Vaccine prevents cervical cancer: but what about the moral issues?
A vaccine is now available for teenage girls to prevent them getting cervical cancer. But this medical break-through is creating moral dilemmas for some schools asked to help dispense it to their pupils, as SARAH CODDINGTON found in this investigation:
The old buildings echo Catholic tradition, and religious symbols that have taken pride of place in the grounds for years stand tall.
Young Catholic schoolgirls wave to her as they pass by to their school next door. Some chatter about their latest hair cut and others giggle over boys they met on the weekend. The bell rings. Girls in uniforms stamped with symbols of Catholic tradition jam into a classroom.
A public health nurse stands at front of the room: “Today, girls, we are going to talk about Gardasil. Does anybody know what that is for?”
Eyes stare upwards in anticipation and one girl pipes up: “It’s an injection against the HPV virus that causes cervical cancer.” Another: “I’m a virgin, but does it work if you’re not?” And another: “Does it hurt?”
The nurse asks if they remember the meningitis shot a few years ago? Well, it will feel a bit like that. Girls giggle nervously at the words “sex”, “genital warts” and “anal cancer”.
They watch a DVD. It tries to relate to them by showing fellow New Zealand teenagers using the term “sweet as” (that sparks a smirk on most faces). But then comes the grim reality of this virus. A 27-year-old female, pale as an “emo”, struggles to stand, starved to her bones from chemo, her slim body draped with fashionable clothes that once fitted her.
The whole room gasps: “That could be me.” This is serious. The usual chatter starts up as the session ends, but there’s a change in the conversation. Friends ask each other if they’re going to get it. It’s cool to get it if everyone else is. One answers: “Why not?”
It is estimated that about 80% of women will be exposed to the HPV virus. About 180 women in New Zealand are diagnosed with cervical cancer each year and 60 women will die from the disease.
Even though most people who get cervical cancer are in their 30s to 50s, there have been cases in women as young as 17. Gardasil seemed like the answer, but since the anti-cervical cancer vaccine was released in 2004, the religious ethics of giving it to young girls have been debated around the world.
From one point of view, it is seen as good and ethical because it prevents a disease; but on another note the disease is spread primarily by sexual contact and under the traditional Catholic belief system, a man and a women should not engage in pre-marital sex. And if you want to be absolutely strict, sex is a gift from God to produce God’s children.
So what does the New Zealand Catholic community think?
Are parishioners comfortable that 12-to-18-year-old girls are routinely offered the vaccine for a disease they only risk getting if they’re sexually active? And that parental consent is not required unless girls are between 12 and 15?
Officially, the New Zealand Catholic Church condones the vaccine’s use in this age group, saying it prevents disease without promoting early sex. But critics within the church insist the vaccine has a potential to encourage promiscuity – and the likely risk of side-effects – meaning it shouldn’t be provided to Catholic girls.
There is tension in some church circles. Schools are split, parents write strongly opinionated anonymous letters in disagreement with the vaccine, board members raise debates and principals want to protect their students’ health.
In July, 2006, when the Ministry of Health said it planned to fund a national Gardasil campaign through secondary schools, the Catholic Church put the matter to its ethical experts and bishops.
Bishop Patrick Dunn of the Catholic Auckland Diocese attended a bishops’ conference to discuss the vaccination in religious terms with the ethics committee, and collectively decided Gardasil did not go against Church teachings and did not promote sexual promiscuity.
They decided that, because a spouse can be exposed to the virus before marriage, HPV infection can be spread by just being in a monogamous relationship.
Bishop Dunn says it would be a tragedy if giving the vaccine was seen to be promoting sexual activity among young girls. “It should not undermine efforts to promote chastity and to reduce non-marital sexual activity.”
The National Catholic Bioethics Centre agrees the most effective way to avoid the disease is to abstain from sexual relations before marriage and to be faithful. It also considers that HPV is spread through sexual contact, but is not limited to it. Thus, it recommends young Catholics get the vaccine.
Two Catholic principals interviewed by NewsWire say the bishops’ conference statement informed them the vaccination was not against the moral teachings of the church. Schools can opt out if they choose, but, as one principal says: “It was not promoting promiscuity nor interfering with the reproductive cycle, so there was really no religious decision to make.”
She points out that other large-scale vaccinations have been carried out in the past. She has no objection to helping young women and their health, and says neither do the parents in the school community.
Another principal says it is a parental/student choice to allow their daughter to get the vaccine. “We vaccinate against other illnesses such as rubella, meningitis, chicken pox, polio, so why not cervical cancer, which can be terminal?”
However, her school community has been divided. She has received objections from “interested groups” and a couple of the school’s board members also disagree with offering the programme. There were also concerns that the girls were too young and it would encourage promiscuity.
Family Life International volunteer Clare McClean takes a different point of view on the matter and thinks that it goes against her Church’s teachings. She says unlike in the case of other preventable diseases people can just pick up, Gardasil is given to prevent possible consequences of somebody’s immoral behaviour. “Catholics aim to live, and help others live, moral lives.”
Family Life International media spokesperson Brendan Malone agrees and points out that it does not matter if a person is Buddhist, Christian or atheist the morals should apply to human values. He says their organisation has been warning young people for years about the risk of HPV.
In the US, Gardasil faced scrutiny and backlash from parishioners, religious groups, parents and even girls who have received the vaccination. In Canada, a Catholic Bioethics report acknowledges parents feel it may encourage promiscuity in young girls. Bishops also outlined strict guidelines for parents to consider when choosing if their child should be vaccinated.
Bishop Dunn also says there are some concerns from parents in the New Zealand Catholic community. A lot of them want to make sure the vaccine is not condoning sexual activity in young girls.
A group of year 13 girls who attend a Wellington Catholic secondary school are in line to receive the vaccination. They believe it is good and will ensure they have healthy lives ahead of them. Their parents also support their decision.
All of the girls have had other major vaccines at school and they consider this one to stop them contracting a deadly virus. “Anything against cancer is good.”
These young women do not think of the vaccine as a tool to promote promiscuity and say they are not even thinking about sex and would prefer to focus on their NCEA exams. “Girls who are going to become sexually active were already thinking about it and they do not need encouragement from a vaccine.” They all want to protect their fertility so they have children in the future.
One of their classmates is not getting the vaccine. She believes she will not need it because she does not plan to have more than one sexual partner. She thinks the vaccine goes against Catholic teachings. Another girl said a friend of hers had concerns about the side effects of the vaccine.
In New Zealand there have been no known serious reactions to the vaccine, but other countries have reported girls becoming paralysed, experiencing abdomen and chest pain and even dying after receiving the injection.
Public health nurse Mary Mather advised possible reactions may include mild fever, swelling of the arm, nausea or a headache. She says it is unlikely any serious allergic reaction will occur.
However, Reuters reported that Spain had temporarily stopped a batch of Gardasil after two girls became ill after the shot. The US Centre for Disease Control and Prevention reports that more than 10,000 people have had adverse effects from the vaccine. Six percent were considered to be serious.
Other reports of death from the vaccine remain unproven, with many found not to be related directly to Gardasil. In all cases the deaths occurred in healthy young women soon after they were given the vaccine.
There are many anti-Gardasil groups set up by parents around the world who have supposedly lost their children to the vaccine.
Bishop Patrick Dunn says some Catholic parents are worried about the side effects. Family Life International’s Brendan Malone says there is no data on the vaccine’s long term safety.
Mary Mather says that if people have had a severe reaction to a vaccine before, they should check with a doctor or nurse before getting the cancer vaccine.
Wellington obstetrician and gynecologist Dr Hanifa Koya says the risk of cervical cancer is high in any ethnicity. There may be a higher chance for obese women, younger Maori women, and younger women who do not get regular smears.
As Dr Koya sees it, the best way to prevent the disease is to have regular smear tests (the standard in New Zealand is every three years). She thinks women should have a smear test two years after becoming sexually active, rather than from the age of 20. “Some younger patients can have high-grade cancer because they have not had a test.”
The vaccine, while expected to protect for five years, does not cover all types of cervical cancer, so smear tests are still recommended.
Mr Malone says that some experts believe that other strands of HPV could become more dominant as more people get vaccinated. He thinks that young people should be aware that you can still contract the virus even using a condom.
Dr Koya points out that about 40% of the population carries HPV and if you have got the virus, you have it forever.
HPV also affects men, causing genital cancers like penal or anal cancer, though both are rare. The virus can also cause genital warts. Men aged 9 to 15 can request the vaccine, but it is not, at this stage, funded by the government.
Dr Koya says girls should be 100% vaccinated before boys, because girls have a higher chance of contracting cancer from the virus.
The vaccine is under scrutiny in the Catholic community, but their religious leaders ultimately agree that Gardasil is suitable for Catholics.
There is still wide concern of the vaccine’s safety around the world, and the health risks that it may entail, but it has been tr1alled in more than 100 countries.
Medics approve of the vaccine, but still insist that a smear test is compulsory even if women have had Gardasil.
The girls who are receiving the vaccine seem to welcome the product, because it will protect them from at least one form of cancer.
Young Catholic women are only too aware of how the disease could destroy their future lives and take away chances of having a family or even cut their life short.
The girls leave the session and as they place the vaccine consent forms in their bags, as they have with so many other vaccine forms, they chat about whose going to get the vaccine and each other’s thoughts on Gardasil.
When they go home they will consider their own moral beliefs, take into account the health benefits, the school’s advice, the government’s advice and talk it over with their parents.
It’s a lot for a teenager to absorb.
In a couple of weeks all the forms will be in with a tick or a cross. Their names will be logged into a vaccination register.
By next month, girls all over the country from different schools, backgrounds and religions will be lining up in their school hall, with their sleeves rolled up and their blazers off to receive the first of three shots of Gardasil.
*Olivia comes from a long line of females who have suffered from the effects of cervical cancer.
On the day of Olivia’s first ball, instead of joining her friends at pre-ball gatherings, she made her way to the hospital all dressed up to see her mum that had just a hysterectomy.
They had photos in the sterile hallway with mum dress in a hospital smock and she dressed to the nines. Her dad proudly admired the efforts he had made to get her there.
Five years down the track a new vaccine came out that was almost sure it could fight this horribly disease that had affected most of her family.
Olivia paid $495 to get immunized that could one day save her life and give her protection against the deadly HPV virus. A year later her cousin was diagnosed with cervical cancer. She was born one year too early to be vaccinated for free.
This year her younger cousin has signed up for free shots at her school. Olivia thinks that families who have a history of cervical cancer should be given priority and be offered free doses of Gardasil no matter what their age.
*Katherine is a young female in her twenties. She has a toddler and is just starting her studies at university. She was diagnosed with cervical cancer two years ago, after she had an abnormal smear test. The doctors have rated cancer to range in the stages of between one and two.
When diagnosed with the disease her doctor decided to monitor her progress and gave her advice on how to look after her health. As she is very young, she was told that it may go away over time, she has regular biopsies.
Her recent check showed that the disease was declining, but her doctor wants a second opinion. She says that before she had the cancer she probably would not have thought about getting the vaccine. She thinks that girls who have the opportunity to get vaccinated should do it because “it is not worth risking your health or worst your life for something that can be so easily avoided.”
The religious view
*Jessica is 17 years old. She was brought up in Catholic family and attends church with her family most Sundays. She has always attended Catholic primary and secondary schools.
Jessica decided that she will not be getting the injection and made her decision on the basis that she will not have sex until she is married.
Because it is a sexually transmitted disease, she thinks she will not need it. Jessica only wants to have one sexual partner. She wants to marry somebody who comes from her own belief system and moral views.
* Names have been changed.
Cervical cancer, which attacks the cervix, is measured in stages from zero to four. It is treated based on how potent the cancer has become, four indicating it has spread to other vital organs. The main treatments are cone biopsy, hysterectomy, hysterectomy combined with chemotherapy or, in advance cases, chemotherapy and radiotherapy. If a pre-cancer is detected it can be treated successfully and there is a high rate of recovery.
Gardasil produced by Merck/CSL Biotherapies is a vaccine that protects against some strands the Human Papillomavirus or HPV. The vaccine protects against two types of HPV that cause 70 percent of cervical cancer and two types of HPV that cause 90 percent of genital warts. The virus can lead to cervical abnormalities and cervical cancer.
Gardasil has been trialled in more than 100 countries and 26 million vaccinations have been given (www.yourbestshot.co.nz). On the first of September 2008 in New Zealand the vaccine was funded by the government for girls born between 1990 and 1991.
Early this year the vaccine became available to girls aged 12 to 18 born after the first of January. However females who do not fit into this category and are between 9 and 26 can receive this injection for approximately $165 per shot. Females
are required to get three shots over a six month period to be protected from the vaccine and it is expected to last at least five years.
Photo 1 – Nuns praying in a church.
Photo 2 – The Gardasil vaccine.