Saturday, March 03, 2007

Should States Require HPV Vaccine?

Over the last few weeks many State Governments have debated if girls entering the sixth grade should be vaccinated against a particular sexually transmitted disease. The specific STD in this case is the human papiloma virus, or HPV. According to the Centers for Disease Control and Prevention, HPV can lead to cervical cancer in some women. Gardasil is a new vaccine designed to protect against four of the HPV strains that account for 70 % of cervical cancer cases and 90 % of genital warts.

There are eight states currently debating if the state should require girls 11-12 years old get vaccinated for HPV before they can enter the sixth grade. The states are California, Georgia, Kansas, Kentucky, Michigan, New Jersey, Texas, and Virginia. Over the last few years, Merck, the manufacturer of Gardasil, has tested the vaccine in girls 9-26 years in age and have not noted any harmful side effects. However, this debate has led some to question if these state governments are overstepping their authority.

Many critics of the HPV vaccine question the wisdom of having an 11 year old girl vaccinated for a STD. The American College of Pediatricians has commended Merck for its ground breaking research, but is against any legislation requiring the vaccine. The organization believes the vaccine should be made available, but that patients and their parents (in the case of young girls) should be made aware of the limits of the knowledge of this vaccine. While there are no known harmful side effects from the vaccine, no one is certain how long the vaccine is good for. There is the possibility that booster shots could be required after the initial three shot series. The American College of Pediatricians argues that it makes more sense to give the vaccine when a girl is closer to sexual activity. When is that? For each girl that is a unique age that should be taken into account. The vaccine appears to work best in subjects within the first two years after receiving it. If a girl decides not to be sexually active until later in life, she might want to wait to get the vaccine until then when it can be most effective.

Because HPV is not a communicable disease, I don’t think the states have the right to force all girls to get this shot. If there is a compelling reason to protect the other students in the class, then I could be convinced to side with the states that want to require the shot. Currently, many kids are required to be vaccinated for Measles, Mumps, Rubella, and other highly communicable diseases. However, HPV is only transmitted though sex. For states to require a STD vaccine prior to entering the sixth grade or any other grade would be a precedent setting decision. If a state requires the STD vaccine, should it require other vaccines, such as Hepatitis? Will states start requiring children submit to a STD screening process before they can attend school each year?

I think this decision is best left to the individual doctors, parents, and girls. There are risks with any vaccine, and there is still more research that needs to be done on this one. Parents should have the flexibility to evaluate their children and decide when it is appropriate to give this shot to their children. I have a three year old daughter. One day, she will probably be vaccinated for HPV. But that should be at a time that my wife and I decide to have her vaccinated based on her doctors recommendation and her own maturity. Girls mature differently and families have different values. To require this “one size fits all” solution doesn’t accommodate different families with different values.


familyman said...

OK Andy, sit down.

I'm with you on this one.

This is simply a personal freedom issue.

Education is the answer here.

What ever money would otherwise be spent ramping up and enforcing a mandated program should instead be spent educating kids and parents about all the options available.

Andy D said...

Wow, I happened to be sitting down when I read that comment. I wanted to get a discussion about the HPV vaccine and see what some of the regular readers of this site thought about it. I have seen a fair number of conservatives against it, but hadn’t heard from the other side. Thanks for the comment Familyman.

familyman said...

It's boring when we agree.

Andy D said...

It's terrible. I will have to think of a new topic.

Epiphany11 said...

Andy, I could not agree with you more! Thank you for exploring the topic. I feel it to be far too invasive a measure for the government to employ on a matter such as this. It should absolutely be left up to the parents to decide what is best for their child. ...and what is "best" - as you mentioned - will be different from child to child. I'm honestly amazed that this issue has gained such a foothold in terms of the number of proponents. Actually, I think I'm more nervous than amazed.

familyman said...

I really think this is being driven by well connected big money interests.

Brandon said...

I think that the schools should strongly urge their female students to get the vaccine in high school, but the final choice should be up to the student and her parent(s). I found your blog randomly today and linked you, I hope that's ok. If not, just let me know and I'll remove you.

Andy D said...

I always appreciate the feedback, and thanks for the link.

I don’t think the schools have any real place in this discussion. Pediatricians should give parents their professional judgment. If States want to issue public service announcements, that is their business. But I don’t think the States should force a decision that should stay between a doctor and patient. I think the schools have enough on their plate teaching students without adding this to it.

Matthew Smith said...

I don't necessarily believe that states should pass legislation requiring girls of any age to get the HPV vaccination; I do, however, think that every state should pass a law allowing girls to get this vaccination without parental consent.

Women can make a choice that greatly diminishes their chances of getting cervical cancer. That's CANCER. The Big "C". Regardless of how you feel about teens having sex and access to birth control, girls can and will decide for themselves when they will become sexually active.

I am saddened that the HPV vaccine is still unavailable to some girls, and that millions more don't even know it exists. This is a simple, simple health issue; let's cast aside our differences. This is about "life" and it's about "choice". I promise you that if we make the vaccine universally and anonymously available, there won't be any lawmakers clammoring to make it manditory.

Andy D said...

Welcome back Matthew, I am glad to hear you weigh in on a few of these issues…

I am going to part with most conservatives on this. I really don’t think this shot will do anything when it comes to an 11 or 12 year olds sex life. If an 11 year old girl is going to have sex (I really don’t want to even consider that), then she is going to regardless of whether or not she has this shot. If she isn’t going to have sex, this shot isn’t going to make her run out and have sex.

I think you are wrong in believing that a girl should be allowed to get this without parent consent. An 11 or 12 year old simply isn’t old enough to know how to make that decision. You keep saying women in your comment. The problem is, most legislation I have seen purposed deals with little girls, and not women.

This vaccine is still very new. I think it holds enormous potential. However, a parent is still the one that needs to make the decision. Once the girl becomes a women, then she can make her own decisions.

Matthew Smith said...

While she may be a girl emotionally and legally, most 11-year-old females are WOMEN. Biology has to come first in this issue. If a not-a-girl, not-yet-a-woman wants to be sexually active she will have sex; if she wants to protect herself against cervical cancer, she should have that right too.

Andy D said...

Matthew, I like our debates, and sometimes I can even see your point. I am afraid I believe you are just wrong here. I can’t think of any way you can classify an 11 year old girl as a woman. Most importantly, she doesn’t have the ability to realize the implications of getting a shot like this at her age. She simply isn’t equipped at 11 to make an informed decision on this topic. I think the shot should definitely be available, and if the parents think she should have it, then great. But an 11 year old child can’t make that decision for themselves.

Matthew Smith said...

Andy - there are no implications. Perhaps the idea of an 11 year old having sex is a tough one to handle...but I promise you it's better than her getting cervical cancer. The HPV vaccine is not absolute, but it's clearly better than any alternative.

You "can’t think of any way you can classify an 11 year old girl as a woman." I have a way: she has had her first period. Wouldn't that make her a woman biologically?

I agree that an 11-year-old cannot make an adult decision, but she can decide to have sex. And if she makes that (admittedly bad) choice, she should have the right to protect herself as well.

Andy D said...

There are implications. While the shot has met the letter of the law with regards to testing, there is still a broad range of questions. No harmful side effects were noted in the study group, but it hasn’t been tested long enough to know if a booster of any sort should be needed. It looks most effective during the first two years after the series of shots, but then starts to taper off. This is a brand new drug being put on the market. I believe it holds the potential to help a lot of women.

I don’t classify a woman simply as a girl who is able to get her period. You believe a girl should be able to go to a doctor and get this shot without parental consent. I believe an 11 year old girl isn’t capable of making an informed decision about this shot. I do believe the shot should be available. I have seen some states issuing laws to ensure that it is covered by insurance the same way any other immunization shot is covered. I think that is great. But, before an 11 year old gets the shot, the doctor needs to inform the parents and the girl about the shot. Then, if the parents and their daughter feel the shot is a good idea, then she should get it.

Anonymous said...

I feel like if we have the power to eliminate a virus that kills thousands of women a year and infects more than 10,000 why not pass a law to make girls get the vaccine. Children at this age can be more informed that most adults.

Yet, if people find it to hard to pass a law that forces girls to get vaccinated to eradicate a potentially deadly virus, then federal funding must be given to inform girls and help those that cannot afford it.

Anonymous said...

You don't think that you can classify an 11 year old girl as a woman?? OMG, in case you didn't know this... once a girl gets her menstrual cycle (usually around 11 or 12), they are completely capable of getting pregnant. We aren't talking "mentally a woman" We are talking "physically" a woman. Obviously girls at that age getting pregnant (and yes they do get pregnant at that age) aren't mentally women but there is no doubt about the physical aspects of 11 and 12 years old these day. My own daughter began showing physical signs of a young woman as young as 10 years old. Yes, I was devastated.. she's my baby.

Andy D said...

I am a little confused by your comment "Anonymous". As I said before, simply able to get a period doesn't mean that you are mentally able to make these kinds of decisions. If I missed the point of your comment, let me know.

Mr President said...

Andy I'm afraid I side with Matthew here.

States should not be entitled to foist this on people and yes, I don't agree schools should have any part to play in this. It's between patients and their doctors, nobody else.

Where I agree with Matthew is that the child is the patient, not the parents. If she wants to get condoms from the local family planning clinic, she can, without parental consent. The same logic must apply here.

You see the same issue is at play in both cases. Many parents find the idea that their children are sexually active unpalatable. This can have two potential results, neither good.

First, the teenager may not feel they can bring the topic up with their parents. This is the very same reason we make condoms available to teenagers without parental consent, as if they don't bring up the issue they won't get the protection they need.

Secondly, even if they muster up the courage to bring up the topic, many parents will see taking such precautions as encouraging promiscuity. Certainly 20% of UK parents said they'd reject the jab for that reason.

Of course I don't blame the parents. It must be hard; sex is a rite of passage and shows that they're growing up and soon won't need you anymore. This is why the decision should be between a doctor and his patient.