As followers of this blog know, I hugely respect Aaron E Carroll, MD, who writes The Incidental Economist blog, and often writes for the NYT’s “Upshot” as well. In the 11-9-15 “Upshot,” he talks about the disappointing uptake of the HPV vaccine (the one that protects against sexually transmitted herpes virus, which can cause cancer of the cervix, throat and tongue , penis, etc.). He blames his fellow docs for not offering the vaccine to parents in the same matter-of-fact way they recommend the standard childhood vaccines. But he also faults “policy,” lamenting that only two states, plus D.C., require HPV vaccination for school attendance, noting that almost all states require other vaccinations, e.g. chickenpox.
Carroll makes an important mistake here. Diseases like mumps, measles, and chickenpox are transmitted at school, through the usual methods of contagion, in the classroom, cafeteria, and playground. To keep the entire school population safe, all (or almost all) children must be vaccinated. It’s not right to require parents to send their kids to school, and then not keep them as safe as possible while they are there. However, the HPV virus is transmitted sexually, and unless schools have changed a lot since I was a kid, that’s not activity that normally takes place in school. Requiring HPV vaccine (or Hep B vaccine) for school attendance is simply using school as a convenient but arbitrary gatekeeper. That’s a bad idea for a number of reasons. For one, school attendance is a good in itself, and we shouldn’t be throwing up unnecessary roadblocks. For another, we shouldn’t get in the habit of using school as a stick and carrot for all sorts of childhood policy goals. Better to have as many kids in school as possible, and then use the school to further health education, including the benefits of the HPV vaccine.