Some health experts concerned proponents of mandatory HPV vaccination are acting too soon

Some public health experts recently have expressed concern that proponents of human papillomavirus vaccination legislation -- including Merck, producer of the HPV vaccine Gardasil -- have acted "far too fast" and are "potentially undermining eventual prospects for the broadest possible immunization," the New York Times reports (Pollack/Saul, New York Times, 2/17).

Gardasil and GlaxoSmithKline's HPV vaccine Cervarix in clinical trials have been shown to be 100% effective in preventing infection with HPV strains 16 and 18, which together cause about 70% of cervical cancer cases. FDA in July 2006 approved Gardasil for sale and marketing to girls and women ages nine to 26, and CDC's Advisory Committee on Immunization Practices later that month voted unanimously to recommend that girls ages 11 and 12 receive the vaccine. GSK in April plans to file for FDA approval of Cervarix, and it expects approval by the end of this year (Kaiser Daily Women's Health Policy Report, 2/9). According to the Times, at least 20 states are considering proposals that would mandate HPV vaccination for young girls. Joseph Bocchini, chair of the committee on infectious diseases at the American Academy of Pediatrics, said HPV vaccination mandate proposals have "created a significant controversy over things that have nothing to do with the vaccine," adding, "If the public had enough experience with the vaccine and had enough knowledge about HPV, the question about whether to get the vaccine or give it to their daughters wouldn't be an issue." According to Bocchini, opposition to the vaccine could cause the public to be mistrustful of the vaccine. In addition, opt-out provisions in most of the proposed bills have caused concern among health experts. Martin Myers, executive director of the National Network for Immunization Information, said that some experts are concerned that if parents "opt out of one vaccine, they will opt out of other vaccines that are due at the same time" (New York Times, 2/17). According to the Miami Herald, Florida Sen. Mike Fasano (R), a sponsor of an HPV vaccination measure (S 660), has said he favors delaying mandatory vaccination until August 2008 to give parents and the Legislature a "chance to get educated" (Tasker, Miami Herald, 2/18). The American Academy of Pediatrics currently does not support mandatory vaccination. Some physicians are concerned about Gardasil's cost -- $360 for a three-shot series -- and low insurance reimbursements to physicians. Bocchini said state legislatures should focus on funding the vaccine for girls and women ages 13 to 26, rather than mandating the vaccine for middle school-age girls (New York Times, 2/17).

Texas House Holds Hearing on HPV Vaccination Legislation
In related news, the Texas House on Monday held a public hearing on mandating HPV vaccination ahead of the House Public Health Committee's consideration of a bill (HB 1098), sponsored by Rep. Dennis Bonnen (R), that would ban schools from requiring that girls receive an HPV vaccine for admission, the Dallas Morning News reports. The bill, which has 90 co-sponsors, was filed in response to Texas Gov. Rick Perry's (R) executive order mandating HPV vaccination for girls entering the sixth grade (Ramshaw, Dallas Morning News, 2/20). Perry signed the executive order on Feb. 2. The order will affect approximately 365,000 girls annually. Perry said that parents who do not want their daughters to receive an HPV vaccine "for reasons of conscience, including religious beliefs," will be able to opt out of the requirement. Under the executive order, girls and women ages nine to 21 who are eligible for public assistance will be able to receive Gardasil at no cost beginning immediately. Perry spokesperson Krista Moody said the state would increase funding for existing health programs by $29.4 million annually to help cover the cost of the vaccine for low-income women and girls (Kaiser Daily Women's Health Policy Report, 2/9). Some medical professionals, as well as a woman with advanced-stage cervical cancer, testified at the hearing in favor of the mandate. Some parents, health care groups and social conservatives voiced opposition to the mandate, the Morning News reports (Dallas Morning News, 2/20).