Debate is heating up about whether or not to require girls to be vaccinated against Human Papillomavirus (HPV)

National Conference of State Legislatures

April 2010

Debate is heating up about whether or not to require girls to be vaccinated against Human Papillomavirus (HPV), which causes virtually all cases of cervical cancer and genital warts.  This flurry of state activity stems from the June 2006 recommendation by the national Advisory Committee on Immunization Practices (ACIP) that routine vaccination is recommended for girls between ages 11 and 12.

According to the Centers for Disease Control and Prevention (CDC), HPV infects approximately 20 million people in the United States with 6.2 million new cases each year.  There is no treatment for HPV, only treatment for related health problems.  There are more than 30 strains of HPV that affect at least half of sexually active people in their lifetime.  Most strains of HPV do not produce any symptoms and disappear on their own.

Cervical cancer is the second leading cancer killer of women worldwide.  In the United States, nearly 10,000 women are diagnosed with cervical cancer each year and 3,700 women die.  This number is much smaller than in other countries largely because of the Papanicolaou (Pap) test, a screening tool for cervical cancer. The American Cancer Society reports that, with early detection, cervical cancer is usually treatable.

Currently, the only HPV vaccine approved by the federal Food and Drug Administration (FDA) is Merck’s Gardasil, which protects against HPV strains 6, 11, 16 and 18.  Almost 70 percent of cervical cancer cases and 90 percent of genital warts cases are linked to these four strains of HPV.  The Advisory Committee on Immunization Practices (ACIP) recommends administering the vaccine to girls between 11 and 12 years of age, before they become sexually active.  GlaxoSmithKline also has developed a vaccine (Cervarix) to target HPV strains 16 and 18 and is awaiting FDA approval.

Even after recommendations by the ACIP, school vaccination requirements are decided mostly by state legislatures.  Some state legislatures have granted regulatory bodies such as the Health Department the power to require vaccines, but they still need the legislature to provide funding.

The debate in states has centered–in part–around school vaccine requirements, which are determined by individual states.  Some states grant regulatory bodies, like the Board of Health, the power to require vaccines, but the legislature must still provide funding.  Some people who support availability of the vaccine do not support a school mandate, citing concerns about the drug’s cost, safety, and parents’ rights to refuse.  Still others may have moral objections related to a vaccine mandate for a sexually transmitted disease.  Financing is another concern: if states make the vaccine mandatory, they must also address funding issues, including for Medicaid and SCHIP coverage and youth who are uninsured, and whether to require coverage by insurance plans.  This has caused some to push for further discussion and debate about whether or not to require the vaccine.

The CDC announced that the HPV vaccine is available through the federal Vaccines for Children (VFC) program in all 50 states, Chicago, New York, Philadelphia, San Antonio and Washington DC. VFC provides vaccines for children ages nine to 18 who are covered by Medicaid, Alaskan-Native or Native American children, and some underinsured or uninsured children.

State Action
The Michigan Senate was the first to introduce legislation (S.B. 1416) in September of 2006 to require the HPV vaccine for girls entering sixth grade, but the bill was not enacted. Ohio also considered legislation in late 2006 to require the vaccine (H.B. 703), which also failed.  Legislators in at least 41 states and D.C. have introduced legislation to require, fund or educate the public about the HPV Vaccine and at least 19 states have enacted this legislation, including Colorado, Indiana, Iowa, Louisiana, Maine, Maryland, Michigan, Minnesota, Nevada, New Mexico, New York, North Carolina, North Dakota, Rhode Island, South Dakota, Texas, Utah, Virginia and Washington.  The CDC announced that The New Hampshire Health Department announced in 2006 that it will provide the vaccine at no cost to girls under age 18. As of May 2007, the department reports they have distributed over 14,000 doses in the state.  South Dakota’s governor also announced a similar plan in January 2007 that combines $7.5 million in federal vaccine funds and $1.7 million from the state’s general fund.  As of May 2007, the department reports distributing over 20,000 doses of the vaccine. The Washington legislature approved spending $10 million to voluntarily vaccinate 94,000 girls in the next two years.  On February 2, 2007, Texas became the first state to enact a mandate–by executive order from the governor–that all females entering the sixth grade receive the vaccine, with some exceptions.  Legislators in Texas passed H.B. 1098 to override the executive order and the governor withheld his veto.

The Virginia legislature passed a school vaccine requirement in 2007 and considered a bill that would delay that requirement but it was passed by indefinitely by the Senate Committee. In 2007, at least 24 states and D.C. introduced legislation to specifically mandate the HPV vaccine for school (California and Maryland withdrew their bills). DC’s bill was enacted and requirement started 30 days after Congressional Review Period expired. See the bills marked under the school mandate column in the table below for more information.

As of February 2010, 17 states have proposed HPV related legislation or resolutions in 2009-2010.  See the charts below for more information.



Author: Leslie Carol Botha

Author, publisher, radio talk show host and internationally recognized expert on women's hormone cycles. Social/political activist on Gardasil the HPV vaccine for adolescent girls. Co-author of "Understanding Your Mood, Mind and Hormone Cycle." Honorary advisory board member for the Foundation for the Study of Cycles and member of the Society for Menstrual Cycle Research.