HPV vaccination updates

By Dr. Ananya Mandal, MDSep 9 2011

Texas Gov under fire for mandating HPV vaccinations in all girls over 12

Texas Governor Rick Perry's GOP rivals sharply criticized him during Wednesday night's debate over his 2007 executive order mandating that teenage girls be vaccinated to prevent cervical cancer. The move had drawn strong opposition at the time from social conservatives and was later overturned by the state Legislature.

Perry's order came after the drug company that manufactured the vaccine hired Mike Toomey, his former chief of staff, as one of the firm's top lobbyists in Austin. This intensified the criticism. Toomey was retained by pharmaceutical giant Merck & Co., maker of the Gardasil vaccine, which is designed to prevent the human papillomavirus, or HPV, an infection linked to cervical cancer in women.

His hiring was part of an aggressive lobbying push in Texas by the drug company, which also donated $16,000 to Perry's gubernatorial campaigns in the two and a half years prior to the executive order. Merck paid Toomey between $260,000 and $535,000 in lobbying fees between 2005 and 2010, according to state lobbying records.

“When he signed that executive order, it turned a lot of heads because it seemed so out of character and didn’t sit well with his base,” said Craig McDonald, director of Texans for Public Justice, a group that tracks campaign contributions and lobbying in Austin. “Then people went looking.” Once the Toomey connection was discovered, “it was so obvious ... This is a prime example of how he [Perry] does something for a crony.”

Asked for comment, Mark Miner, a spokesman for the Perry campaign, emailed, “It's a 'prime example' of the Governor standing on the side of life.” On the campaign trail, Perry had recently apologized for the executive order-which would have made Texas the first state in the country to mandate that all teenage girls, starting with 12-year-old sixth graders, be vaccinated with Gardasil.

“I readily stand up and say I made a mistake on that,” Perry said during an Iowa radio call-in show last month. But he appeared to mostly defend the executive order during the debate, saying his goal was to “save lives.” “We wanted to bring that to the attention of these thousands of-tens of thousands of young people in our state,” he said. “We allowed for an opt-out … Now did we handle it right? Should we have talked to the Legislature first before we did it? Probably so. But at the end of the day, I will always err on the side of saving lives.”

Two doses of HPV vaccine as effective as recommended three

Two doses of the human papillomavirus (HPV) vaccine may offer just as much protection against cervical cancer as the three-dose regimen now being used, new U.S. government research shows.

The findings stem from an analysis of data from the National Cancer Institute's Costa Rica Vaccine Trial, in which 7,466 women were enrolled, according to a news release from the Journal of the National Cancer Institute, which published the results on Thursday.

The women were either given the HPV vaccine Cervarix or a Hepatitis A vaccine. Although researchers intended to give the women receiving Cervarix the full three doses, 20 percent of them got only one dose or two doses for a variety of reasons. After four years, the researchers found, two doses of Cervarix offered the same level of protection against HPV infection as three. Even one dose offered a high level of protection.

While the researchers said that more studies are needed to evaluate the long-term effectiveness of the fewer doses, they wrote, “Our clinical efficacy data provide suggestive evidence that an HPV vaccine program that provides fewer doses to more women could potentially reduce cervical cancer incidence more than a standard three-dose program that uses the same total number of doses but in fewer women.”

The analysis was led by Aimee R. Kreimer, of the division of cancer epidemiology and genetics at the U.S. National Cancer Institute.

In an editorial accompanying the journal article, Cosette Marie Wheeler, of the University of New Mexico, noted, “The age-old adage of less is more may apply to HPV vaccination, and if so, the report … represents an important step on the road to more effective and sustainable cervical cancer prevention programs.”