D.C., Md., Va. Proposals Part of National Effort to Prevent Cervical Cancer
By Susan Levine and Hamil R. Harris
Washington Post Staff Writers
Friday, January 12, 2007
The District, Virginia and Maryland are at the forefront of a growing nationwide effort to encourage or even require adolescent girls to receive the new cervical cancer vaccine -- the first vaccine ever developed specifically to prevent cancer.
In the seven months since the federal government approved the vaccine for human papillomavirus, or HPV, the virus that causes cervical cancer, half a dozen states have introduced legislation that would mandate immunization of students by the middle school grades. Several others are making doses, which cost $360 for the full regimen of three injections over six months, available at no charge.
"It's red hot, coming fast," said former Maryland senator Gloria G. Lawlah, immediate past chairwoman of a national group of female state lawmakers who have pushed legislatures to increase public awareness of and testing for cervical cancer.
This week, the District became the latest jurisdiction to propose adding the vaccine to the list of shots girls would have to get before enrolling in the sixth grade. Yesterday, Mayor Adrian M. Fenty (D) voiced his support, saying hearings to flesh out the program should satisfy parental concerns.
At least two similar bills were introduced last week in the Virginia General Assembly. And in Maryland, state Sen. Delores G. Kelley (D-Baltimore County) has prepared a bill that requires middle school vaccinations. Kelley said she expects strong support from teachers and female lawmakers.
"This is an issue that is cross-generational," she said.
HPV vaccination is being promoted across the country, in such states as California, South Dakota and New Hampshire. In New Hampshire, officials called the vaccine a major scientific breakthrough when they began offering it without charge to females 11 to 18.
"For goodness sake, how long in our lifetime have we prayed: If we can only have a vaccine against cancer?" said Kentucky state Rep. Kathy Stein (D), sponsor of a mandatory immunization bill filed there last week.
The attempts to require vaccination have been criticized by groups concerned that it might encourage promiscuity or infringe on parents' authority over their daughters' health care. Others oppose such efforts because of worries about vaccines in general.
But many organizations support the proposals, most of which would allow exemptions for religious, medical or philosophical reasons.
"We are dealing with a public health crisis," Pernessa C. Seele, head of Balm in Gilead, said yesterday. The group addresses health issues affecting African Americans and is teaming up with African American medical professionals to combat cervical cancer.
Cervical cancer affects nearly 10,000 women in the United States every year, killing more than a third of them. Minority and low-income women are most affected; African Americans die at a rate more than double that of white women.
The virus at the root of the suffering is rife throughout the population, with 20 million Americans ages 15 to 49 infected. HPV is transmitted through sexual activity or other intimate contact, although most people's bodies fight it off without their even knowing they had the virus. There is no treatment.
Cervical cancer results when certain high-risk types of the virus trigger abnormal cell growth. The vaccine, Gardasil, was tested on more than 11,000 girls and women worldwide. It proved to be 100 percent effective against two of the most prevalent high-risk types, according to the Centers for Disease Control and Prevention.
No side effects were seen in the trials, other than a slight soreness at the site of the injection. Given the vaccine's newness, the length of protection the shot offers is unclear.
In June, the federal Advisory Committee on Immunization Practices recommended that the HPV vaccine be administered routinely to girls 11 and 12 and to women as old as 26. It is most effective when given before a first sexual contact.
Joseph Zanga, professor of pediatrics at East Carolina University's Brody School of Medicine, favors the vaccine for girls who plan to be sexually active. But "mandating is the wrong approach to this issue," he said.
"If a kid with measles is sitting in a classroom, he or she is going to infect many other classmates. A kid with HPV infects no one other than one she might have sex with," he said. "We're not protecting the public health in the same way that we protect public health when we require measles vaccine."
Virginia Del. Phillip A. Hamilton (R-Newport News), sponsor of a bill that would mandate HPV inoculation for middle school children, disagrees.
"This is not a prevention for a sexually transmitted disease. This is a prevention for cancer," he said. "And if a vaccine can eliminate even one case of that, I think it's a worthwhile initiative."
HPV vaccination can be administered along with other inoculations and does not need to initiate a major parent-child discussion about sex, he said.
The Michigan doctor who led the HPV panel that prepared the federal recommendation made the same point.
"The reality is, many children get shots and they don't ask what they're for," said Janet Gilsdorf, director of pediatric infectious diseases and immunology at the University of Michigan C.S. Mott Children's Hospital.
She supports making vaccination as universal as possible. "No question that school mandates increase vaccine uptake," she said.
Staff writers Lisa Rein, Michael E. Ruane and Nikita Stewart contributed to this report.
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