Each year, 6.2 million Americans become infected with human papillomavirus (HPV), usually through skin-to-skin contact during sex, and nearly 4,000 American women die from HPV-related cervical cancer. People with HIV-weakened immune systems have a far higher risk of developing cervical and other, less common HPV cancers, including anal. (A recent study found that 50% of HIV positive gay men in San Francisco had signs of precancerous lesions from anal HPV infection.) In June, the FDA is expected to approve a vaccine that has tested 100% effective in preventing the two strains of HPV that cause 70% of related cancer cases when given before a person is exposed to HPV. Gardasil, from Merck & Co., would become what is in effect the first cancer-fighting vaccine; GlaxoSmithKline (GSK) will likely submit another HPV blocker for review this year. Gardasil’s loudest buzz, however, comes not from its lifesaving science but from its socially conservative foes. Proponents of abstinence-only have made Gardasil another flashpoint in their war against treatment—including HIV meds and any potential vaccine—that they claim could lessen the medical risk of (and thereby encourage) premarital sex and other sexual behaviors they deem inappropriate.

The issue is particularly charged because it involves the under-18 crowd. Studies show that 40% of HPV infections occur within 16 months of first sexual activity, and medical experts are recommending that all kids from 10 to 12 get vaccinated before they enter school, in the hope of reaching them before they have sex. “I would absolutely recommend that it be given to all schoolchildren,” says Juan Carlos Felix, head of the National Cervical Cancer Coalition’s Advisory Panel. Indeed, recent data suggest that vaccines and safer-sex education do not increase sexual activity in adolescents. What’s more, studies show that kids taking an abstinence pledge are less likely to use condoms and have the same rate of sexually transmitted infections as kids who don’t take the vow.  

Despite the scientific support, many conservative organizations, including Focus on the Family and the Family Research Council, initially opposed any vaccinating of children against HPV. However, most have since limited their opposition to fighting mandatory school vaccinations after Merck and GSK tailored educational campaigns to address their concerns and the media berated them for opposing a cancer preventive. “It should be left up to parents to make an informed decision about vaccinating their kids,” says Linda Klepacki, a sexual-health analyst for Focus on the Family. “HPV can be completely avoided by not being sexually active outside of marriage, and we oppose efforts to make the vaccine mandatory.” Many vaccine advocates are bracing for a possible state-by-state battle over schoolwide immunization.

Regardless of what happens in schools, Gardasil could hit doctors’ offices as early as this summer, pending the Centers for Disease Control’s Advisory Committee on Immunization Practices (ACIP) usage recommendations, expected in June. Though the committee includes such conservative Bush appointees as Reginald Finger, MD, a former medical adviser to Focus on the Family, medical experts at a February ACIP Gardasil meeting said the committee seemed to favor highly recommending the vaccine. “It’s a very exciting vaccine,” says ACIP chair Jon Abramson. “I hope one day we can eliminate cervical cancer.”

How will the Gardasil furor impact HIV’s elimination? “I hope the HPV vaccine will reveal the stumbling blocks, show that this is not an issue of promiscuity and pave the way for an HIV vaccine,” says Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition. Neal Halsey, MD, head of the Johns Hopkins Institute for Vaccine Safety, says, “In the ’80s, people thought the hepatitis B vaccine was the wrong message to send children. Now, well over 90% of them get the vaccine. It just takes a few years with any vaccine,” he says. Meanwhile, cervical cancer accounts for the second-highest cancer death rate in women in the developing world. This month, perhaps, with Gardasil’s approval, the true moral issue will become getting a costly treatment to the millions who need it.