Texas Governor Rick Perry signed an executive order February 2 making Texas the first state to require that all 11- and 12-year-old girls entering sixth grade be vaccinated against the human papillomavirus  (HPV). Parents will be allowed to opt out of the requirement if they have “reasons of conscience, including religious beliefs.”

The governor’s action averted debate in the Texas legislature over mandatory HPV immunization of young girls. Vaccination at ages 11-12, before girls become sexually active, is recommended by the Advisory Committee on Immunization Practices but is opposed by some parents and by groups such as Focus on Families, who argue that requiring immunization usurps parental authority over health care for their children and will send a message that sex is allowed, running counter to school programs that encourage abstinence.

HPV infection is the most common sexually transmitted disease. It’s believed to affect 20 million people in the United States, with one in four 15-to-24-year-olds infected. HPV is known to progress to cervical cancer in some women.

Currently, only one HPV vaccine—Gardasil, produced by the pharmaceutical company Merck—has been approved by the federal Food and Drug Administration. It protects against HPV strains 6, 11, 16, and 18; almost 70 percent of cervical cancer cases and 90 percent of genital warts cases are linked to those four strains of HPV. The vaccine is given in three shots over eight months. The shots are effective for at least five years and would cost approximately $360, according to the federal Centers for Disease Control and Prevention.
.
 The fact that HPV infection can result in cervical cancer has led to characterization of Gardasil as “the first vaccine against cancer.” Cervical cancer is the second-leading cancer in women, worldwide. In the United States, nearly 10,000 women are diagnosed with cervical cancer each year and 3,700 die. The number of cases is smaller in the United States than in some other countries as the result of widespread use in this country of the Papanicolaou (Pap) test, which screens for conditions that may lead to cancer.

Although the Texas action is the first HPV mandate to emerge so far, the National Conference of State Legislatures (NCSL) notes that HPV proposals are being considered   in a number of state legislatures, with California, Connecticut, Indiana, Kansas, Kentucky, Minnesota, Mississippi, Oklahoma, and Virginia among those considering bills to require vaccination of girls before entry into sixth grade or middle school, or at the age of 12.

Other states are stopping short of a school requirement but are considering bills to require that insurance policies cover the vaccine, or that states provide parents with information about HPV and cervical cancer. In Michigan, which last year became the first state to introduce legislation requiring vaccination for girls entering sixth grade, a senate bill was narrowly defeated last month.

In explaining his action to mandate HPV immunization, Governor Perry said, “Requiring girls to get vaccinated before they come into contact with HPV is responsible health and fiscal policy that has the potential to significantly reduce cases of cervical cancer and mitigate future medical costs.”

A summary of state actions so far on HPV vaccination is available from the National Conference of State Legislatures at http://www.ncsl.org/programs/health/HPVvaccine.htm.

Also see: “HPV Vaccination: Should States Make It Compulsory?” at http://www.healthinschools.org/ejournal/2007/Jan2.htm.