States Are Divided on Vaccinations for HPV

Requirements approved so far in Texas, Virginia, as other measures falter.

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Even as legislators across the country debate the merits of a vaccine designed to prevent cervical cancer, Gov. Timothy M. Kaine of Virginia has announced his intention to sign legislation passed in that state mandating such vaccination for school enrollment.

But while the Virginia legislature overwhelmingly approved the measure Feb. 19—making it the first in the nation to approve a bill requiring vaccination against human papillomavirus, or HPV, for middle-school-age girls—lawmakers in other states have been less willing to do so.

In Texas, for example, legislators are discussing whether to overturn Gov. Rick Perry’s Feb. 2 executive order requiring 6th grade girls to receive the vaccine, and proposals in Maryland, Michigan, and Mississippi have either failed or been withdrawn. ("Education Groups Noncommittal on Mandatory HPV Vaccinations," Feb. 14, 2007.)

“There’s nothing else that’s anywhere close to reaching the governor’s desk,” Jody Ruskamp-Hatz, a health-policy analyst for the National Conference of State Legislatures, said of other mandatory-vaccination proposals. Whether other bills will get that far will depend on a “whole slew of reasons,” she said, including state budgets, the amount of time legislatures are in session, and local culture.

HPV Vaccine Requirements

Although legislators in more than half the states have introduced measures concerning the vaccine for human papillomavirus, or HPV, Texas and Virginia so far are the only states that have taken executive or legislative action to mandate such vaccinations.

• Gov. Rick Perry, a Republican, issued an executive order last month requiring girls entering the 6th grade in the 2008-09 school year to have received the HPV vaccine.
• The state will provide the vaccine for uninsured or underinsured girls and women up to age 21.
• The state health department will undertake a campaign to educate the public about the importance of such vaccination, the availability of the vaccine, and the state vaccination requirements.
• Parents, on behalf of their children, can opt out of the HPVvaccination program.

• The legislature last month passed a bill requiring such vaccination for girls entering the 6th grade in the 2009-10 school year.
Gov. Timothy M. Kaine, a Democrat, has said that he would sign the measure, which he had not received as of last week.
• The state would provide the vaccine for free at local health departments.
• After reviewing materials developed by the state describing the link between HPV and cervical cancer, parents would be permitted to opt out of the vaccination program on behalf of their children.

The Denver-based organization said that, at some point since last June, bills were introduced in the legislatures of 21 states and the District of Columbia to amend vaccination policies to include the vaccine that protects girls and women against four strains of HPV, a sexually transmitted disease that causes genital warts and 70 percent of cases of cervical cancer.

In discussing the plans, some lawmakers and members of the public have raised questions about the safety and effectiveness of the vaccine, parents’ rights, states’ ability to pay for every girl to receive the $360, three-shot cycle, and lobbying efforts—since ended—by the vaccine’s manufacturer. Legislators in some states have responded to public concern by amending their proposals to allow for exemptions.

Sen. Janet D. Howell, the sponsor of the Virginia legislation, attributes her bill’s success, in large part, to a provision that allows parents to refuse the vaccine for their children. The measure would require girls to be vaccinated before entering 6th grade, beginning in the 2009-10 school year, costing the state an estimated $1.4 million a year.

“It was controversial until we added an opt-out provision,” Ms. Howell, a Democrat, said. “It was surprisingly not controversial once that was added.”

Most, but not all, proposals in other states include an opportunity for parents to opt out for a variety of reasons.

Corporate Connection

Other supporters credit the Virginia plan’s success to its delayed implementation.

“By the time this is mandatory in Virginia, there should be one, if not two, other products available,” said Kevin Hall, a spokesman for Gov. Kaine, a Democrat.

The flurry of legislation—and controversy—began last June, when the federal Food and Drug Administration approved the first HPV vaccine, Merck & Co.’s Gardasil. Gardasil is the only HPV vaccine with FDA approval, although other vaccines are in development.

The federal Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices subsequently voted to recommend routine vaccinations for girls ages 11 and 12. ("U.S. Panel Backs Vaccine for Girls to Combat Virus Linked to Cancer," July 12, 2006.)

Though health-care providers and public-health officials hail the drug as a breakthrough, critics say that policymakers are jumping the gun by pushing for mandatory vaccinations so soon after the vaccine’s approval.

“There are way too many questions left unanswered,” Texas Rep. Dennis Bonnen, a Republican sponsor of one of the bills that would overturn Gov. Perry’s order, said at a hearing last month.

States should allow more time to study the drug’s long-term safety and effectiveness, Rep. Bonnen and others say, as well as for the approval of other vaccines. The order by Gov. Perry, a Republican, takes effect in the 2008-09 school year.

Lawmakers criticize the Texas governor for mandating the vaccine without the legislature’s approval and question his relationship with the vaccine’s Whitehouse Station, N.J.-based manufacturer.

Last month, Merck announced that it would stop donating to state-level candidates and party committees after the company’s lobbying efforts for mandatory vaccination came to light. A Feb. 5 report by the Helena, Mont.-based Institute on Money in State Politics shows that Gov. Perry had received $21,000 from the drug company’s political action committee.

Gov. Perry maintains that his decision to require the vaccinations was based solely on public-health concerns.

“I refuse to look a young woman in the eye 10 years from now who suffers from this form of cancer and tell her we could have stopped it, but we didn’t,” he said in his Feb. 6 State of the State address. “If I err, I will err on the side of protecting life.”

Rep. Bonnen’s bill, which is co-signed by nearly two-thirds of state representatives, was approved by the House public-health committee last month and has been sent to the floor for a vote.

Vol. 26, Issue 27, Pages 18, 20

Published in Print: March 14, 2007, as States Are Divided on Vaccinations for HPV
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