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Council Tentatively Backs Mandatory HPV Vaccine

By Susan Levine
Washington Post Staff Writer
Wednesday, April 4, 2007

The D.C. Council moved yesterday toward requiring preteen girls in the District to get inoculated against a virus that can cause cervical cancer, despite some of the same reservations fueling a national debate.

The council agreed 7 to 3 to support a vaccination bill targeting the human papillomavirus, or HPV. Although the proposal faces a second and final vote in coming weeks, the margin yesterday portends likely passage. Critically to some supporters, it contains a provision allowing parents or guardians to opt out of the mandate.

If the initial endorsement of Mayor Adrian M. Fenty (D) holds and he signs the measure into law, the District would be one of the few jurisdictions in the country to add the HPV vaccine to its school immunization schedule.

"We have to seize this opportunity to save our daughters from the scourge of HPV," co-sponsor Mary M. Cheh (D-Ward 3) told colleagues.

Attempts to mandate the HPV vaccine have proven so controversial across the country that only one state has done so and two others, including Virginia, have passed legislation awaiting governors' signatures.

In Virginia, lawmakers approved a requirement in February targeting girls before they start middle school, but Gov. Timothy M. Kaine (D) wants to amend their action to make it easier for parents to opt out. The General Assembly, which would have parents submit a letter to the school to opt out, is to consider the change today.

In Maryland, backlash over a mass HPV immunization bill doomed its chances shortly after its introduction in January. Legislation that both chambers sent this week to Gov. Martin O'Malley (D) would merely create a panel to study the HPV vaccine.

The D.C. Council's action came just hours after Children's Hospital finalized its position on the issue. The hospital's directors approved a recommendation that the three-dose Gardasil be mandatory for pre-adolescent and adolescent girls. However, the board said any mandates should include an opt-out provision and not take effect in the District or states for up to two years.

That time window, according to a Children's announcement, would allow for public information campaigns about HPV infections and cervical cancer, vigorous monitoring of the vaccine's safety and efficacy, and adequate funding for low-income families unable to afford the $360 cost.

Under the D.C. legislation, the series of shots would have to be administered before a student enrolls in sixth grade.

Girls could be excused for any reason, a no-questions-asked flexibility that some medical experts worry could decrease compliance with other vaccinations.

Yet the three council members who voted against the bill were not swayed by its exemption clause. Carol Schwartz (R-At Large) withdrew her backing and, like council member Harry Thomas Jr. (D-Ward 5), argued that less-informed families would not know they had any right of refusal. Schwartz also expressed concern over the extent of Gardasil's testing, especially on younger age groups, before the federal government approved its use in June.

To scattered applause from listeners in the council chambers, she urged that "an experimentation" not be allowed on children.

Her comments elicited a strong response from the bill's other co-sponsor, health committee chairman David A. Catania (I-At Large), who detailed the District's high incidence of cervical cancer and its impact on minority women.

"Rolling our eyes and twiddling our fingers is not going to make it better," Catania said. "We have got to get more aggressive."

After nearly a hour of discussion, Schwartz, Thomas and Kwame R. Brown (D-At Large) voted against it. Jim Graham (D-Ward 1) abstained. Marion Barry (D-Ward 8) voted in favor after successfully offering an amendment for an extensive parent education program.

The human papillomavirus is transmitted by sexual contact, making it far different than the other diseases, easily spread in public settings, that are addressed by school immunization laws. Gardasil protects almost completely against two HPV strains that cause more than 70 percent of the 10,000 cervical cancer cases in the United States annually.

Although the vaccine, manufactured by Merck & Co., is approved for women up to 26, the federal government has recommended administering it to 11- and 12-year-old girls to ensure that they are protected before they become sexually active. Many medical organizations support that guideline. But few have gone further, saying the drug is too new, and public understanding and financial support not well enough established, to require girls to receive it.

To date, only Texas, through the executive order of Gov. Rick Perry (R), has mandated the HPV vaccine. Legislation passed in New Mexico awaits the signature of Gov. Bill Richardson (D).

Staff writer Lisa Rein contributed to this report.

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