Texas Gov. Rick Perry (R) circumvented the state legislature in early February when he issued an executive order making vaccination against a sexually transmitted virus a requirement for girls entering sixth grade, beginning September 2008. The move outraged conservatives and civil libertarians alike.
In July 2006 the U.S. Food and Drug Administration (FDA) approved the sale of Gardasil, an inoculation against the human papilloma virus (HPV), which has been linked to cervical cancer. Since then, the inoculation has been aggressively marketed to girls and women between the ages of nine and 26.
Texas was the first state to make inoculation mandatory for girls for school attendance. Similar legislation is pending in Colorado, Connecticut, Kansas, Michigan, Wisconsin, and Washington, DC.
According to the National Conference of State Legislatures, 28 states have introduced and considered legislation mandating the inoculation’s use. Maryland withdrew its bill, and Utah’s was defeated in the state House of Representatives.
Unusual Measure
“Normally, governors do not order mass vaccinations unless there is a clearly defined ‘infectious’ epidemic, with a rapid onset, large contagion factor, etc.,” said Sandy Bourne, a former nurse who currently serves as vice president for policy and strategy at The Heartland Institute. “This is a violation of individual rights that normally does not take place in the public health arena without clear and compelling evidence that a pandemic is about to wipe out a population in a relatively short period of time.
“This is clearly an overreaching extension of authority by the executive branch that is normally used for short-term emergency situations,” Bourne said.
On February 7, a coalition of dozens of civil liberty, privacy, and tax groups, as well as several legislators, sent Perry a letter asking him to rescind the order.
Parental Control
Conservative groups in particular stressed the key role parents play in their children’s health care.
“We support the widespread availability of the HPV vaccine, but we also support parental rights and oppose making it mandatory in schools,” said Linda Klepacki, analyst for sexual health at Focus on the Family, a Colorado-based Christian organization. “Parents are the medical decision-makers for their children and should have the right to decide if their daughters will be vaccinated.
“There is a difference between the chicken pox and HPV,” Klepacki explained. “The four types of HPV covered by the vaccine are sexually transmitted. You can get chicken pox by sitting in the classroom. You cannot contract or transmit HPV in the classroom unless you are engaging in sexual activity. Therefore, there is no reason to mandate this.”
Opt-Out Problems
Washington, DC Councilmember Mary Cheh, who co-introduced a similar bill currently pending in the District, said parents would not be forced to vaccinate children against their will under her proposed law.
“There is an opt-out provision in our bill,” Cheh explained. “So I would not say the vaccine is required.” However, she admitted, “If a parent does not want to participate for whatever reason, the burden of initiative is on them.”
In addition, Cheh’s bill does not explicitly state the provisions of the opt-out procedure.
Fuzzy Details
Some health officials say creating such mandates is premature.
“We think it is too early for mandates because there are other priorities that need to be taken care of first,” said Dr. Joseph Bocchini, chief of infectious pediatric diseases at Louisiana State University Health Sciences Center and chair of the committee on infectious diseases at the American Academy of Pediatrics (AAP), a national group based in Illinois.
“We have to make sure a mandatory vaccination of sixth-graders is not to the exclusion of older girls and women who need it as well,” Bocchini continued.
The three-shot vaccination, administered over six months, currently costs $360.
Sexual Transmission
Most required vaccinations are deemed necessary to protect public health. Bocchini said HPV is a public health concern that calls for education, not obligatory directives.
“The mode of transmission should not play a role in whether to mandate it,” Bocchini said. “It’s really too early to make mandates, because we don’t know that we need to do that to improve public health.
“There needs to be a significant campaign to inform people about the risks of HPV,” Bocchini said. “People underestimate the chances of contracting it–40 to 50 percent of people who are sexually active acquire at least one strain of HPV within two years.
“People should not get caught up in the issue in terms of control or making decisions for their children,” Bocchini continued. “And people should not resist the vaccine just because it may be mandatory. Our position is that the vaccine may not need to be mandated once people are educated about what it can do. But mandate or not, it’s a significant advancement in women’s health.”
The HPV vaccine fights four strains of the virus. Both Gardasil and GlaxoSmithKlein’s (GSK) Cervarix have been found to be 100 percent effective in preventing infection with the two strains that cause 70 percent of cervical cancer cases.
GSK will request FDA approval in April for Cervarix, aiming to market the vaccine by the end of this year.
Aricka Flowers ([email protected]) writes from Chicago.
For more information …
National Institute of Allergy and Infectious Diseases HPV fact sheet, http://www.niaid.nih.gov/factsheets/stdhpv.htm
