Gardasil for Boys?

Three years ago a hefty lobbying campaign by Merck, the pharmaceutical giant, led some states -- including Virginia -- to require Gardasil vaccinations for girls and young women. Gardasil can help prevent the spread of HPV, a sexually transmitted pathogen that causes cervical cancer.

Social conservatives objected to a costly mandate that is based on the presumption a teenager will be promiscuous, but even in Virginia their objections carried little weight against the counsel of prudence: Talking about what people ought to do, said vaccination advocates, was fine in theory, but less relevant in the real world. The commonwealth approved a Gardasil requirement in early 2007. (Parents have the ability to opt out if they do not want their daughters vaccinated.)

Get ready for round two. The FDA has approved Gardasil for use in boys and men. Gardasil can protect males from genital warts, which are not life-threatening. It also can prevent males from being unwitting carriers of the HPV that poses a serious threat to women.

The decision invites another debate freighted with the same arguments as the previous one -- and then some. It seems excessive to require universal vaccinations against the threat of a minor health problem. (A Harvard study says vaccinating boys isn't cost-effective; Merck, quite naturally, says the opposite.) So any argument for requiring boys to be vaccinated probably will rest on the argument that doing so will benefit girls. As Nancy Berlinger of the Hastings Center, a bioethics institute, said to The Wall Street Journal: "It may seem unfair: Should this burden be borne by only girls and women?"

She's got a point: It takes two to tango, after all. On the other hand, the question introduces a distinctly ethical consideration into the mix: Boys should be vaccinated not so much because it might protect them from their own behavior, but because it might protect someone else (although perhaps not much, since girls already are receiving the vaccine). The case for mandatory vaccination of boys, then, becomes a case for mandating altruism because it is simply the right thing to do.

But once the debate shifts from the realm of good and bad, prudent and reckless, to the realm of right and wrong, then the floor would seem to open up for another debate over what young people should and shouldn't be doing in the first place. And there, social conservatives stand on much firmer ground.