By Woodrow J. Hinton

Protecting children and women has been a popular rallying cry for thousands of years and something politicians have used to their advantage. So the idea of mandating a vaccine that can prevent serious health issues for girls and teens and save the lives of thousands of women falls into the category of essential legislation for any elected official.

That's what State Rep. Edna Brown (D-Toledo) thought when she learned about the human papillomavirus (HPV) vaccine. The Food and Drug Administration approved the drug in 2006 as a method for preventing cervical cancer and genital warts.

There are more than 100 different strains of HPV, and more than 30 of them are sexually transmitted, according to the Centers for Disease Control (www.cdc.gov). The vaccine, approved for girls and women ages 9 to 26, helps build the immune system's response to four HPV viruses, two of which are precursors to cervical cancer.

"I could not believe what I was reading when I saw that this immunization could reduce cervical cancer by up to 70 percent," Brown says. "I thought, 'This can't be true. Why haven't I heard about this?' So I started to look into it, and I felt that it was something that should be done to protect females in the future."

What she learned is that 10,000 to 11,000 women living in the United States get cervical cancer and 4,000 to 5,000 die from it every year. That's what motivated her to move quickly, to save lives, she says.

"I decided to go forward with this when I learned it had been approved by the Food and Drug Administration," Brown says. "Then the Federal Advisory Committee on Immunization Practices recommended the immunization to prevent cervical cancer in June of 2006."

Educate, then vaccinate
Brown's proposed legislation, House Bill 81 (www.legislature.state.oh.us/ bills.cfm?ID=127_HB_81), mandates immunization for all girls entering the sixth grade. Given that the drug has been on the market less than a year, there is some question as to whether Ohio -- and more than 19 other states considering a mandatory vaccination program -- are moving too fast.

"Typically there's a few years lag between when a vaccine is licensed and when it's mandated," says Dr. Jessica Kahn, associate professor of adolescent pediatrics with Children's Hospital Medical Center. "It is prudent to mandate a vaccine once we have long-term safety data. Do I think the vaccine will be safe in the long run? Yes, based on what I know so far. But usually decisions about mandating vaccines are not made until we have long-term safety data, which we don't have. We have medium-term."

Another thing that's missing is education about the disease and the drug.

"Ideally we would have a public that's more comfortable and knowledgeable about the vaccines before mandating," Kahn says. "The public is better educated about HPV and HPV vaccines than it was a year or two or three years ago, but we have along way to go in terms of educating the public."

As a doctor who has followed the HPV vaccination development, Kahn surveyed Cincinnati physicians to get their opinions.

"They're generally split," she says. "Some think it should be mandated; some think it's soon."

Some conservative family groups are speaking out against mandatory vaccinations. Linda Klepacki, a sexual-health analyst for Focus on the Family, says the vaccine is "an important scientific breakthrough" and the group supports its widespread use. But they aren't happy about mandates.

"We also support parental rights to determine decisions for their minor children, and this is no exception," Klepacki says. "We support the parents' right to decide whether they will vaccinate their young daughters or not."

Moira Gaul, director of women's reproductive health for the Family Research Council, agrees.

"Because the cervical cancer-causing strains of HPV are not transmitted though casual contact -- they're sexually transmitted -- there is not sufficient public health justification for making vaccination mandatory as a condition of school attendance," she says.

Gaul also set the record straight about whether or not her organization believes the vaccine will encourage promiscuity by removing the consequences for sexual behavior.

"A colleague of mine was quoted out of context," she says. "We would like to see a risk-avoidance or an abstinence message be delivered with the administration of the vaccine. Without a doubt, that is the best form of prevention that they can receive to prevent infection with a wide range of sexually transmitted disease."

The promiscuity myth
That focus on morality is precisely why the director of the Cincinnati Health Department, Dr. Lawrence Holditch, would like to see a mandated vaccine: to keep the focus on health.

"I would be in favor of (mandatory HPV vaccination) because it takes it out of the moral and puts it into public health," he says. "The vaccine doesn't give people license to be more sexually active. That hasn't been borne out."

Holditch would also like to see more public education. HB 81 requires informing young patients' parents about HPV and the vaccine. But a program is needed for the community at large, he says.

"This is a common infection," Holditch says. "Some studies show as many as 80 percent of women are infected with some form of HPV by the time they're 22."

The vaccine is expensive -- $120 per shot, with three shots administered over six months -- but treatments for HPV-related illnesses are much more costly. Brown says Medicaid will cover the cost, as will some private insurers, but the details of making sure others have cost-free access to the mandatory vaccine are still being worked out.

Even though there's no cure for HPV, the vaccine could save billions of dollars in treatment because it helps boost the immune system's response, thereby preventing serious illness.

Giving parents the power to make the best health care decisions for their children is why there's a liberal "opt out" clause in Brown's bill.

"There is a lenient opt-out option," she says. "It's very, very broad for practically any reason. A parent can just say, 'No, I don't want my daughter vaccinated,' and she would not be vaccinated."

This doesn't undermine the goal of the mandate, Brown says.

"I believe by making it a requirement to enter the sixth grade, we will have more people participate," she says. "Today we are just so busy with our everyday lives, I felt that the financially secure families -- families who have medical insurance, families who do take more time to take care of the health needs of their children -- will take advantage of it. But it's the lower income and the very people where, if it's optional, they'll put it off 'til another day." ©