Gardasil

12/27/07

I had heard about the Human Papillomavirus (HPV) vaccine, Gardasil, because of the furor it had caused among American politicians and the public. The vaccine, a series of three injections administered over the course of six months, protects women against the types of cervical cancer caused by four strains of HPV, which amount to about 70% of the cases of cervical cancer. Its efficacy for protecting women against these types of cervical cancer is nearly 100%, and there are few side effects. When over 10,000 women annually are diagnosed with cervical cancer, and 3700 die as a result of the cancer, this vaccine represents a significant achievement.

Then why the moral outrage? Cervical cancer is caused by HPV, a sexually transmitted infection. Estimates state that about 75% of sexually active people in the US have contracted the infection or will contract it in their lifetimes, and the infection is most common in young adults. HPV is usually a transient, asymptomatic infection, adequately dealt with by the body’s immune system, but certain strains can lead to infections that develop into cervical cancer if left untreated.

A generally asymptomatic infection that leads to cancer years after a woman has initially contracted the virus is a frightening concept that concerns me. Thus, a vaccine that can prevent the majority of cervical cancers was a welcome medical breakthrough in my view. Yet sectors of the American public expressed outrage over the vaccine and claimed that it would corrupt the youth. They said that the vaccine would encourage women to be sexually active because it would eliminate some risk of sexually transmitted infections, and that promiscuity would increase as a result. Yet to deny women medical treatment based on this fallacious argument is ludicrous.

I had noted the controversy the vaccine had caused but had not thought it had any personal implications. Knowing and accepting what Islam mandated, I fully believed that the vaccine had no audience among the American Muslim community. That idea changed recently, when I contemplated receiving the vaccination after reading information about it that a fellow medical student had distributed. I was deeply uncertain about getting myself vaccinated, but I could not understand why I was feeling this way.

What about this vaccination made me reluctant to be vaccinated? While I’m not a fan of needles (my pediatrician probably still remembers the time I kicked him in the shins when he tried to vaccinate me for mumps), I had suffered through a variety of vaccinations that would immunize me to hepatitis B, rabies, and measles. Clearly, pain and needles were not part of the issue—it was my way of thinking that was causing the problem. As a Muslim woman who followed the tenants of my religion, I had dismissed the vaccine as irrelevant to my lifestyle. Not only had I labeled it irrelevant, I had endowed the vaccine with a moral value, much in the same way that the protestors had. I felt that being vaccinated against a cancer caused by a sexually transmitted infection implied that I needed the vaccination because I was breaking religious decrees. Because of its associations with issues considered culturally taboo, I feared the moral implications of the vaccine.

This realization gave me pause. Until that moment, I had not understood that I was confounding a medical treatment with morality. It was a strange thought, because I knew women who had been vaccinated, and I applauded them for protecting themselves. However, I judged myself differently, especially because I was the only Muslim woman I knew who was contemplating being vaccinated. I kept thinking: I don’t need the vaccine because whoever I marry will be Muslim.

Then I had a moment of lucidity where I realized that it did matter. I couldn’t assume things about my partner’s life before marriage, especially if those assumptions had a direct impact on my health. I would never place my health in someone else’s hands, and by not being vaccinated, I was doing precisely that. Being vaccinated to protect myself against cervical cancer was not a moral judgment, and it did not indicate anything about my lifestyle or about my religious practices: it was just one more way to lead a healthy life. The same arguments used to vaccinate people against tetanus should be used to vaccinate women against HPV.

The very next day, I was sitting in my doctor’s office with my sleeve rolled up and my eyes tightly shut so I wouldn’t see the needle that was hovering over my arm. “I can’t watch,” I wailed, and the nurse resisted smiling.

I’m not going to lie, ladies: that shot hurt. When I communicated this to the nurse, her prompt response effectively shut me up: “Well, it hurts a lot less than cervical cancer.”