HPV Vaccination Mandates — Lawmaking amid Political and Scientific Controversy

The New England Journal of Medicine

Health Policy and Reform

NEJM | August 18, 2010 | Topics: Drugs, Devices, and the FDA

James Colgrove, Ph.D., M.P.H., Sara Abiola, J.D. and Michelle M. Mello, J.D., Ph.D.

The June 2006 licensure of Merck’s human papillomavirus (HPV) vaccine, Gardasil, and the recommendation of the Advisory Committee on Immunization Practices that it be routinely given to girls starting at 11 or 12 years of age set off a flurry of state-level policymaking. The vaccine protects against four strains of HPV, the most common sexually transmitted infection in the country and the major cause of cervical cancer. Within a year, legislators in 41 states had proposed measures intended to increase uptake of the vaccine, including educational campaigns, public subsidies, and insurance-coverage requirements.1

The most contentious proposals were those to make the vaccine mandatory for girls attending school. Bills to make HPV vaccination compulsory were introduced in 24 states, and one state governor imposed a school mandate by executive order (Table 1). Between 2006 and 2008, however, policymakers turned decisively away from the idea that the vaccine should be required for school attendance. As of February 2010, only Virginia and Washington, D.C., had enacted mandates, and Virginia’s legislation included an opt-out provision so broad that it may be a misnomer to refer to the law as a mandate.2

mmunization requirements, like all compulsory health measures, are politically and ethically sensitive because they intrude on individual autonomy.3-5 Mandate proposals for HPV vaccination are particularly fraught because they lie at the intersection of two highly charged policy areas: immunization safety and adolescent sexuality. Weighed against these concerns is the success of mandates at achieving high levels of immunization coverage.6The debate over compulsory HPV immunization represents a case study in public health lawmaking amid political and scientific controversy. Given the centrality of compulsory immunization to the control of vaccine-preventable diseases, it is critical to understand the determinants of policy in this area. We analyzed the policymaking process in a sample of states to identify the factors that were most influential in determining how states acted on the issue of mandates…..

The article goes on to cite recent efforts to educate the public and legislators
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Antivaccination Activism

The debate was also influenced by general antivaccination activism by organizations and individuals who believed that vaccines cause autism and other health problems in children. Although these groups could not plausibly argue that Gardasil, a vaccine given to adolescents, might cause autism, they reportedly were “using HPV as a tool to get the focus on . . . vaccine safety issues,” according to one respondent. In some cases, they communicated their concerns by making direct contact with lawmakers or testifying at public hearings. In other instances, lawmakers’ awareness of previous activism among these groups with respect to other vaccines was sufficient to make them reluctant to enact a mandate, knowing it would face resistance.

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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.