Sense of rush infects plan to require HPV shots

January 30, 2007|By JEAN MARBELLA

There are recommendations, and then there are mandates.

In the case of vaccinating young girls against the sexually transmitted virus that causes cervical cancer, maybe there should be something in between - something along the lines of: We really, really think you should, but we're not making you.

There's something slightly chilling about the recently introduced bill that would require all sixth-grade girls in Maryland to be inoculated against the human papilloma virus (HPV), the most common sexually transmitted virus. Sixth grade! Eleven years old! I think at that age, I was still playing with Barbies and thinking that boys - except the dreamy ones in Tiger Beat magazine - were gross.

I know this puts me in the same general vicinity as some social conservatives - generally foreign territory for me - who have argued that vaccinating girls against HPV is akin to giving them license to have sex. It's not, of course, since they still aren't inoculated against all those other reasons not to have sex at such a young age - such as pregnancy, other sexually transmitted diseases, and the fact that they're just not old enough to be making such a grown-up decision.

The problem is the nature of the vaccine, which is most effective before the onset of sexual activity. Proponents say that given the chance to prevent the second-most-common cancer in women, girls should be inoculated early on. The Food and Drug Administration has approved the vaccine, called Gardasil, for girls as young as 9 years old, and the Centers for Disease Control and Prevention has recommended that girls be routinely given the vaccine when they turn 11 or 12 years old.

But the Maryland bill - similar to measures currently under consideration in a number of other states - takes that recommendation a step further, making it mandatory. (Never mind the irony that this bill comes at a time when officials can't even get the existing immunization requirements met - 12,000 students were barred from classes last week because they weren't vaccinated against hepatitis B and chicken pox. )

You don't have to be a religious conservative, or someone who thinks preaching abstinence is the only sex education kids should get, to be a bit leery of mandating that preteenage girls be vaccinated against a sexually transmitted virus.

"I think it's kind of taking us into a discussion we don't need to have at this point," says one mother I talked to, Martha Bishai, who lives in the Riderwood neighborhood. Bishai and her husband have two sons and two daughters, who are 12 and 14. "I don't see either of my daughters as being at risk in the near future.

"I also think in our culture, we do kids a lot of disservice, if we don't give them a little bit of space to just be kids."

It seems to me that by making the vaccine mandatory, we're giving up and accepting that parents have no idea when girls are going to decide to have sex, so we might as well line them up and vaccinate all of them at the earliest possible moment. Maybe it's worth it for those few girls who do slip through despite the best intentions and efforts of their parents and society - an estimated 2 percent to 4 percent of girls have had sex before the age of 12.

But it seems like such a broad solution to so limited a problem - what, in other words, is the rush to vaccinate?

One reason might be found in a story in The Sun yesterday by Laura Smitherman, who reported that the push to mandate the vaccine is driven, at least in part, by the only manufacturer of the vaccine, the pharmaceutical giant Merck.

You remember Merck - purveyor of Vioxx, the popular pain medication that the company pulled from the market in 2004 after it was linked to a heightened risk of heart attack and stroke and, um, death.

For Merck, whose stock price plummeted in the aftermath of the Vioxx debacle, the cervical cancer vaccine has the potential for "blockbuster sales worldwide," according to a personal finance column that ran in The Sun last year, and some Wall Street analysts were advising investors to hold on to their shares. (Not too tough a call since Merck stock has recovered this year.)

Yes, making every sixth-grade girl get the vaccine - which costs about $360 for a course of three shots - might indeed result in blockbuster profits. There are an estimated 160,000 11- and 12-year-old girls in Maryland alone, according to Smitherman's story, and at least seven other states are considering similar mandates.

Dr. Joshua Sharfstein, the city's health commissioner, has concerns about the bill, but not about the age of the girls, or even the possibility of making the vaccine mandatory.

He, like most public health officials, is enthusiastic about the vaccine. "It's a leap forward. It's unbelievable," Sharfstein said of Gardasil and its potential effect on controlling cervical cancer. "We want to see as many people get it as possible."

But he also believes the state needs to first address several issues before it gets to the point of mandating the new vaccine: How will it be financed, for example, as well as how will the new vaccination program be introduced to the public. He favors launching an educational campaign, and then making the vaccine mandatory after that.

"It's much more complicated than the requirement," he says, noting that it's unknown how many insurance companies will cover the vaccine. "We want people to have confidence in the vaccine first, and then require it."

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