Vaccine for Girls Raises Thorny Issues

Lourdes Lopez, 14, of Silver Spring prepares to get a shot of the Gardasil vaccine from  Kennedy Kwende at Georgetown University Hospital.
Lourdes Lopez, 14, of Silver Spring prepares to get a shot of the Gardasil vaccine from Kennedy Kwende at Georgetown University Hospital. (By Susan Biddle -- The Washington Post)
By Rob Stein
Washington Post Staff Writer
Tuesday, November 7, 2006

Amy Groff has heard all about the new vaccine that guards girls against a sexually transmitted virus that causes cervical cancer. But the Cincinnati mother has no interest in getting her 11-year-old inoculated.

"We haven't even talked about the birds and the bees yet," Groff said. "She needs to be innocent a little bit longer."

Ellen Hoffman, who lives outside Chicago, also has decided to hold off giving her 11-year-old daughter the shots. Her reason, though, is that the vaccine is so new.

"We don't know enough about it to know whether it's safe," Hoffman said. "If children are not in a risky situation, then it seems to me it's better to wait and see."

While many parents are clamoring for the vaccine for their daughters, others are less enthusiastic. Some worry about safety. For others, it's the cost. For still others, it's queasiness about even thinking about sexual activity among girls so young.

The reservations highlight the complex matrix of social, psychological, economic and logistical obstacles that public health authorities face in trying to spur widespread use of the vaccine, which is being hailed as one of the most important advances in women's health in decades.

"This is not going to be easy," said Jon S. Abramson of the Wake Forest University School of Medicine, who chairs an influential expert committee that advises the government about vaccines. "This is a really important vaccine. But it's going to be complicated. This raises some issues we've never had to deal with before."

The vaccine, known as Gardasil, protects against human papillomavirus (HPV), a ubiquitous sexually transmitted virus that causes genital warts and cervical cancer. In June, the Food and Drug Administration approved Gardasil for women and girls ages 9 to 26, making it the first vaccine marketed specifically to prevent a cancer.

Experts are recommending that girls start getting the vaccine routinely at age 11 or 12 in the hopes of catching them before they become sexually active and saving them from a malignancy that strikes about 10,000 women in the United States each year and kills about 3,700, according to the American Cancer Society.

"This is now a vaccine-preventable problem," said Stanley Gall of the University of Louisville, a spokesman for the American College of Obstetricians and Gynecologists. "We have a huge opportunity to make a significant improvement in the health care of women."

The prospect of the vaccine initially raised alarm among groups promoting sexual abstinence until marriage, who feared it might encourage promiscuity. Most now say they support the shots, as long as parents can decide whether their daughters get vaccinated and it is not mandatory for school. Such a requirement is advocated by many experts and has been proposed in at least one state, Michigan.

Interviews with pediatricians and parents around the country in recent weeks indicate that most are enthusiastic about the vaccine. Many doctors promote it, many young women want to get it, and many parents are eager to have their daughters inoculated.

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