Democracy and HPV Vaccine

Sep 21, 2011 by Russell Fraley

The Republican presidential debates have highlighted an interesting public health issue that is relevant to our current discussion of the role of politics in science.  Texas Governor Rick Perry has been criticized by his rivals for mandating that Texas girls entering the 6th grade receive the vaccine for the HPV virus, which causes cervical cancer.  The mandate included an opt-out for parents, but Perry has been heavilycriticized for government intrusion into private health decisions.

In response to the controversy,  Georges Benjamin, Executive Director of the American Public Health Association, said in part:

“Vaccines save lives. The HPV vaccine in particular attacks cancer through its infectious source and will save the lives of thousands. It is the forerunner of a new approach to disease prevention; an approach that has enormous promise to save millions of lives in the future and be part of our 21st century tool chest to end cancer as we know it. Some vaccines should be required, as we do for some of our childhood vaccines. However the decision to mandate the vaccine in Texas did not go through an appropriate public policy decision making process, and we are now seeing the negative political and social ramifications of that decision.”

In other words, Benajamin approves the role of government in mandating certain vaccinations that are perceived to be necessary to address significant public health threats, as has been done for years with the polio vaccine and others.  He is critical, though, of the process, or lack therof, by which the decision was made.

My own view, as the parent of a daughter who was affected by the decision, is that Benjamin has it right:  there are situations — and this may be one — where the public interest justifies a government mandate of health care.  The problem here was exactly the lack of an open public process for the decision to be made.  Rather than an executive order, this should have been a legislative decision that was preceded by public hearing, scientific input and public debate, determined by a vote of elected representatives (ultimately, the Texas Legislature overturned the executive order).  Unfortunately, Perry effectively bypassed the democratic process and the benefits it can provide to difficult scientific decisions like this that have an immediate impact on the public welfare.

So what do you think?  Should the government be allowed to mandate health care?  In what cases?  By what process or method?  Please leave your comments and feedback.