Parents Question HPV Vaccine
Sunday, March 4, 2007
In barely nine months, the first cancer-specific vaccine to win federal approval has gone from licensing and the enthusiastic embrace of dozens of states to a widespread backlash against moves to mandate immunization for adolescent girls.
Health experts are dismayed by the controversy over Merck's Gardasil, which protects against two common forms of the sexually transmitted virus that causes cervical cancer. But it has hardly surprised them. Never has compulsory use of a drug been pushed with such breakneck speed -- with concerted lobbying by its manufacturer. Never have such efforts advanced largely through political and legislative channels instead of medical authorities and public education campaigns.
Votes to require the three-dose vaccine before students enter the sixth grade remain likely in the District and numerous jurisdictions. On Friday, Virginia Gov. Timothy M. Kaine (D) announced he would sign the first bill in the country to prescribe vaccination, albeit with an opt-out provision. However, doctors question whether there will be adequate funding and access to support these measures, and some fear that the opt-out clauses, included to counter opponents' concerns, could erode support for immunizations in general.
If parents are given broad opportunity to exempt their 11- and 12-year-old daughters from the vaccine for the human papillomavirus, or HPV, will they be less willing to have children of any age inoculated against other, more communicable diseases?
"The message that we send to parents is exceedingly important," said Gary Freed, a professor of pediatrics and health policy at the University of Michigan and chairman of the federal government's National Vaccine Advisory Committee. "Are we going to be creating a culture of vaccine refusal that's not going to serve us well?"
Few people dispute the promise of the new vaccine, which clinical trials proved to be highly effective against two HPV strains that cause nearly three-quarters of the 10,000 annual cervical cancer cases in the United States. About 40 percent of women who receive the diagnosis die. Low-income and minority women are most affected, with African American mortality rates more than twice that of whites.
Still, for some parents those numbers might not be great enough to justify state intervention. Maureen Siegel of Manassas, who has a 10-year-old daughter, acknowledged she must learn more. "I don't know everything there is to know about the basics," she said. "I also don't know if cervical cancer is a big enough epidemic to make [vaccination] mandatory."
Because the virus is transmitted through intimate contact, the arguments for required vaccination differ from the rationale for enforcing shots against diseases easily spread in schools, such as measles. They are less about safeguarding the public and more about safeguarding individuals.
"Why is this happening so fast? Why is there a mandate when this is such a different kind of disease?" asked Barbara Loe Fisher, president of the National Vaccine Information Center, a nonprofit consumer organization that opposes HPV legislation. Most states did not add the chickenpox vaccine to schoolchildren's immunization schedules until several years after its approval in the mid-1990s, she noted.
Yet the backlash is also about the age of children targeted. Although the government approved Gardasil for women up to 26, it recommended routine administration to girls 11 and 12 to ensure they be protected before they become sexually active. The vaccine is most effective when given before first sexual contact. Its duration is unclear.
Some people argue that vaccination could encourage adolescents to be more promiscuous. More believe that parents' authority over their daughters' health care would be usurped. Others point out that cervical cancer will occur in only a fraction of the more than 7.5 million girls and young women estimated to be infected with the virus in this country.
A Maryland state senator retreated quickly in January after being deluged by irate letters about her bill for mass HPV vaccination before middle school. Still pending is a second bill to create a task force of legislators, teachers and health professionals to study the issue through 2008.