as they can and making it affordable to people on a world-wide basis."