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The Centers for Disease Control and Prevention recently announced new vaccination recommendations for 11- and 12-year-olds. Preteens should receive vaccinations against meningitis, tetanus, diphtheria, and whooping cough. Adolescent girls also should receive the vaccine for human papillomavirus, or HPV.
The HPV vaccine, which protects against the most common viruses that cause cervical cancer, ignited controversy earlier this year when policymakers in several states made steps toward making it mandatory. The HPV vaccine debate has all the elements for a perfect political storm. It raises a host of contentious issues—the sexual behavior of teenage girls, parent’s rights and state’s rights, vaccine safety concerns, and the lobbying and marketing practices of pharmaceutical companies. ("States Are Divided on Vaccinations for HPV," March 14, 2007.)
While the CDC offers vaccination recommendations, ultimately state lawmakers determine the vaccines required, exemptions (if any), and enforcement. Which vaccines should be required in order to attend school and which vaccines should be voluntary? Under what circumstances may someone forgo a mandated vaccine? And how does the state ensure compliance?
Those in support of school vaccination policies argue that they are essential to maintaining public health. The CDC considers vaccination practices, such as school immunization requirements, one of the top 10 public health achievements of the 20th century. Public health experts and supporters of school immunization programs also oppose lenient waiver policies, citing research published in the Journal of the American Medical Association that has shown increased incidence of vaccine-preventable diseases in states where exemptions are easily obtained.
Arguments against school vaccination policies vary. Some argue that state vaccination mandates for students are no longer necessary because the family healthcare provider can be responsible for making certain that a child is properly immunized. Others believe that school vaccination laws should be reserved for only highly contagious diseases, such as whooping cough and measles, not sexually transmitted diseases, such as HPV. Still others argue against mandated vaccines because of concerns about parents' rights and vaccine safety.
Finally, some focus on the difficulties of implementing state immunization policies. They note how inadequate tracking systems, limited resources, and escalating costs result in some children falling through the cracks.
"Vaccination is going to do a whole lot to reduce the incidence of this disease [meningitis]. The CDC recognizes that all adolescents are at risk for this disease, and they are doing what is in the best interest of the public. If this recommendation had been in place nine years ago, my son would be alive. You have a vaccine that can prevent the killer disease. To me it's a no-brainer—you just go and protect your children."
—"CDC Panel Recommends Meningitis Vaccine for All Teens," The Washington Post, June 28, 2007
"The Centers for Disease Control and Prevention (CDC) and professional societies, such as the American Academy of Pediatrics, can't enforce their [own] recommendations. Only states can do that—usually when children enter day-care centers and elementary schools—in the form of mandates."
—"Fatal Exemption," Commentary, Wall Street Journal, January 20, 2007
"The people who deliver 85 percent of vaccines are doctors in their offices. They don’t need states to take action at all."
—"Will States Require Cancer Vaccine?," Stateline.org, June 30, 2006
"Using school laws, which were developed to protect children from communicable diseases like smallpox and measles, to mandate vaccination against a sexually transmitted infection, is to use the ends to justify the means."
—"Texas Puts HPV Controversy Under Microscope," State Net Capitol Journal, February 12, 2007
"If some state lawmakers around the country prevail, girls as young as 10 could soon face a mandatory medical appointment: They would need to be vaccinated against a sexually transmitted virus said to cause cancer—or risk being denied entrance to school. If this vaccine becomes mandatory, where will such government intrusion stop? If other vaccines become available, promising to prevent or cure noncommunicable diseases, might they, too, be required by law? Families deserve options, not coercion, in private health matters. The decision belongs to parents, not state governments."
—"Keeping Choice on the Gardasil Vaccine," February 13, 2007
"It’s very challenging for schools to verify that everyone has the recommended immunizations and the records are complete. School nurses have tremendous challenges just to do school nursing, let alone track down immunization records."
—"Education Groups Noncommittal on Mandatory HPV Vaccinations," Education Week, February 14, 2007
The number of new vaccines recommended for children and adolescents has nearly doubled during the past 5 years, and the cost of fully vaccinating a child has increased dramatically in the past decade [from $155 in 1995 to $1,170 in 2007].
The current vaccine financing system has resulted in gaps for underinsured children in the United States, many of whom are now unable to receive publicly purchased vaccines in either the private or public sectors. Additional strategies are needed to ensure financial coverage for all vaccines, particularly new vaccines, among this vulnerable population.
—"Gaps in Vaccine Financing for Underinsured Children in the United States," Journal of the American Medical Association, August 8, 2007
Share your thoughts on the debate about mandatory school vaccinations.
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