A recent presidential debate kicked off a controversy over the HPV vaccine. The flurry of media attention that followed the debate reflects the concerns of both advocates and critics of the use of the vaccine, and the various questions about the efficacy of the vaccine and the government’s role in this public health issue.
What is HPV?
Human Papillomavirus or HPV is the most common sexually transmitted infection in the United States. According to the Centers for Disease Control and Prevention, approximately half of all sexually active persons will get some form of HPV in their lifetimes. There are about 100 HPV strains, with over 40 known strains that can infect the genital area. Certain HPV strains are known to cause genital warts in men and women and cervical cancer in women. Approximately 70% of cervical cancers worldwide are caused by two strains of HPV (types 16 and 18). All cases of genital warts are caused by HPV with 90% of cases resulting from two HPV strains (types 6 and 11).
More than 12,000 women are diagnosed with cervical cancer each year and most cases are associated with HPV. However, most people do not experience HPV symptoms as 90% of cases are cleared naturally by the body’s immune system within two years.
What is the vaccine?
Two vaccines prevent HPV infection. Gardasil was first approved by the U.S. Food and Drug Administration in 2006 for its efficacy in preventing genital warts and cervical cancer in women. Gardasil use by males was authorized in 2009. It protects against four HPV strains (types 6, 11, 16, and 18) that are known to cause lesions and cervical cancer. The second vaccine, Cervarix, was approved for use in 2009 and protects against HPV strains 16 and 18.
Both vaccines are administered in three doses and are most effective when given to patients prior to the time they become sexually active.
In 2006, the CDC’s Advisory Committee for Immunization Practices (ACIP) first recommended routine vaccination for girls aged 11-12, but girls as young as age 9 may begin vaccination. The Advisory Committee also recommended vaccination for adolescents and women aged 13-26 who had not yet been fully vaccinated. In October 2011, the committee recommended vaccination for boys aged 11-12.
According to the CDC, as of 2010 32% of females aged 13-17 nationwide had received the recommended three doses of HPV vaccine, but coverage varied greatly by state. Thirteen states, for example, had rates above 40%: Colorado, Connecticut, Delaware, Massachusetts, Nebraska, New Hampshire, Pennsylvania, Rhode Island, South Dakota, Virginia, Washington, Wisconsin, and Wyoming. Four states had rates at or below 20%: Alabama, Arkansas, Idaho, and Mississippi.
What are the benefits and risks of HPV vaccination?
Routine HPV vaccination is controversial. Advocates argue that increased vaccination offers benefits to the whole population because “widespread immunization reduces circulation of the virus.” Critics point to possible health risks and argue that the government should not force a vaccination.
Risks associated with vaccine use include pain, swelling and redness in the vaccination site, mild to moderate fever, headache, fainting, nausea, and in more serious but rare cases, extreme allergic reaction and/or death.
What is the policy in Virginia?
Currently, only Virginia and the District of Columbia require vaccination for girls. In Virginia, HPV vaccination is required before a girl reaches sixth grade. Parents and legal guardians can easily opt out, in part because HPV is not communicable in a school setting. Some argue, in fact, that Virginia’s opt-out policy is “so broad that it may be a misnomer to refer to the law as a mandate.”
Virginia’s law passed in 2007 under Governor Tim Kaine with little controversy. During the 2011 session of the General Assembly, the Virginia House of Delegates voted to overturn the HPV mandate in H.B. 1419. The bill was indefinitely passed by senate committee during the same session but not voted on by all members of the senate. Thus, the mandate is still currently on the books.
What are other states doing?
In most states, state legislatures determine school vaccination requirements. While no states other than Virginia and the District of Columbia require HPV vaccination, other state legislatures take different approaches. They have, for example, addressed the HPV vaccine issue by funding or requiring education on HPV, cervical cancer, and/or the vaccine, mandating health insurance coverage, and/or publicly funding vaccinations.
Currently, North Carolina, Michigan, North Dakota, and Washington require that information on the HPV vaccine be provided to parents.
Rhode Island, Oregon, and Iowa require health care plans to cover the HPV vaccine.
And, South Dakota, in its 2006-2007 legislative term, provided $9.2 million to its department of health for voluntary HPV vaccination to women aged 11-19.
What is the Federal government doing?
The Vaccines for Children Program (VFC) is a federally-funded program that provides ACIP recommended vaccines, including the HPV vaccine, at no cost to Medicaid eligible, uninsured, underinsured, or American Indian or Alaskan Native children under the age of 19. Parents can take their children to be vaccinated at eligible VFC physician providers, public health clinics, federally qualified health centers, and rural health clinics. Although the Federal government funds the program, state health departments generally manage its operation in each state.
by Elizabeth Vestal, Policy Analyst, Schroeder Center for Health Policy, [[bevestal]]