Cervical Cancer Vaccine Continues to Spark Debate

THURSDAY, March 29 (HealthDay News) -- As 24 states consider laws that would require girls entering sixth grade to be vaccinated against the cervical cancer-causing human papillomavirus (HPV), the morality behind the move has taken center stage.

However, public health experts note that a medical debate is going on about whether mandating a vaccine for a disease that is not highly contagious is smart or cost-effective.

Some experts support mandating vaccination for all girls, while others support voluntary use of the vaccine. Conservative groups and some parents have also voiced the concern that immunizing girls against HPV -- which is transmitted sexually -- might lead to more premarital sex. Other experts worry that mandating the vaccine, called Gardasil, will open the floodgates to the compulsory use of other shots as they are developed.

Countries elsewhere are also considering widespread use of the vaccine. On Wednesday, Italy became the first European nation to offer the HPV vaccine free to its citizens. Health officials there said they will launch a campaign to encourage the immunization of 12-year-old girls, but the shot will not be mandatory.

Routine, voluntary use of the vaccine in young girls does have the support of most major U.S. medical groups. In fact, on Thursday, the U.S. Centers for Disease Control and Prevention's Advisory Committee on Immunization Practice formally recommended use of the Gardasil vaccine for girls aged 11 and 12, and for females aged 13 to 26 who have not yet been immunized.

Members of the American Academy of Pediatrics' (AAP) Committee on Infectious Diseases have described the vaccine as safe and effective in preventing cervical cancer, but they also stopped short of recommending mandatory vaccination.

"The vaccine is an important vaccine, and it has the ability to decrease cancer," said Dr. Robert Frenck, a professor of pediatrics at Cincinnati Children's Hospital and a member of the AAP committee.

"My concern is that HPV is a different kind of transmission than diseases we normally look at for mandating vaccines," Frenck said. "Diseases such as measles or chickenpox are transmitted by casual contact. With HPV, it's not a casual contact."

In addition, Frenck believes there will be significant economic consequences for states if the HPV vaccine is mandated. Pending bills that mandate the vaccine have provisions for the state to pay for immunization, he noted. That could turn out to be very expensive.

"Right now, the three-dose series is approximately $120 a dose -- that's $360 for the full series," he said. Without extra funds, the cost of the vaccine would strain already overburdened public health systems, he said.

Another expert is also against mandating the vaccine, but this time for medical reasons.

"The vaccine is too new to be thinking about mandates," said Dr. Jon Abramson, a professor of infectious diseases at Wake Forest University Medical School and chairman of the CDC's immunization practices committee.