Parents Question HPV Vaccine

"I thought it was imperative to continue the conversation," explained Del. Joseline Peña-Melnyk (D-Prince George's), who introduced the study initiative. "People need to be educated on the issue in order to be able to support it."

In the District, a mandatory immunization bill could be voted out of the D.C. Council Health Committee as early as Friday. One sponsor, council member Mary Cheh (D-Ward 3), has heard mixed reaction from residents, with the positive responses coming "almost uniformly from women."

"I really hope people don't lose sight of the fact that this is the first time we've ever had a vaccine against a cancer," Cheh said. "You seize and take advantage of it."

Local health experts urge more deliberate consideration. "There has to be a period of awareness," said Joseph Wright, executive director of the Child Health Advocacy Institute at Children's Hospital in Northwest Washington. The hospital has not decided its position on the council's pending bill. "Legislators would be wise to recognize the way the public winds are blowing and build in a very strong public education campaign before stressing the mandatory aspect."

Kim Koontz Bayliss, for one, was initially angered by the proposal, seeing it as an intrusion on her judgment of what is best for her 11-year-old, Nell. The Cleveland Park resident has come around some in the past month. After a television commercial on Gardasil prompted questions from her daughter, she read up on HPV and the vaccine. Nell is due soon for her annual checkup, and her mother plans to discuss it with the doctor.

But, she added, "I'm not going to make a move until I talk to the pediatrician."

Virginia's legislation would not take effect for most sixth-grade girls until the 2009-2010 school year. (In Texas, an executive order recently issued by Gov. Rick Perry (R) would begin mandatory HPV immunization there in September 2008.) Proponents say the lengthy notice will allow enough time to watch for complications as the vaccine is used more broadly. In the clinical trials, in which 11,000 girls and women participated, a slight soreness at the site of injection was the only identified side effect. Recent reports suggest some cases of fainting, dizziness, fever and nausea.

"It's a very cautious approach," said Del. Phillip A. Hamilton (R-Newport News), who championed the bill. It passed with no organized opposition.

Both he and Kaine have stressed the opt-out clause, which will allow parents to say no without explaining why. Some contend that if enough children are excluded, there will be little strength left in the requirement.

"We have no clue yet what the uptake will be for this vaccine," said Jon Abramson, chairman of the committee that advises the federal Centers for Disease Control and Prevention on immunization practices. The panel never addressed the issue of inoculation as a condition of school attendance. Abramson, who also is a professor of pediatrics and infectious diseases at Wake Forest University medical school, does not support the legislative moves.

Although mandates help reduce disparities in health care, he agreed, they have to be funded. And cost is a key concern in his mind: A three-dose regimen of Gardasil, given over six months, runs $360 or more, and a significant part of the population would have to pay out of pocket because families lack private insurance or do not qualify for a subsidy through the federal Vaccines for Children program. Dollars often follow mandates, but they are not guaranteed. Virginia is unusual in that Kaine has added $1.4 million to the budget for coverage.

"It's very, very unclear to me that states have the money to pay for it," Abramson said, "and I would be very concerned that kids would be kicked out of school because parents can't pay."

Maryland's recent experience with older students and vaccines provides little reassurance of early compliance. Thousands of teens were barred from school for weeks in January because they didn't get newly required chickenpox and hepatitis B shots -- despite extensive publicity and free clinics.

Abramson advised Merck & Co. not to lobby lawmakers over Gardasil. Merck disregarded his and others' suggestion, until its role became such a distraction that the company stopped two weeks ago.

"Politics are not a good driver of health-care recommendations," Abramson said. "Time will help us decide what's the best policy."

Staff writers Theola Labbé and Christy Goodman contributed to this report.