States consider bills mandating HPV vaccine for young girls

But so far, only one state, Virginia, has passed a law to require students to receive the vaccine to prevent the human papillomavirus (HPV) as a condition of enrollment. That law, to take effect in October 2008, mandates girls be vaccinated before they enter the sixth grade. Parents who object would be able to opt out.

In Texas, Gov. Rick Perry signed an executive order mandating the vaccine, but state lawmakers are mounting a counteroffensive to override it.

According to the National Conference of State Legislatures, bills have been introduced in 33 states and the District of Columbia to “require, fund, or educate the public about the HPV vaccine.”

A handful of school districts has also gotten involved in this issue. The Los Angeles Unified School District started offering the vaccine, Gardasil, to girls with parental consent at its school-based clinics Feb. 26.

“It’s really more of a supply issue for us,” said Dr. Kimberly Uyeda, director of student medical services for the district. “Whatever we get from the county is what we’re able to administer.”

Lu Ann Fillpot, a registered nurse at the Farwell (Texas) Independent School District, said she was disappointed that her 525-student district could not offer the vaccine in February on a voluntary basis when it offered other vaccines to students. But she is confident it will have the vaccines on hand and be able to do so by late March. She also said her 15-year-old daughter will be one of the first in line for it.

The strongest argument in favor of vaccinating young girls is the potential to prevent cancer and save lives. Without a mandate, health officials fear a quarter of girls will not be immunized.

According to the Centers for Disease Control and Prevention, about one in four U.S. females ages 14 to 59 may be infected with HPV, which is spread through sexual contact. Once a person is infected, there is no treatment.

Gardasil, manufactured by Merck & Co., is the first vaccine to be approved by the U.S. Food and Drug Administration for cancer prevention.

It guards against HPV types 16 and 18, which cause 70 percent of cervical cancer cases, and types 6 and 11, which cause 90 percent of genital warts cases. Approval of another HPV vaccine is pending.

The CDC recommends the vaccine and says doctors may give it to girls as young as 9. “It is important for girls to get the HPV vaccine before their first sexual contact -- because they have not been exposed to HPV,” the CDC states.

The National Medical Association issued a statement March 6 “strongly encouraging” the use of the HPV vaccine, but said immunization should be voluntary, not mandatory.

Public health officials have registered concern about requiring the vaccination, citing its newness, cost, liability, and availability.

Opponents of a mandatory vaccine argue that it might lull girls into a false sense of safety and thus lead to promiscuous behavior. Some parents have said the mandate usurps their power and they don’t want to start discussing sex and sexually transmitted diseases with their daughters at such a young age.

The National Vaccine Information Center, an organization created in 1982 to help prevent vaccine injuries, said side effects to the vaccine, such as headaches, dizziness, loss of vision, and loss of consciousness during seizures have been reported.

But the American Cancer Society, which estimates there were 9,710 new cases of cervical cancer in the United States last year, said such side effects are no cause for alarm.

“No doubt this is a very hard decision because it involves parental responsibility, the well-being of young adults, and the potential burden on schools, health care providers, and pocketbooks,” said Brenda Greene, NSBA’s director of school health programs. “The discussions that are going on are beneficial to help states and communities determine their course of action in the wake of this rare medical breakthrough that will help young people avoid a life-threatening disease.”

In Texas, Perry was able to evade opposition from conservative legislators and parents-rights groups and issued an executive order Feb. 2 requiring girls to be vaccinated for HPV before they enter sixth grade starting September 2008. The order included an opt-out clause for parents.

But on March 13, the Texas House of Representatives voted to rescind the executive order and passed a bill to ban schools from using HPV vaccinations as a condition for admission.

“My concern is, we just don’t know enough about this vaccine,” said the bill’s sponsor, Rep. Dennis Bonnen.

If the vaccination program does go forward, it is estimated to cost the state $50 million the first year.

The Texas Medical Association, Texas Pediatric Society, and Texas Academy of Family Physicians took a neutral position on the bill, Dr. Jane Rider, a pediatrician from San Antonio, told a Texas legislative committee.

“After considerable discussion and debate, we all concluded that while we strongly support the ability of physicians to provide the HPV vaccine, we do not at this point support the state mandate,” Rider said.

The Texas Eagle Forum, an affiliate of Phyllis Schlafly’s conservative group, said the mandate contradicts the state’s abstinence-only sex education policies. And the parents of five Dallas students filed a lawsuit against the governor Feb. 22 in opposition to the HPV shots, arguing that their children should not be guinea pigs.

Despite such criticism, Perry “stands by his order,” said the governor’s spokesperson, Robert Black. “He believes the state should do everything it can to protect young women from getting cancer.”

“I don’t understand the big deal, except Perry made it a law and people don’t like the government telling them what to do,” said Fillpot, the school nurse.

“It’s such a good thing,” she said. “Would you prefer to hold your daughter’s hand one day as she suffers with cervical cancer and explain that this could have been avoided? . . . It’s an awful thing, and we have the means to protect our children from it.”

Merck officials had been working with policymakers in at least 20 states to urge schools to require the vaccine.

But on the eve of Perry’s testimony before a House committee, the company announced it was shelving its lobbying campaign due to pressure from medical groups, politicians, and parents. Company officials also said they didn’t want the campaign to be a distraction in making the vaccine against cancer widely available.

The vaccine is fairly expensive -- usually $360 for the three doses required over a six-month period -- but the federal Vaccines for Children program covers vaccination costs for children whose parents are uninsured or are on Medicaid.

Several states are making Gardisil available on a voluntary basis, particularly to lower income and uninsured girls. The New Hampshire Health Department, for example, announced in 2006 that it will provide the vaccine at no cost to girls under age 18. South Dakota, New Mexico, and Oklahoma have similar programs.

Michigan was the first state to consider legislation last fall to require the HPV vaccine for girls entering the sixth grade. That bill wasn’t enacted, and a similar bill proposed in late 2006 in Ohio also failed to pass. Legislation introduced in Maryland was withdrawn by its sponsor.

Minnesota State Sen. Yvonne Prettner Solon, a cancer survivor, backed away from plans to introduce legislation to require the HPV vaccine and instead proposed a task force be created to study the issue.