BY CHRIS GAETANO
Staff Writer
A new bill before the state Assembly would require all girls entering the seventh grade to be immunized against the virus responsible for most cervical cancers and genital warts. Proponents argue that the vaccine can save countless lives, but opponents say it removes parents’ rights to be the sole arbiter of their children’s health.
The bill, A-3920, was introduced Jan. 18 and would require all female students to be vaccinated against the human papillomavirus (HPV) in order to enter the seventh grade. It also calls for the state departments of education and health to work together in creating an educational fact sheet about HPV, to be distributed to parents across the state. If passed, the bill would take effect in the 2007-08 school year, with all new girls entering these grades requiring the vaccine, with two exceptions.
The first would excuse students if a valid medical reason exists, to be confirmed with a written statement by a licensed physician. The second would excuse students if the shot presented genuine conflict with one’s religious beliefs or practices. Philosophical or moral objections to it, however, would not be grounds for an exception to this bill.
New Jersey has joined 17 other states, as well as the District of Columbia, in floating proposals for mandatory HPV vaccinations. Texas and Michigan are two states that have enacted such measures already. If all states manage to pass and implement these bills, Merck, the drug company that is currently the sole provider to the market of the vaccine Gardasil, stands to make between $3 billion and $4 billion. The treatment comes in the form of three shots, costing around $120 each.
The nature of the debate
Groups opposing mandatory vaccinations for HPV say that it takes away parents’ authority to decide what is best for their child’s health. While not officially opposed to the treatment itself, the New Jersey Family Policy Council, a traditionally conservative organization, has opposed the bill for these reasons.
“It takes away the responsibility for parents to be the primary decision-makers regarding children’s health, and we don’t think they should be coerced into relinquishing those rights, especially since HPV is transmitted not through casual activity but through sexual behavior,” said Len Deo, the group’s president. The bill’s proponents, however, view mandatory vaccination not as a conflict between parents and schools but as a public health issue that will both save lives by reducing the number of cervical cancer cases and money by reducing expensive treatments. The text of the bill itself states that “it is estimated that vaccinating 12-year-old girls could reduce by 95 percent the number of certain HPV-related cervical cancer cases.” It is for these reasons that one of the sponsors of this bill, Assemblywoman Valerie Vainieri Huttle (D-Bergen), feels that it is imperative to pass it.
“I think parents and teachers and guardians and all those involved will understand that the vaccine is there to protect them from cervical cancer,” said Huttle.
Huttle said that the bill has not been reviewed by any committee yet, and so is still open to amendment and compromise. The assemblywoman said that as the mother of two girls, the conversation at least needed to be started. She acknowledged the parental authority criticism brought forth by Deo, but answered that parents subject their children to many kinds of various mandatory vaccinations, from polio to rubella. If someone’s objection is to the removal of parental authority, she said, they would be better served railing against mandatory vaccinations in and of themselves.
“There are many vaccines, even hepatitis vaccines are required at this point, to get into whatever grades. As a parent, you know what vaccines are required and this has to be incorporated,” said Huttle.
This answer does not sit well with Deo, who believes that what makes the HPV vaccine and other mandatory immunizations different is that HPV, he said, is primarily transmitted through sexual activity.
“Things like polio, measles, these are transmitted diseases that don’t need to involve direct contact. Some are airborne. So we’re very supportive of that vaccination. But the HPV issue has that component of being the only way to catch it is by being sexually active, and if a child is taught to be abstinent until marriage, they will never have to worry about HPV,” said Deo.
While the vaccine is powerful, giving protection from the four more common strains of HPV, it is no panacea. According to the Centers for Disease Control and Prevention, 30 percent of cervical cancers will not be protected by this vaccine, so it is still important for women to get tested regularly. Ten percent of genital warts will also not be affected by the vaccine. Deo feels that the treatment, due to it being used on a virus that is primarily sexually transmitted, may send mixed messages to girls and encourage promiscuity by creating a false sense of invincibility.
“It sends a mixed message to kids: we want to vaccinate you for being promiscuous. This will cure sexual diseases, obviously which are very dangerous, however we know that this is basically a disease that is sexually transmitted,” said Deo.
“There’s a lot of teenage promiscuity right now, and it’s a case we have to deal with the reality of,” countered Assemblyman Sam Thompson (R-Monmouth and Middlesex), also the former director of clinical lab improvement at the New Jersey Department of Health. “I think it’s a good program and, yes, we should make this available to all of our young female citizens because it does have a potential to prevent some very serious diseases here.”
Thompson also noted that the vaccine was recommended to be made mandatory by the Advisory Committee on Immunization Practices, which oversees such things and also recommended the age at which it should be administered. It advised that girls entering the seventh grade be immunized because the vaccine is most effective if people are not already sexually active when it is taken.
Logistical obstacles
According to Huttle, one of the difficulties, should the bill pass, will be implementation. There are numerous children, she noted, who do not get regular checkups for a variety of reasons – their parents or guardians may not be able to afford it, or they simply don’t go to the doctor, as many people don’t, or there may be no time.
“There are children out there today that really don’t have health care and people who don’t go for regular checkups. These are the kids we really need to reach, the kids lost through the system, these are the kids that the schools need them to require them to get it,” said Huttle. “What I’m trying to say is, there may be many kids out there that don’t have that parental guidance or supervision.”
This is a difficulty that is acknowledged by South Brunswick Board of Education member Matthew Speesler, who is a pediatrician by trade. He said that getting every student to actually come in for the shot, even when it is required, can be a difficult task.
“The biggest problem is, because it is multiple doses, and at that age group it’s difficult to get patients to come to the doctor anyway. We’ve seen this problem with immunizing with hepatitis B,” said Speesler.
Speesler noted that another large difficulty might come from medical costs, especially since some families might view $360 as a significant chunk of their budget. According to New Jersey Department of Education statistics, there were 100,724 sixth-graders in the 2005-06 school year. Assuming that roughly 51 percent of the population is female – roughly the world average – this means that 51,369 girls would need the HPV vaccine. Multiplied by $360, parents and guardians would have needed to spend $18.4 million combined if the measure had begun with last year’s class.
This financial cost was anticipated by Assembly members Bill Baroni (R-Middlesex and Mercer) and Jennifer Beck (R-Monmouth and Mercer), who together have proposed a bill that would require all insurance companies to cover the costs of the immunizations.
“There are few times where the Legislature can act to directly save lives. This is one of those times. We have the power to bring an end to a type of cancer, and we would be failing the women of New Jersey if we don’t act now. Lives are at stake, and we can save them,” Baroni said.
Baroni said that he is still deciding whether he would support any measure that would make the vaccinations mandatory, however.
Too much, too soon?
The company that makes the vaccine, Merck, is a large pharmaceutical corporation based in New Jersey. It has also produced, among many others, the drug Vioxx, which despite passing review from the FDA and being released to the market, was soon withdrawn once connection to heart disease was alleged. The actual vaccine itself was approved in June 2006. Some medical organizations, such as the American Academy of Pediatrics and the National Network for Immunization and Information, are concerned about the speed at which these measures are moving, suggesting a slower approach that incorporates awareness campaigns.
Huttle said that she hopes that because the bill has yet to even go to committee, that she will be able to hear criticism and use that to further sharpen its focus.
“I’m certainly willing to listen if there are any real concerns with the bill and amend it, and I think we need to get this out there immediately. God forbid, we wouldn’t want to hurry this, but let’s hope this is headed for a cure for a cancer that affects females,” she said.
Speesler noted that the company that makes this vaccine is the same one that makes many of the standard vaccines that are mandated, such as those for measles and mumps.
According to published reports, Merck has been dispatching medical experts to talk to power brokers across the nation in order to promote the vaccine’s use.
Huttle said she first heard of the vaccine through conversations with her daughter’s doctor, who, when the vaccine first came out, advised her to hold off on it, but later advised her in favor of it. She also said that she hadn’t even been aware that Merck was the sole provider of the vaccine, citing the company’s involvement in the legislation to be “absolutely zero.”
Huttle said that with a mandate, market forces may spark the creation of other companies’ versions of the vaccine.the FDA and being released to the market, was soon withdrawn once connection to heart disease was alleged. The actual vaccine itself was approved in June 2006. Some medical organizations, such as the American Academy of Pediatrics and the National Network for Immunization and Information, are concerned about the speed at which these measures are moving, suggesting a slower approach that incorporates awareness campaigns.
Huttle said that she hopes that because the bill has yet to even go to committee, that she will be able to hear criticism and use that to further sharpen its focus.
“I’m certainly willing to listen if there are any real concerns with the bill and amend it, and I think we need to get this out there immediately. God forbid, we wouldn’t want to hurry this, but let’s hope this is headed for a cure for a cancer that affects females,” she said.
Speesler noted that the company that makes this vaccine is the same one that makes many of the standard vaccines that are mandated, such as those for measles and mumps.
According to published reports, Merck has been dispatching medical experts to talk to power brokers across the nation in order to promote the vaccine’s use.
Huttle said she first heard of the vaccine through conversations with her daughter’s doctor, who, when the vaccine first came out, advised her to hold off on it, but later advised her in favor of it. She also said that she hadn’t even been aware that Merck was the sole provider of the vaccine, citing the company’s involvement in the legislation to be “absolutely zero.”
Huttle said that with a mandate, market forces may spark the creation of other companies’ versions of the vaccine.