June 23, 2009
Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States, however in 2000, 70% of Americans had never heard of it and 89% had never discussed it with their health care provider. The Centers for Disease Control and Prevention (CDC) estimates that about 6.2 million Americans are infected each year, over half of all sexually active men and women become infected at some point in their lives and at least 80% of women will have contracted it by age 50.
On June 8, 2006 the FDA announced approval of Gardasil, the first vaccine developed for females 9-26 years of age to prevent cervical cancer, precancerous genital lesions and genital warts due to HPV types 6, 11, 16 and 18 with an efficacy rate of near 100%. Of the 15 types of high-risk HPV, 6, 11, 16 and 18 account for approximately 70% to 90% of cervical cancers. Gardasil has the potential to improve the reproductive health and well being of women and men, however because it is only effective in individuals not currently infected by the virus, it is important that it be administered before the onset of sexual activity. A significant amount of research has been done to examine the sexual behaviors of adolescents in an effort to determine how to administer this vaccine. In 2003, nearly 28% of young women and more than 37% of young men in the ninth grade had engaged in sexual intercourse. As a result, the CDC Advisory Committee on Immunization Practices (ACIP) recommended that the vaccine be administered to girls starting at age 11 and 12.
Soon after the recommendation, dozens of state legislatures began to introduce bills which would require HPV vaccinations for girls entering the 6th grade. This produced a flurry of activity from public and private organizations, parents and elected officials which sparked a significant debate about the ethics of mandating a vaccine against a sexually transmitted disease.
Policy supporters touted the vaccine’s efficacy and argued mandates would reduce infectious disease rates, eliminate health disparities and increase access. Those opposed to the policy criticized it for interfering with parental autonomy and authority to make decisions regarding the health of their children. Opposition groups, while supporters of other vaccination policies opposed widespread use of a vaccine targeted at a sexually transmitted disease. Many felt that the vaccine would condone sexual activity and give young women a false sense of protection from other sexually transmitted infections (STIs).
During the 2006-2007 and 2007-2008 legislature sessions over one hundred different bills were introduced in 41 states and the District of Columbia to require, fund or educate the public about the HPV vaccine. At the end of 2008, Virginia and DC were the only legislatures to mandate the vaccine for school entry. During the 2008-2009 session, no bills were put forth by any state, giving the appearance that no one was willing to risk their re-election on such a controversial topic. However, with the 2009-2010 session quickly approaching, 12 states have proposed HPV related legislation or resolutions. Of those, Kentucky, New York and Texas are considering mandates. These new resolutions are likely to spark up the debate once again in the coming months.
Comment from Leslie
Hell, no this the HPV debate is not over – the fight has just begun with more and more awareness of the dangers of this vaccine. Merck is behind the lobbying efforts to make the vaccine mandatory to increase diminishing sales – since education and awareness of the dangers of the vaccine is growing.