Why Are So Many Jewish Parents Opting Not To Vaccinate Their Kids for HPV?
Concerns grow about the shot’s efficacy, despite promising results. Maybe we’re more worried about our daughters’ sexuality.
And white, educated, upper-middle-class parents (you can substitute the word “Jews” there if it helps you to visualize) seem most likely to distrust vaccine recommendations in general. A recent Israeli study found that the more highly educated the parents, the more likely they were to create their own infant vaccine schedules, ignore official governmental recommendations, and decide on their own which vaccines they wanted administered. The Israeli Health Ministry is trying to figure out what to do about these well-off, stubborn, independent, suspicious-of-authority parents. And here in the good ol’ USA, white families are far more likely than others to opt out. Only 48 percent of white girls got the first HPV vaccine dose, compared to 56 percent of black girls and 65 percent of Latinas. In general in this country, white people have better health outcomes than people of color, but that’s not looking to be true with HPV. “I can’t remember a vaccine where I saw a pattern like this,” said Walter A. Orenstein, director of Emory University’s Program for Vaccine Policy and Development, in an interview with the Times.
Part of me suspects that Jews have more reason than most people to be suspicious of secular authority. We know from our history of getting accused of drinking Christian baby blood and charged with treason and being told our devious Hebraic genes are inferior that governments lie. But another part of me is surprised that parents aren’t being driven by Jewish values, which consider the needs of the community as highly as the needs of the individual: Al tifrosh min ha’tzibur: Do not separate yourself from the community. Seen in this light, this “do whatever you want” perspective on vaccines seems awfully libertarian—and goyish. And Jewish sexual ethics involve respect for one’s partner and protecting oneself.
I chatted with Paul Darden, author of the Pediatrics study, about his theories on why educated parents shy away from the HPV vaccine. I was delighted to find him sympathetic and nonjudgmental about parents’ concerns. (And he wears spiffy bowties.) He understands that telling people they’re stupid for having the beliefs they do is not a way to increase compliance and improve public health. “I do think there’s more anxiety about this vaccine than about other vaccines,” he told me. “Less than 1 percent of parents in our study said they had safety concerns about the vaccine for tetanus, diphtheria, and whooping cough and the vaccine for bacterial meningitis. But 15 percent say they have safety concerns about the HPV vaccine.”
He was refreshingly open in responding to parents’ concern that this vaccine is a pure money-grab by drug companies. “Oh, the pharmaceutical industry operates in a free-enterprise system, and they want to make money, no question,” he said cheerily. “I’m sure they jack up the price on us as much as they can, because that’s what everyone does in this country. But I’ve actually found vaccine developers to be pretty altruistic. They’re like the redheaded stepchild of the industry, because if you want to make money in pharmaceuticals, you don’t go into vaccines. You don’t want a vaccine someone gets a few times. You want a prescription they’ll have to fill every month for 20 years!”
His response to the scary information floating around the Internet about the safety of this vaccine is to tell parents they need to understand correlation versus causation. Yes, bad things can happen after someone gets a shot. “But they can be temporally associated and have nothing to do with causation,” he said. “You could say, ‘Cereal consumption kills adolescents!’ Because some kids had cereal the morning they got the vaccine, and later that day THEY DIED.”
“The one thing [the HPV vaccine] does cause is fainting,” Darden continued. “It is a painful shot. But syncope [fainting] occurs to a degree with every vaccine we give. Back in the measles epidemics of ’89 to ’91, I went out to schools to help vaccinate, and the boys would faint and girls would have hysterics. It’s infectious. Once a guy fell down, they all fell down. I think you’re trying to be brave and you lock your knees and it’s a fear response and you have a little pass-out spell.” And if girls tell other girls they’re going to faint when they get the vaccine, they’re more likely to faint.
This collective response happens to parents as well as kids. Vaccine refusal tends to occur in clusters. “The people you really trust are your friends and social networks, not just doctors,” Darden said. “If your friends have concerns, that will influence what you want to do.” (I can testify to that from my own visceral response to the flute party, which made me go from 100 percent sure my kids would get the vaccine to, let’s say, 45 percent sure by the time the last cupcake was eaten.) But this tendency is “bad from an infectious-disease point of view,” Darden said. “You’re out there hanging around with a group that’s not protected, so you’re really not protected! We know for whooping cough that there are much higher rates [of infection] in those clusters, and measles clusters happen in people who are not vaccinated coming over to the United States on planes.” (And in ultra-Orthodox non-vaccinating communities, too.)
And despite my friends’ fierce pro-women’s-sexual-empowerment, anti-slut-shaming worldviews, I do wonder whether they’re being honest with themselves about their ability to see their own daughters as sexual beings. “When you look at the reasons given for not getting the vaccine in 2010, ‘not sexually active’ was only given by 11 percent of the people responding,” Darden said. “The most frequent response, at 17 percent, was ‘not necessary,’ and another 4 percent answered ‘not appropriate age.’ ” All those answers could actually be related anxiety about daughters’ sexuality. After all, the vaccine is most effective at age 11 or 12, before kids are having sex, so “not sexually active,” is an illogical reason for refusing the vaccine.
As for “not necessary,” that perspective jibes with my hipster community’s general lack of fear of HPV. You can’t Reefer Madness us about it, because we’ve seen how little damage it can do. But put down that metaphorical HPV joint, urges my friend Lena Antimonova Cerbone, a midwife who runs a family-planning clinic in West Virginia, in one of the poorest counties in the nation (and who also works in a hospital that serves a far more affluent and educated population—and yes, she says, her wealthier clients are far likelier to opt out of the HPV vaccine than her poor ones). First of all, just because most of us had HPV that was a minor inconvenience doesn’t mean our kids will be as lucky. If they’re infected with those nasty serotypes 16 and 18, their prognosis isn’t necessarily as sunny. And Cerbone points out that we shouldn’t be cavalier in assuming that Pap smears will make everything A-OK, regardless. “Think about this,” she told me in an interview. “Yes, your daughter will get Pap smears when she’s living in your house and in college, but she’s way less likely to get them in her 20s. And the 20s tend to be when people are having stupid sex. Yes, there are cervical-cancer screening and prevention programs, and yes, Pap smears are the best tool we have, but cervical cancer is still the third most common killer among gynecological cancers in this country.” Besides, there are long-term concerns besides cancer. “Think about your daughter’s future fertility,” she urged. “Having a LEEP or cone biopsy—that is not a cervix that likes to stay pregnant. You don’t want your daughter to have miscarriages and pre-term babies.”
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