Vaccine bill is gone, but the debate should live on

February 02, 2007|By JEAN MARBELLA

SB 54, we hardly got to know ye.

The bill that would have required sixth-grade girls in Maryland to be immunized against the sexually transmitted virus that causes cervical cancer was withdrawn Tuesday, two weeks after it was introduced, before it could be debated anywhere but on the pages of this and other newspapers.

As someone who had some concerns about the bill - that was the subject of my column Tuesday - I still would have liked to see the issue hashed out. But not this year, at least not in the General Assembly.

Call it a case of when bad legislation happens to a good vaccine.

Whether or not to mandate the vaccine was always "the wrong discussion" for Dr. Joshua M. Sharfstein, the Baltimore city health commissioner.

"The first thing we should be talking about is why this is such a great thing - this is a breakthrough therapy," Sharfstein said. "That's what I wouldn't want to get lost in all of this."

The vaccine is still relatively new - it was approved by the FDA only in June - and the first time many heard of it was in news accounts reporting that the Maryland Senate was considering a new law requiring 11-year-old girls be vaccinated against the virus that causes cervical cancer. "Why wouldn't we do it?" a co-sponsor, Sen. Lisa A. Gladden, a Baltimore Democrat, was quoted as saying. "I don't think we should even be debating this."

Not debate a new vaccine that you want every sixth-grade girl to receive? Not debate a new vaccine requirement at a time when thousands of kids are still barred from school because they aren't up-to-date on the vaccines already required?

Legislators seem to have underestimated the reaction from some parents over the notion of, as one woman e-mailed me, vaccinating young children against illnesses stemming from adult behavior. The sensitivity comes from the fact that the virus that causes cervical cancer is spread primarily through sex, leading some parents to wonder just what officials think their 11-year-old daughters are up to that they needed this vaccine. The explanation - that the vaccine is most effective before the onset of sexual activity - is one of those things that could have been explained in an educational campaign before heading straight to a bill mandating the vaccine.

Many of those fears are already being allayed in doctors' offices. Dr. Crossan O'Donovan, a pediatrician in Dundalk, says some parents have asked for it for their daughters, and he recommends it - at least by their 15th birthday, if not sooner. "Many parents see it as just a fact of life," he said.

O'Donovan had some reservations about the mandate - he worried about being able to stock enough of the $360 vaccine, given the lag time between when his office buys it and when insurance companies reimburse for it, to inoculate the estimated 1,500 girls in his group practice in the targeted age group by the bill's September 2008 deadline.

While many girls will get vaccinated, with or without a law requiring it, you have to worry about the ones whose parents aren't as vigilant - like those 5,000 or so Maryland middle school students currently barred from classes because, despite extensions and grace periods, they still haven't gotten the chickenpox and hepatitis B vaccines required before entering sixth grade.

At this point in what is now a two-week vacation, these kids probably are at greater risk for growing up uneducated than contracting chickenpox or hepatitis. Even with a mandate, you have to wonder what the chances are that those same kids - or rather, their parents - would have been able to meet a new requirement for another vaccine that (like the one for hepatitis B) involves three shots over the course of six months.

Sharfstein hopes to launch an educational initiative that will make the public comfortable with the new vaccine. That could go a long way: In Michigan, where last year legislators tried and failed to mandate the new vaccine, health officials are optimistic that a re-introduced bill will succeed this time around. In the interim, a state task force on cervical cancer has issued a report laying out a plan to cut the number of cases in half by 2010 by encouraging wider use of Pap tests to screen for it and the new vaccine.

For some consumers, only time will convince them that widespread inoculation is necessary.

"Just because it was approved by the FDA does not mean that it is safe. Remember Vioxx? Bextra?" said Jana Hussmann Meacham, who has an 11-year-old granddaughter and has worked in health care since the 1970s, referring, respectively, to the painkiller and anti-inflammatory drugs that have since been pulled from the market.

Meacham, who lives in Laurel, says she isn't necessarily opposed to voluntary use of the vaccine, but would like more information before it becomes a law. "My opposition to making it mandatory has nothing to do with perceived moral issues," she said. "It is strictly related to possible health consequences."

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