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Force Is Not the Only Way to Administer a Vaccine

By Courtland Milloy
Wednesday, January 24, 2007

Let's get something straight: I am not against a vaccine that prevents strains of the human papillomavirus, as some readers have contended. Nor am I for cervical cancer, which is caused by the sexually transmitted HPV. However, as my previous column on this subject indicated, I am opposed to the government mandating the vaccine. I say leave the role of strong-arm drug pusher to the thugs on the street.

There is no reason that a voluntary program, based on an informed and sensitive health education campaign, would not work. New Hampshire, consistently one of the nation's healthiest states, has a voluntary HPV vaccine program, with plans to vaccinate 63,000 girls ages 11 to 18 over the next four years.

But wait, you say: Nearly 12,000 Maryland students could not go to school Monday because they failed to get their required vaccinations for chickenpox and hepatitis. If a mandatory program doesn't work, what chances does a voluntary plan have?

Here's the deal: Running a government-funded, voluntary immunization program doesn't mean doing nothing. It means getting serious about providing health education and access to health care.

"Education is something that we do -- in the schools and, most importantly, in our communities and in the pediatrician's office," said Greg Moore, a spokesman for the New Hampshire Department of Health and Human Services. "How do we do it? Old-fashioned legwork. We make sure the right people have the right information. We have people who go out at the regional and local level, sit down and talk to health-care providers and ask, 'What can we do for you?' Cervical cancer is a huge issue for us, and now we have this tremendous opportunity to educate and protect women even more."

The New Hampshire approach encourages residents to take more responsibility for their lives. With the government acting as partner -- instead of some antebellum massa -- parents are encouraged to make choices that are in the best interest of their children. And guess what? They usually do.

So far this month, about 3,300 doses of the HPV vaccine have been made available to girls in New Hampshire. State health officials say they are receiving feedback and determining where demand is greatest and how soon to order more vaccine. "We are at the beginning of the process, but from the anecdotal evidence, there appears to be a great demand from parents," Moore said.

All child vaccinations in New Hampshire are voluntary. The state doesn't kick girls out of school because they didn't get a vaccine. It understands that parents can become overwhelmed and need encouragement -- not just threats and kicks in the butt. And as a result, the state has one of the highest rates of child immunization in the nation.

"We know that there are parents who have expressed concern about children and childhood vaccines," Moore said. "Our program was designed with an emphasis on education and addressing whatever concerns parents might have."

Legislation mandating the HPV vaccine for pre-adolescent schoolgirls is pending in the District, Maryland and Virginia. Those who advocate it are quick to note that parents can opt out of the program. But few can say exactly how many bureaucratic hoops a parent will have to jump through to do that. Besides, why should the onus be on the parents to figure out how not to be in a government-mandated program? In New Hampshire, parents opt in -- and the burden is on the government to show how the vaccine can benefit their children.

The District does have more poverty, but we also have more money to deal with it. D.C. public schools get more than $1 billion a year to educate roughly 76,000 students. Use those resources wisely. With all of the teaching hospitals in this region, surely somebody can figure out a way to set up a realistic and relevant health-education curriculum in our schools.

So are New Hampshire residents somehow smarter and better able to develop effective public health programs? Are they more concerned about their children than the rest of us? Hardly. What they have that we do not is the right attitude. They take their state motto seriously: "Live Free or Die," while too many of us are content to live and die as slaves.

E-mail:milloyc@washpost.com

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