The federal Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices voted to recommend routine vaccinations for girls ages 11 and 12 against human papillomavirus, the common sexually transmitted disease that can cause cervical cancer, opening the door for debate nationwide about the vaccine’s inclusion in school vaccination policies.
According to the Atlanta-based CDC, at least 80 percent of women will have been infected with HPV by the time they are 50. It is the most common sexually transmitted disease in the United States and causes 70 percent of cases of cervical cancer. Cervical cancer is the second most common type of cancer among women worldwide, resulting in 233,000 deaths every year. Breast cancer is the most common type of cancer among women.
Though Gardasil, the first vaccine ever developed to prevent cancer, has received widespread support as a medical breakthrough among healthcare providers and public health officials, some people take issue with the possibility that it could be required for enrollment in public schools.
“Parents rights must be respected,” said Wendy Wright, the president of Washington-based Concerned Women for America. “The public health sector can be very powerful and very disrespectful of parental rights.”
Vaccination policies are established at both the state and local level, and vary widely across the country. States and districts often require different vaccines to be administered for entry at various grades. Parents can have their children exempted from mandatory vaccinations for medical, religious, or philosophical reasons.
Debating the Merits
Some experts point out that HPV is unlike many other illnesses that schools require students to be immunized against, in that it is not spread through the air but is caused by sexual contact.
HPV is a “disease that you can’t catch from sitting in a seat at school,” said Linda Klepacki, an analyst for sexual health at the Colorado Springs, Colo.-based Focus on the Family.
But Barbara Frankowski, the chairwoman of the Elk Grove Village, Ill.-based American Academy of Pediatrics’ Council on School Health, says that schools often choose to require immunizations not only to prevent the spread of contagious diseases in the school setting, but also for public health reasons. She noted that many schools require students to get vaccinated against Hepatitis B and Tetanus, neither of which are airborne diseases.
Public health authorities use the term “herd immunity” to describe stopping the spread of a disease through the immunity of a high proportion of the population. Usually, officials estimate that at least 90 percent of a population must be vaccinated or have an immunity to a disease in order for the rest of the population to be protected. School vaccination policies have been used in the past to control the spread of diseases such as smallpox, measles, diphtheria, and polio.
In order for Gardasil to be effective, it must be given to an individual before she has been exposed to the virus. Health officials highlight the importance of vaccinating girls before they become sexually active, and the CDC committee recommended that girls as young as 9 could get the vaccine at the discretion of their parents and health-care provider.
Most parents won’t get around to vaccinating their daughters at the right age, though, because cervical cancer and sexually transmitted diseases are not usually at the forefront of their minds when their children are young, said Diana Zuckerman, the president of the Washington-based National Research Center for Women & Families.
“Well under half of girls will get [the vaccine] if it’s not mandatory,” she estimated.
High Price Tag
Ms. Zuckerman also said that the high cost of the vaccine would be an impediment to its widespread use. Gardasil, which is manufactured by Merck & Co., is given in three doses over a six-month period, at a total cost of $360. Further studies will be conducted in order to determine if follow-up boosters will be needed.
Despite the high price tag, Anne Schuchat, the director of the CDC’s National Center for Immunization and Respiratory Diseases, said in a press conference after the panel’s vote that the vaccine was cost-effective in “almost every way.”
In addition, the CDC’s immunization practices panel voted to include the drug in the federal Vaccines for Children program, which funds vaccine programs for poor children. The panel’s recommendations also tend to influence insurance companies, which could provide coverage for the vaccination.
Julia Graham Lear, the director of the Center for Health and Health Care in Schools at George Washington University in Washington, encourages communities to weigh all of the pros and cons of the vaccine before deciding to require it for school enrollment.
“Not all communities feel the same way,” she said, but they have an obligation to consider it.
Because it’s the first vaccine developed to prevent a form of cancer, she added, “it’s not just a nice idea—it deserves more than that.”
