Reduce harm vs 1st do no harm?

So, after reading an article in Prescriber journal  entitled “Introducing HPV vaccination for boys in the UK” I got to thinking about this.

Human Papilloma Virus is a little bug, of which there are many variants, that seems to be nearly ubiquitous in the human population. This would not be a problem if it was not associated with illnesses such as cervical cancer, genital warts and other forms of cancer. So the clever bods in the Public Health Agency and the Department of Health decided that it would be reasonable to vaccinate girls between the ages of 11 and 19 against the most problematic types – 16 and 18, later extended to 6 and 11 also. The rationale being, that if you keep these girls from being actively infected with these conditions, you substantially reduce the rates of cervical cancer (a good thing) and genital warts (also a good thing, but maybe not just as good). All well and good so far.

How does one catch HPV then? It is primarily a sexually transmitted disease – vaginal, anal or oral intercourse are all associated with infection. There is some talk of possible infection through kissing, if the kissee has oral infection, although that’s not a definite.

So, for girls, there’s a lot to be said for it. And I’ve thought about the ethical side of this, having a daughter who will one day be offered the HPV vaccine.

Question : What is the best way to avoid HPV/genital warts and by extension, cervical cancer?

Answer: abstain from sexual intercourse, or at least with people who have had other sexual partners.

As a Christian, should I allow my daughter to get vaccinated when, really, I should be ensuring that she be raised with a healthy and Biblical view of sex within the context of marriage?

On balance, I think it is reasonable to let her be vaccinated. I hope and pray that she will be chaste and godly when she grows to womanhood. At a certain point, she will leave my household and no longer be under my jurisdiction; hopefully, she will marry and have children with a godly Christian husband. However, she is, and will be, a moral agent separate from me, and may make decisions which I disagree with, including who she has relationships with. On the other hand, perhaps she will meet someone who has turned from a life in chaos to a life in Christ. She may, at some stage in her life, be exposed to an individual who has HPV (potentially through her own bad choices, or potentially through no fault of her own) and be at some degree of risk from a selection of unpleasant illnesses. If there is something simple, safe and morally acceptable that I can do to prevent that, then I should choose it. (am I morally obliged to choose it? Should I be compelled to choose it? That’s for another day…). That is why she will most likely get the HPV vaccine.

As a Christian, should I let my son be vaccinated against HPV?

This is a trickier one. The above guidance on raising children applies also. The Government and PHA feel it reasonable to vaccinate all boys in the same age group. But boys don’t have cervices! Genital warts is not a killer disease! Aha, but HPV has also been associated with anal cancer, oropharyngeal, laryngeal cancer and penile cancer, they say. And also, by vaccinating boys, it increases the ‘herd immunity’ effect – the more vaccinated individuals floating about, the less HPV floating about to infect the non-vaccinated crowd – doing your bit for society by not harbouring infection.

And this will be coming to Northern Ireland, at least once we have a government.

Now, a little on those other conditions. I have seen cancer of the penis once, maybe twice in 10 years. I have seen oropharyngeal cancer a handful of times, and I’ve seen anal cancer once. There have usually been other complicating factors at play, especially smoking and alcohol.

By vaccinating boys, what we’re doing here is treating populations, not individuals. The easy win is the cervical cancer. The fringe benefits are the genital warts, and the 1 in a 100,000 reductions are the other cancers.

What are the odds of that HPV vaccination helping the boy who gets it? And what are the harder to perceive secondary effects?

Let’s look at the secondary effects. What effect does vaccinating against a STD have on how we view sex? STDs are largely a problem with sex outside of a committed, monogamous marriage relationship. That’s a bald assertion, but show me that it’s not the case. By reducing the risks of sexual intercourse, of whatever form, outside of marriage, we are practising a harm reduction strategy.

Let’s look at harm reduction as a brief aside. It started as a concept in intravenous drug users – rather than preventing the use of IV drugs, health authorities instead do their best to make that IV drug use safe – providing clean needles, sharps disposal  boxes in public toilets, safe areas to shoot up. That is harm reduction – it’s a non judgemental approach, as witnessed by the statement by the Harm Reduction Coalition :

Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs”

Vaccinating boys against HPV is essentially a harm reduction strategy. It does nothing for the underlying problem of illicit sex outside of the marriage bond. It’s an acceptance that the problem is too vast to do anything about, but let’s do damage limitation – hey, we can’t stop these kids/adults sleeping around, but let’s keep them safe while they do it. Not so different from the thinking about oral contraception and the Morning After Pill, really.

To what degree should Christians engage in this harm reduction approach to sexual behaviour in boys? To what degree is the ethos behind this treatment discordant with Christian belief about sexuality and sexual behaviour? I think it’s radically different, and an entirely pragmatic, and in fact rather lazy approach to dealing with the causative factors.

As a whole, do I think that these vaccination programs are bad, then? No. They are somewhat consequentialist in their thinking – the ends justify the means. If lives are saved, that’s a good thing, I suppose. I’m not saying that droves of people should boycott the vaccinations. But if I was running the programs? Harm reduction would not be my primary strategy. Sadly, in a nation bereft of an underpinning moral foundation based on Judeo-Christian ethics that provides clear reasoning for monogamy and faithfulness, we are not going to find lifelong exclusive marriage an easy sell.

Bringing it all back home, for me, the real question is – do I treat my child as a potential heathen-in-disguise, or do I treat them as a brother or sister in Christ? Do I treat them in the expectation of them turning from God, or treat them in accordance with a humble trust in the Lord that He will save His own Covenant children to the utmost? Do I remove all risks to prevent my kids from coming to harm if they transgress, or do I educate them and make it clear to them that there remain consequences in this life, as well as the next, for that transgression, which may be borne in their bodies for the rest of their lives, or potentially even shorten those earthly lives, and allow them to find their own way?

Help me out here people! What would you advise?

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