Should schools require a cervical cancer vaccination?

NO
Lucille Hollander
Move carefully, thoughtfully and deliberately

Although vaccines can and do save lives, there have been vaccines in the past that have had harmful side effects, ones that do not necessarily appear during testing. States need to bear this in mind as they consider mandates for schoolgirls to be vaccinated with the cervical cancer, or human papillomavirus (HPV) vaccine, which was approved last year.

Gardasil, the new vaccine, was fast-tracked by the FDA, which means the time between application and approval was faster than usual. And widespread contro-versy prompted Merck, the only company currently producing the vaccine, recently to abandon its lobbying push to have state lawmakers require the vaccine for preteen girls. Merck certainly has a huge financial incentive to persuade states to mandate Gardasil: At $360 for the three-part immunization, the profits from the vaccine could be enormous. Because rival GlaxoSmithKline reportedly is developing a similar vaccine, Merck’s hard marketing might be due in part to a sense of impending competition and, thus, lowered profits.

So far the Gardasil vaccine seems safe—but many medical experts are counseling an approach that would see it in wider use prior to mandate.

Certainly, the introduction of Gardasil has political undertones. In Texas, the furor was fueled by news of an intense marketing effort by Merck, including word that the company’s political action committee gave a $5,000 contribution to Gov. Rick Perry. When Perry then took the unusual step of signing an executive order for the mandatory HPV immunization in schools, a storm ensued. Ultimately, a state House committee rescinded the order.

It is the push for mandate, not the vaccine itself, that is causing much of the controversy. Merck predictably faces a hard sell: marketing a product targeted to 11-year-old girls, a vaccine for a disease that is primarily sexually transmitted. Parents have traditionally felt strongly about their right and freedom to control when they speak to their children about sex. The U.S. Supreme Court recognized this when it held, “the interest of parents in the care, custody and control of their chil-dren—is perhaps the oldest of the fundamental liberty interests recognized by this Court.”

The Texas Medical Association advises: “Mandating a vaccine for a disease not spread by casual and/or occupational contact, only available to one gender, rep-resents a considerable departure from past practice.”

When Maine Rep. Marilyn Canavan, state director of Women in Government, found that the national WIG organization (whose members are helping to intro-duce many new bills mandating this vaccine) had accepted contributions from Merck, she resigned from WIG. She states that so many authoritative voices are urging a go-slow approach that she wants to err on the side of caution when it comes to imposing a mandate.

Despite its fast-track testing and hard-sell marketing, the vaccine may gain more acceptance by parents and by doctors if it is introduced more slowly and not under mandatory conditions.

YES
Jo-Ann Lynch
It will save lives, particularly among the most vulnerable

The American Cancer Society estimates that last year more than 9,700 women were diagnosed with cervical cancer and 3,700 women in the United States would die from the disease. This is a statistic that can be changed right now, starting with the important and necessary step of vaccinating young girls against the virus that causes cervical cancer.

The movement for vaccinating school-age girls already has taken hold in more than a dozen states. In my home state of New Mexico, lawmakers are considering legislation that would require girls entering the sixth grade to be vaccinated against HPV, the sexually transmitted virus that can cause cervical cancer. Eighty per-cent of women will contract HPV in their lifetime♦and for some, exposure is life threatening.

I speak from experience on this issue: I had cervical cancer. I had been married for 10 years when I got the doctor's life-changing phone call. Eventually, I was one of the lucky ones. The cancer protocol worked. I have been free of cervical cancer for many years now. Some women are not so lucky.

If you are among the millions of low-income individuals in this country who do not have access to solid healthcare plans that encourage preventive care, the prospect of cervical cancer is grave and life threatening. That makes it all the more critical that we support a program of mandatory HPV vaccinations in schools; it is one of the best ways to ensure that the most vulnerable of citizens, the ones least likely to see a doctor regularly, do not pay with their lives.

It is important to begin vaccinations before girls are sexually active. HPV is very common, and most women will notice no symptoms. But the virus doesn't just "go away." For many women, HPV exposure causes changes that will bring about cervical cancer, and the vaccine can prevent two of the types of HPV that cause 70 percent of all cervical cancer.

I understand that parents are concerned about talking to a 12-year-old about cervical cancer. Some critics have even exploited those fears by suggesting that the HPV vaccine will become "a license" for sexual activity among young adults. In a word, that emotionally charged argument is preposterous.

Parents who have objections can opt out under the proposals now being considered across the states, but I hope that those parents will reconsider. Vaccine or not, they still need to talk to their daughters, and their sons, about responsible behaviors. Men don't get cervical cancer, but they may carry HPV and spread the disease through sexual intercourse. These types of parent-child talks can be disconcerting, but such concerns take a back seat both to the danger cervical cancer poses and to the hope that this killer can be all but eradicated through a strong vaccination program. Smallpox was once a scourge, yet today it essentially has been eradicated worldwide because of vaccinations. Why not HPV? Imagine a world where women didn't have to worry about HPV and the threat it poses.

Isn't the prospect of making the next generation cervical cancer-free what really matters?