Vaccination against the human papillomavirus can be an effective means of reducing the rate of cervical cancer among women. Although some might argue that its use signals that a young woman is destined to engage in sexually inappropriate conduct, this is not necessarily the case. One who is chaste and enters into marriage may still contract HPV as a result of a spouseÕs prior sexual activity. Also, and tragically, there are women and girls who are sexually assaulted. These too would be protected. But it would nonetheless be wrong to use the power of the state to compel parents to have their children immunized against their better judgment. In the long run, it is counterproductive to require mandatory immunization for a contagious disease that is transmitted not by casual social contact but by intimate sexual activity.
Many parents see the HPV mandate as a government intrusion into private family life and a trespass upon their right to make decisions on behalf of their children. We know that the rate of sexually transmitted disease increases the more sexual partners one has. Given that acquiring HPV is typically the result of the free choices made by an individual (though not always, as I have noted), it would appear that the best solution to the problem would be the recognition that sexual activity should be reserved for marriage, and that prior to marriage, abstinence is the only course that gives an absolute guarantee of no transmission, not only for the human papillomavirus but for every other sexually transmitted disease as well.
For those who find this standard too difficult, we can still say that the closer one approaches this ideal, the better for them and for society, for we know that the fewer the sexual partners one has, the better it is for our sexual health. Of course, no one has ever made any money advocating sexual restraint. Sex sells. But unfortunately, sexual promiscuity can bankrupt the immune system, leading to a host of serious and even lethal diseases.
Some respond to this problem by seeking to change behavior. Parents, for example, want to guide their children into choices that will benefit their health in both body and mind. Others respond by downplaying the need for changes in behavior (or by presuming that change is impossible) and seek instead to discover medical strategies or technological devices that will fix the problem.
Those who favor changes in moral behavior as the principal means for tackling the problem of sexually transmitted disease take exception to plans that undermine their ability to make their own informed decisions or, if they are parents, that would undermine their authority to direct the moral development of their own children. In the case of the HPV vaccine, parents are beings asked to draw a parallel between vaccinations against diseases such as rubella (German measles) and a new line of vaccines that will protect against sexually transmitted diseases. But are these two cases the same?
To mandate immunization against rubella makes perfect sense. We have a duty to ensure that we are not the cause of harm to others. Typhoid Mary, who spread disease wherever she worked and, when fired, simply took up employment elsewhere, was properly quarantined by public health authorities. She did not intend to do anything wrong, but that made no difference. The state, in the interests of public health, was justified in taking measures that would prevent the spread of a disease caused by casual contact. Coughing or sneezing may happen on a public bus, in a school cafeteria, or at a movie theater. The same is not true of sexual activityÑat least we hope not. An element of consent plays an important role in the spread of STDs; hence, a logical response to the problem is to focus on the possibility of changing behavior.
Those who instead favor the technological approach may not specifically reject efforts to change human behavior, but sometimes their strategies undermine that effort. They tend to recast what the first group sees as a moral problem in the language of medicine or health care policy. Thus, in the case of HPV, a vaccine that immunizes those who might engage in risky conduct is seen as an ideal medical solution. Mandating the vaccine for everyone ensures that all are protected, just as they would be against any other communicable disease.
The problem is that these two approaches conflict. One focuses on the need for a change in behavior; the other offers a technological solution that requires no such change. If the problem of sexual promiscuity is approached by getting a series of shots and taking various pills, then we are not exercising self-control, but are using medicine to palliate our vices. The HPV vaccine does not address the cause of the problem, but masks it, and so actually undermines our efforts to find an effective solution.
But we are always hopeful that science or technology will relieve us of the difficult work of living moral lives and making sound choices. We see this in other areas as well. Every year there are new fads in dieting, with lots of money spent on books, prepared meals, exercise machines, and the like. We are told to eat nothing but meat, or dairy products, or popcorn, when all that is really needed to reduce our weight is to eat a little less each day, and to engage in a minimal amount of exercise, such as a fifteen- minute daily walk. But we like to deceive ourselvesÑto think that there is some magic formula, some pill, some technological device, that will resolve our moral problem without any need for self-discipline.
I am afraid the same is true here. The HPV vaccine is a technological solution, but what we face is not a technological problem. We face a moral problem. We solve moral problems through moral means, specifically, through an improvement in our individual choices and in our general social condition. Technology can be an aid in that effort, but it can also offer us the appearance of any easy solution, and thus thwart progress. Even worse, it can undermine the legitimate efforts of parents and others to encourage the young to lead healthy moral lives.
Perversely, the more the public at large suffers from STDs, and the more vaccines and other technological therapies are invented to remedy these illnesses, the more money there is to be made by companies that cater to our vices. Contrariwise, the more the public exercises self-control, and the fewer STDs there are, the less need there is for these vaccines and therapies, and the less money there is to be made by these same corporations. I am not saying, of course, that the major pharmaceutical companies want us to become ill so that they can provide us with products that will cure us, but I am saying that if we do not become ill they cannot make any money. Pharmaceutical companies can be strong supporters of programs that try to elevate the institution of marriage, call for abstinence in sex education, or generally promote a change in sexual mores, but they derive no financial benefit from achieving these goals.
Considered in this way, the vast amounts that these companies spend in the pursuit of cures for what are typically self-inflicted illnesses represents an extraordinary waste of money, for what these researchers are seeking to remedyÑand only in their effectsÑcould be far more effectively addressed, once again, by attacking the causes. This requires a change in behavior and so only a minimum of expenditures. The billiions of dollars that are directed toward alleviating the painful results of our own poor choices could be put to far better uses. Those monies could be channeled to the defense of the nation against terrorism, to the improvement of our educational system, to the strengthening of public transportation, and to other positive goods for society. Instead, these monies are spent on remedying our own lack of discipline.
Parents who have taken on the challenging task of trying to bring up children who will live lives of sexual restraint are simply asking the government to leave them alone. They are not interested in winning any wider social debate. They want to be free to give their children the best possible upbringing they can. They do not understand why the government finds it necessary to interfere with their own considered judgment in personal matters that pertain directly to the family. Working toward a reform of sexual mores seems to a great many parents a far more sensible approachÑeven if it is only one person at a timeÑthan getting onto an endless treadmill of new vaccines, therapies, and technological devices designed to contain an increasingly wide range of sexually transmitted diseases brought about through our own poor choices.