02.08.07
Mandate HPV vaccine?
Mandate HPV vaccine?
Lawmakers, parents, doctors debate if state should follow Texas’ lead
BY EMILY HAGEDORN, Californian staff writer
e-mail: ehagedorn@bakersfield.com | Wednesday, Feb 7 2007 10:56 PM
Last Updated: Wednesday, Feb 7 2007 10:55 PM
In a state often liberal when it comes to women’s health — it was one of the first to dispense emergency contraception without a prescription — some people wonder if mandatory human papillomavirus vaccines for school-aged girls are not far off.
If California mandated the vaccines, which have been shown to prevent some cervical cancers, it would follow Texas, which became the first state to do so Friday.
“It’s a very wonderful and proactive way of avoiding disease,” said Dr. B.A. Jinadu, director of the Kern County Department of Public Health. “But let’s not take the responsibility away from the parent.”
Through a Republican governor’s order, Texas girls must now receive the HPV vaccine before entering sixth grade unless their parents opt out. Now there’s a bill pending in the California Assembly, AB 16 by Assemblywoman Sally Lieber, D-Mountain View, carrying the same requirement.
“Because it’s largely for a sexually transmitted disease, then I’m not sure of the medical necessity for all students,” said Assemblywoman Jean Fuller, R-Bakersfield.
Sen. Roy Ashburn, R-Bakersfield, is definitely opposed because “there’s a direct correlation between the government mandate and a lack of personal responsibility.”
Sen. Dean Florez, D-Shafter, says parents should decide if their daughter gets the vaccine and “we can then look at participation rates and adjust accordingly.”
But Assemblywoman Nicole Parra, D-Hanford, says she is “encouraged by any effort to make the HPV vaccine more readily available and affordable to all women.”
Gov. Arnold Schwarzenegger hasn’t taken a position on mandated HPV vaccinations, said spokeswoman Sabrina Lockhart, but has proposed spending $11 million to provide the vaccine to Medi-Cal-eligible women age 19 to 26.
HPV is one of the most common sexually transmitted diseases, infecting at least 80 percent of women by age 50, according to the Centers for Disease Control and Prevention. The virus includes more than 100 different strains and types.
Most HPV infections are asymptomatic and clear up on their own, but some can cause genital warts or cancer.
The HPV vaccine, given in three shots over six months, is recommended for girls before they become sexually active because the vaccine is most effective in women who have not acquired the four types of HPV covered by the vaccine, the CDC says.
The vaccine has been found to be almost 100 percent effective in preventing these four types, which cause 70 percent of cervical cancers and 90 percent of genital warts.
What Kern doctors think
Parents and patients are more curious about the vaccine’s availability than risks, local physicians said.
“We’re very keen on it,” said Dr. Philip Davis, obstetrician/gynecologist with San Dimas Medical Group, which will soon offer the vaccine. “If we can knock out the majority of cervical cancer, hallelujah.”
Potential side effects worry Dr. Joel Cohen, chief of service for obstetrics and gynecology at Bakersfield’s Kaiser Permanente. Gardasil, the only HPV vaccine, was just approved by the U.S. Food and Drug Administration in June. But to date, he doesn’t know of any major complications, only injection-site pain and swelling. Cohen opposes mandatory HPV vaccinations.
“I still believe patients have their right to be well-informed and to choose their own health care,” he said.
Unless HPV is a public health problem, it shouldn’t be mandatory, said Dr. Michael Thorpe, independent family practice physician with Lake Truxtun Medical Group.
“HPV is just rampant,” he said. “Anything that can help these poor ladies is good.”
Some patients are concerned about the cost, Davis said. It’s $360 for the three-shot series, the CDC says. Others have quoted it as high as $500.
Medi-Cal and many insurance companies are starting to cover it, local doctors said.
Parents chime in
Any mandate would face a lot of opposition locally, said Kimberly Van Horne, a Bakersfield parent of teen and preteen boys.
The fact the vaccine is supposed to be administered before someone is sexually active should be stressed, she said.
“When we get the vaccine for measles, it doesn’t mean we’ll get it that week,” Van Horne said.
The fact this health issue involves reproduction makes mandating the vaccine an unfortunate taboo, said Paul Anderson, a Bakersfield father of three boys.
“If it was for breast cancer, this wouldn’t be as big an issue,” he said. “Prevention is always a lot cheaper than fixing it later.”
Activists react
Terri Palmquist, a Bakersfield mother and well-known anti-abortion rights activist, says a mandate would promote promiscuity.
“I’m happy I home-school my children,” she said. “I think we should be spending our money on telling our kids how to save themselves rather than on every little disease we could prevent.”
Planned Parenthood supports a mandate and for the government to help people pay for the shots, said Patsy Montgomery, spokeswoman for Planned Parenthood Mar Monte.
Requiring vaccination would also protect young girls and women who are raped or sexually abused from getting HPV, she said.
Hopefully this debate will help more people learn about STDs, said Linda Davis, executive director of the abstinence-based Pregnancy Center.
“There’s a responsibility on the part of the public health sector to be fully informed,” she said. “I hope parents will discuss it with their daughters.”
Human Papillomavirus
Cause: genital contact
Symptoms: Visible genital warts or precancerous changes in the cervix, vulva, anus or penis. Men can get HPV too but it largely affects women.
Complications: Anal or genital cancers
Treatment: There is no cure, but in most women, the infection goes away on its own.
Prevention: Abstinence from sex. Women can get the HPV vaccine, which protects against four types of HPV. A latex male condom only protects the area it is covering, and HPV can be spread elsewhere.
Source: Centers for Disease Control and Prevention
