The HPV Debate

CURE, Spring 2007, Volume 6, Issue 2

Texas becomes the first state to require HPV vaccination, while other states are debating to mandate the vaccine as well.

In early February, Texas Governor Rick Perry enacted a controversial executive order for Texas to become the first state to require girls entering middle school to receive a vaccine to prevent cancer-causing human papillomavirus, or HPV, although the Texas House passed a bill in mid-March to overturn the mandate. At presstime, the bill awaits a vote by the state’s Senate. New Mexico and Virginia lawmakers passed bills in March to make the vaccine mandatory in their respective states, and more than a dozen other states have authored similar bills.

While more than 99 percent of the 11,000 cervical cancer cases diagnosed each year are caused by HPV, the vaccine Gardasil, approved in June 2006, only protects against specific types of the virus. Specifically, HPV-16 accounts for half of cervical cancer cases, HPV-18 accounts for as many as 12 percent, and HPV-31 and HPV-45 cause about 5 percent of cases. HPV may cause other cancers, including head and neck cancer, and genital warts.

Gardasil has been a controversial subject among parents, medical professionals and politicians over whether the vaccine should be mandatory. Following Gardasil’s approval, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices recommended the vaccine be given to the two million 11- and 12-year-old girls in the United States. (The $360 three-shot vaccine is approved for 9- to 26-year-old females.) Other groups have followed suit, including the American Cancer Society, which issued guidelines in early 2007 echoing the CDC’s decision.

But while many groups have voiced support for the vaccine, controversy exists over whether it should be a requirement to enter school, much like the measles, mumps and rubella immunizations given now. A small group of conservative organizations have publicly opposed the vaccine because HPV is a sexually transmitted disease, while other dissenters argue there are not enough data on the vaccine’s long-term effects in young girls. States considering legislation have included exemptions for moral, medical or religious purposes.