The Scientific Activist

On 2 February, Texas became the first state in the nation to enact a mandatory vaccination scheme for human papilloma virus (HPV), the primary cause of cervical cancer. The vaccine, Gardasil, is produced by Merck. Although welcomed by many, this was a surprising development since it was brought about by an unusual executive order from conservative Republican governor Rick Perry.

The executive order requires all girls entering the sixth grade to undergo the series of vaccinations, although concerned parents are given the choice to opt out if they so desire. Not surprisingly, there was an uproar from conservatives (unconvincing arguments about mandatory vaccinations encouraging sex), and now Republican Dennis Bonnen has filed a bill (HB1098) to overturn the executive order. Debate on the bill will begin this Tuesday (13 March) in the Texas House. From the AP:

AUSTIN — Legislation that would override Republican Gov. Rick Perry’s executive order that schoolgirls receive a vaccine against the human papilloma virus is set for debate in the Texas House on Tuesday.

Perry issued the order Feb. 2 requiring girls entering sixth grade as of September 2008 to be vaccinated against HPV, which causes most cases of cervical cancer. That met with a firestorm of public protest and opposition from some conservative lawmakers.

Opponents said the order interfered with parental decisions, and some said the Legislature should decide whether the state will require the vaccine, not the governor.

The anti-mandate bill before the House next week was filed by Rep. Dennis Bonnen, a Republican from Angleton. At least 90 state representatives have signed on as co-sponsors of Bonnen’s bill. A similar measure is pending in the Senate.

The full House and Senate can start debating all bills next week. Until now, the two chambers have been limited to passing only bills declared emergencies by Perry.

Conservatives oppose the vaccine requirement because they believe it contradicts Texas’ abstinence-only sex education policies and strays too far into families’ lives. Others have balked at the $360 cost for the vaccine, called Gardasil, and questioned the vaccine’s efficacy and safety.

Perry says he wants to protect young girls from cancer.

This is an unfortunate development. Although I do not know how much support this bill has (probably quite a bit, considering the number of co-sponsors), it looks like the Texas legislature is on the verge of shooting down quite possibly the first progressive thing Rick Perry has done during his otherwise uninspiring tenure as governor. Preventative medicine suffers so often in our health care system, and it’s a shame that such a promising preventative measure for cervical cancer is facing these stumbling blocks.

Merck itself has come under fire for its aggressive campaign pushing the adoption of mandatory vaccination policies, which many saw as premature since Gardasil was only approved for use in June 2006. Merck later announced in February of this year that it would end this campaign.

Skepticism is warranted, however, in addressing the question of why Rick Perry issues his executive order. Here’s The Economist’s (subscription required) take:

Why did Mr Perry do it? Some sneerers have noted that his former chief of staff is now a lobbyist for Merck. Others think that the wily governor is distancing himself from his conservative base so that he can make a plausible vice-presidential candidate in 2008. But there is another explanation: that he had the courage to make a politically difficult but sound policy decision. As he said this week: “If the medical community developed a vaccine for lung cancer,” he asked, “would the same critics oppose it, claiming it would encourage smoking?”

I’m not so starry-eyed as The Economist here, and based on Perry’s history, I have trouble believing that there was a humanitarian motivation behind all of this. I don’t doubt the significance of the Mike Toomey (Perry’s former chief of staff) connection or the power of Merck’s lobbying machine. Despite it’s dubious origins, though, this executive order has the potential to do a lot of good for Texans, and hopefully the legislature will do the right thing and let it stand.

Comments

#1 Gene Goldring
March 11, 2007

Will health insurance companies be privy to who opted out? Could they deny coverage of someone that contracted cervical cancer due to the parent�s mistake in the past of opting out?
#2 Shelicia Schultz
March 12, 2007

Last I remember this was a free country where people were free to make their own informed decisions. I have major reservations about a drug that was pushed through the FDA approval process in 5 years (instead of the normal 11-17 years). There were very few studies done on girls under 12. Do we really want to force a vaccine on our kids when it’s safety hasn’t been proven beyond a doubt? Once a drug is mandated by the state the pharmaceutical companies no longer have any liability for adverse reactions. I don’t know why everyone is getting hung up on this conservative drivel about the shot encouraging sex. That’s not the issue and honestly I think it’s being thrown out there as a diversion to the real issue. The issue on most parent’s minds is safety. These drug companies are notorious for cherry-picking their results to show that they are completely safe….only to concede later that they knew there were problems all along. Remember Vioxx? Why should our kids be the guinea pigs for this brand new vaccine?
#3 Nick Anthis
March 12, 2007

In order to have an informed debate here, we need to make sure we distinguish between a drug (something generally used to treat a preexisting condition and something that could have one of a practically infinite number of mechanisms of action) and a vaccine (something used to prevent a condition and something that has a well-known mechanism of action). While a vaccine still needs to undergo extensive testing, there are fewer unknowns associated with a new vaccine compared to a new drug, like Vioxx.
#4 Ali
March 12, 2007

Unfortunately, arguments based on the faulty logic that the vaccine will “encourage” premarital sex (which is ludicrous) fail to address an extremely important aspect of STI prevention: that women get raped.

Additionally, Shelicia, does mandatory vaccination of children against polio, rubella, measles and mumps, etc. violate your freedoms?
#5 Hannah
March 13, 2007

“does mandatory vaccination of children against polio, rubella, measles and mumps, etc. violate your freedoms?”

More relevant would be the question, “is HPV transmitted through casual contact?” If not, then it is ridiculous to even think about mandating it as a vaccine required for school entry.

The vaccine doesn’t prevent all HPV by a long shot, its long-term risks are unknown, Perry received big campaign money from the company that produces it, and these are 10-12 year old girls. How is this mandatory vaccine “progressive” again?
#6 Nick Anthis
March 13, 2007

We’re talking about what is in effect a “cure” for a certain type of cancer. This isn’t even about pushing the vaccine being progressive so much as this is about holding it up being borderline absurd.
#7 Shelicia Schultz
March 13, 2007

I understand that it’s extremely unpopular to be against vaccination. But yes, I think 36 mandatory vaccination required for children today before they get to gradeschool is excessive and ‘violates their freedom’. Especially if they die or are permanently injured. 30-25 years ago there were relatively few mandatory vaccines (around 10 I think)—the one’s Ali states above–polio, rubella, measles, mumps. These have been studied for years…we have the data on these vaccines, they have been proven safe. But the jury is still out on many of the 26 odd vaccines that have been added to the list in the recent past. The Hep B vaccine given to infants for example has had an alarming number of negative reactions–many deaths. But since the reporting system is largely volutary we just don’t have reliable numbers. 36 vaccines seems a bit excessive.

Check out this scary fact I came across on the web.

In a May 18, 2006 Background Document for the FDA Vaccines and Related Biological Products Advisory Committee (VRPBAC), the FDA staff stated that Merck clinical trial data indicated there may be �the potential for GARDASIL to enhance cervical disease in subjects who had evidence of persistent infection with vaccine-relevant HPV types prior to vaccination.� [2] Girls and women now being vaccinated with GARDASIL are not routinely being tested for active HPV infection before vaccination.

Less than 1200 girls under 12 were studied during the development of the HPV vaccine. While it may be true that “there are fewer unknowns associated with a new vaccine compared to a new drug, like Vioxx”, I’m still concerned about the safety of new and relatively untested vaccines.
#8 Mr. Gunn
March 13, 2007

Shelicia – You answered your own question. You want to give it to people before they’re exposed. That’s why you give it to young women. That makes the whole “promoting sexual behavior among young girls” argument kinda silly, doesn’t it?

The same people who’ve always been against vaccination are against this now, and the politician who’s against it is just playing to this group for votes. I just love to see the religious right take on battles that reveal just how much they care about power, and how little about the human lives it costs to get it.
#9 Davis
March 14, 2007

But yes, I think 36 mandatory vaccination required for children today before they get to gradeschool is excessive and ‘violates their freedom’. Especially if they die or are permanently injured.

What if they die or are permanently injured from not receiving a vaccine? This is a far more likely outcome than injury from vaccination; or rather, it is in the absence of herd immunity. And without mandatory vaccination, there’s no guarantee that herd immunity will be maintained.

Nothing is 100% safe, so we will always need to make these sorts of decisions. If you want a life free of risk, you picked the wrong universe to live in.
#10 van price
June 11, 2007

since the hpv’s that cause cancer are only 13 of the 30-40 known hpvs, and those 13 hpv’s are commonly recognized as sexually transmitted, a vaccination, although good for public health, would be yet another reason for someone who perhaps would not have engaged in intercourse to go ahead and do it. should fear be a motivation for abstinence? in today’s world it has to be.
#11 knobody
August 23, 2007

But yes, I think 36 mandatory vaccination required for children today before they get to gradeschool is excessive…

wow. 36. staggering. but, compared to the natural challenges our immune systems face before age five (espeically if there is an older sibling in school), it’s paltry. every toddler shoves floor crud and boogers in their mouths. they share toy slobber. they are exposed to pet dander, pollen, and dust mites. and lets not even begin to talk about toilet training. let’s face it, kids are just gross (i say this lovingly as a parent of three). compared to all that, 36 additional challenges to the immune system just doesn’t seem like that much.
#12 Leni
August 24, 2007

Slightly OT: What I don’t understand is why we aren’t giving it to boys from the start too. I know they won’t get cervical cancer, but they can certainly pass on the virus and give it to someone else who may die later on as a result.

I’m a bit troubled that only some of us are required to get the vaccination.
#13 Leni
August 24, 2007

Van Price wrote:

should fear be a motivation for abstinence? in today’s world it has to be.

Should death be the price for bad a decisions or a broken condom? Should it be the price for getting raped?

What is wrong with you?
#14 hibob
August 24, 2007

on fear and abstinence:
how many teenagers currently abstain from sex due to their fear of catching (or transmitting) a strain of HPV that might cause cancer later in life? How about the readers of this blog – did anyone here abstain from sex as a teenager in order to prevent infection/transmission of HPV and subsequent cancer? (other VDs don’t count). Kudos to Leni upthread.

On mandatory vaccinations:
It’s “mandatory”, but parents can opt out. Says so in the post, and in all the news stories and press releases that came out earlier this year too. So no one is forced to get the vaccination. One reason for making it “mandatory” is that it forces insurance companies to pay for the vaccination, so that parents that do want their children vaccinated but can’t afford it/aren’t willing to pay for it will still participate.

On the governor: Perry was lobbied hard on Gardasil, as were a lot of state legislatures and governors. I haven’t heard anything about him yet that makes me think his motive was public health rather than disguised self interest.
#15 Graculus
August 24, 2007

What I don’t understand is why we aren’t giving it to boys from the start too.

Because the clinical trials on males have not been completed.
#16 Leni
August 24, 2007

Graculus:

That sounds plausible. Nevertheless, the legal issues being discussed should probably include boys.
#17 Drekab
August 24, 2007

how many teenagers currently abstain from sex due to their fear of catching (or transmitting) a strain of HPV that might cause cancer later in life? How about the readers of this blog – did anyone here abstain from sex as a teenager in order to prevent infection/transmission of HPV and subsequent cancer?

Personally, I don’t like this kind of argument. I’d like to see vacines for all the STD’s out there come out someday and be mandatory (along with any other nonSTD related vaccines). I don’t want people saying, okay you convinced that HPV wasn’t really a big deal to teenagers, but AIDS, that’s actually pretty scary to kids, maybe we should keep this one around.
#18 Sarah
October 1, 2008

My intention is to show all people male or female that the HPV vaccine is very hazardous and is being administered to villages in parts of africa to enduce sterilization of the females there. If the vaccine has that capibility then why are we Americans saying yes to “one Less” ! SAY NO MAYBE “ONE lESS’ MEANS “ONE lESS” PERSON ALIVE????!!!!!! THIS VACCCINE DEFFFFFIIIINNNATTTEEEELLLYYYY SHOULDNT BE MANDATED