By Yamiche Alcindor
Washington Post Staff Writer
Friday, August 21, 2009
For Denise Haggans, the decision to get her 11-year-old daughter Lanise vaccinated against the human papillomavirus (HPV) was an easy one.
"It wasn't really a choice," Haggans said while waiting in line at Kelly Miller Middle School during one of the District's free immunization clinics Thursday. Lanise received her second of three doses of the HPV vaccine at the clinic. "The school said she needed it, so I got her it," Haggans said.
For the first time since the Food and Drug Administration approved the controversial vaccine in June 2006, schools in the District and Virginia are asking that girls entering sixth grade receive the vaccine designed to protect them against HPV, which causes genital warts and can cause cervical cancer. District schools open Monday while most Virginia schools open Sept. 8.
Parents in both jurisdictions can choose to opt out of having their daughters vaccinated. In the District, parents must fill out a form affirming their decision; in Virginia, parents can simply choose not to have their daughters vaccinated.
"This is a liberal opt-out policy," said Sandra Sommer from Virginia's Department of Health. "The legislation was passed but parents can opt out without a waiver."
Supporters of the vaccine say it will help millions of young people avoid contracting one of the most common sexually transmitted diseases in the nation. According to the Centers for Disease Control, more than 20 million people in the United States are infected with HPV and at least half of all sexually active people will acquire the virus in their lifetime. Gardasil, the vaccine, is most effective if administered before a girl becomes sexually active.
"Certainly in terms of preventing the most common strains of the disease that cause genital warts, this vaccine is effective," said Kathy Woodward, a doctor at Children's National Medical Center in Washington who specializes in sexually transmitted diseases. "As opposed to being resigned that everyone will get HPV, we now have a tool that can prevent it."
Opponents say that the drug has not been tested enough and that parents have not been properly educated about potential side effects.
Tilli Williams, a licensed naturopathic doctor in the District, counsels her patients against receiving the vaccine. She believes schools should wait to see the effects of the drug after 10 or 15 years before requiring it.
"I'm just totally against mandating this," said Williams who often treats women with HPV by encouraging them to exercise, eat healthfully and take vitamins.
In Maryland, such concerns have kept the state from mandating vaccinations, said Greg Reed, a program manager at Maryland's Department of Health and Mental Hygiene.
After the release of Gardasil, Maryland's General Assembly commissioned a group of school officials, doctors and parents to study whether the state should require vaccinations. After reviewing the drug's availability, affordability and effectiveness, the group recommended in June that the HPV vaccination should remain voluntary in Maryland, Reed said.
District resident Tracy Lloyd, 32, applauded Maryland's decision not to mandate the vaccine. Lloyd is a member of the Parents and Citizens Committee to Stop Medical Experimentation in D.C., a group of about a dozen activists who believe the HPV vaccine needs more testing.
"They are using our girls as guinea pigs," said Lloyd, who has a 2-year-old daughter. "I wouldn't have my daughter vaccinated."
She also believes the District's efforts to educate parents have fallen short. "The city is steamrolling this legislation through as if it's made a good faith effort to educate the community," Lloyd said.
Pierre Vigilance, director of the District's Department of Health, said his office held community forums in each ward, passed out fliers and e-mailed school discussion groups to help parents understand the issues surrounding the vaccine. "We hope parents can make informed decisions about whether to follow through with this decision," he said.
An analysis published in Wednesday's Journal of the American Medical Association found that at least three medical associations promoted Gardasil using funds provided by Merck, the vaccine manufacturer. Lloyd and Williams believe that such tactics have caused parents to have their daughters vaccinated without proper scrutiny of the drug's effects.
"I wish they would have made it an opt-in policy," Williams said. "To make it an opt-out policy makes it hard on parents who don't have the time, the energy and the knowledge to see if is something that they have to do."
To Haggans, however, the vaccine means protecting her daughter against a potentially deadly virus. "I thought it was a good idea," she said. "I think it will help her, and the school telling me it was required was enough for me."
District resident Shauntese Young, 29, agrees. Her 10-year-old daughter, Paris, also received the HPV vaccine Thursday at Miller Middle. "I feel confident in it," she said of the vaccine. "I'm not worried, but I hope it works. I hope it prevents cancer and does what it's supposed to do."
The HPV vaccine is given in three shots over a six-month period and costs a total of about $375. In the District, more than 2,300 girls will be asked to get the vaccine this year. Most of the costs will be covered by Medicaid and private insurance companies, said Julie Hudman, director of the District's Department of Health Care Finance.
"The cost of the vaccine should not keep a child from receiving it," Hudman said.