Should we recommend a mandatory HPV vaccination program?

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According to CDC, approximately 12,000 women get cervical cancer in the United States each year. Most cervical cancers are caused by the Human Papillomavirus (HPV), which is a sexually-transmitted disease. One of the best ways to prevent HPV is to get the vaccine, Gardasil®, which works against many common strains of HPV. This vaccine is recommended for girls ages 11 to 12. The goal is to get girls vaccinated before they are sexually active.

Although highly effective in preventing HPV among girls, HPV vaccine has very low coverage in the United States. Only 33.9% of American girls reported to the CDC in 2010 that they had been vaccinated against HPV. For the distribution of state rates of vaccination, there is a dramatic difference, from only 19% in Idaho to 60% in South Dakota.

The State of Arizona is now considering a vaccine policy requiring mandatory vaccination of adolescent girls for the HPV vaccine. However, this policy alternative has been criticized by some parents and groups. Parents opposed to the HPV vaccination believe that this would encourage earlier sexual activities. Some groups, such as Family Research Council, Focus on the Family, and Concerned Women for America, are also opposed to the mandatory vaccination program. These groups believe that parents should have the right to decide whether to get their children vaccinated or not.

Despite of all these oppositions, I still recommend a mandatory vaccination program. The risk of early sexual activities can be reduced by education. The vaccination program itself won’t make a big difference. Also, some parents are misinformed on the vaccination and refuse to get their children vaccinated. Since the safety of HPV vaccine has been proved, why should we say no to HPV vaccines?

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14 Responses to “Should we recommend a mandatory HPV vaccination program?”

  1. kylejacobsherman Says:

    Having a daughter, this topic hits close to home. On one hand, I understand the arguments against making the HPV vaccination required, namely the idea that it might lead to earlier sexual activity and a parent’s right to choose. However, on the other hand, the public health professional inside of me sees the “no brainer” benefits of requiring the vaccination, namely the decrease in incidents of cervical cancer and its proven efficacy and safety. If push came to shove, I think I would support the required vaccination mandate.

    First, I think the idea that it might lead to earlier sexual activity is simply ridiculous. It’s no secret that adolescents today are having their first sexual activity at younger and younger ages (which I think is sad, but that’s besides the point). Anyway, if parents are worried about their children engaging in earlier sexual activity simply because of the HPV vaccine, then they need to educate themselves (and educate their children) on what’s really going on. Like you said, chances are the vaccination program is not going to change a lot of young girl’s behavior, so if parents do not want their children engaging in earlier sexual activity, it’s on them to find more creative ways to talk to their children about it (it’s risks, consequences, etc.) For example, one simple message I could see parents reminding their girls of is that even though they got the HPV vaccine, that does not prevent them from getting pregnant (certainly a deterrent used when our generation received sex ed in school).

    Second, I do agree that parents should have a right to choose, BUT, like vaccines required for school, if parents choose not to have their girls vaccinated for HPV, then they have should have to face similar consequences (i.e. they need to be home schooled). It’s as simple as that. Most states have a laundry list of vaccines that are required for children to attend pre-school, elementary, and so on, and while there are always a few parents that fight the system, for the good of public health, the required vacccination programs simply make sense. We’re talking about communicable diseases. HPV is no different. Moreover, I would argue that the average parent, while informed about required vaccines, takes their kids to the pediatrician’s office and if the doctor says that it’s time for the little one to get a shot, the child gets the shot. My point is this, if HPV vaccinations were made mandatory, I think it would fall in line with all the other vaccinations that children are required to receive, and the average parent would simply not care enough to fight the system and keep it from becoming standard procedure across the country (especially if its been proven to be safe and effective).

  2. mikekingdvm Says:

    Mandating vaccination coverage is definitely a “hot button” issue for some parents. I would agree with you that it seems reasonable to require this vaccination for adolescent girls. Guardasil is also approved for use in males 9 through 26 years of age. I would even be in favor of mandating this vaccination of boys as well. This vaccine not only helps prevent cervical cancer, it can also help prevent genital warts and anal cancer. These are reason enough to want to have them given to your child. The argument that the vaccine will promote promiscuity is really laughable in my opinion. The risk of pregnancy and much more serious STIs would seem like a much larger deterrent for promiscuity, assuming that the school or the parents have taken the time to properly educate their child about such issues.

  3. miyoha Says:

    Definitely vaccination is one of the most important and least expensive interventions in the past 100 years. Its importance in infectious disease eradication in many developed countries and control in developing countries is an established fact. Cervical cancer is also the third most common female cancer worldwide.
    Therefore it is very persuasive to recommend a mandatory vaccination program for all female children in light of the obvious advantages. Likewise arguments that vaccination would increase sexual activity among female children is an assumption that seems to have no evidence backing it.
    However human rights must be upheld no matter what. It is the right of parents to make such health decisions for their children without the influence of the State. Infringing on this right by initiation of a policy that makes vaccination mandatory could lead to various abuse and legal battles.
    Parents should be informed/educated on the benefits of the HPV vaccination repeatedly rather than been forced to a decision.

  4. ymdoffice Says:

    Right from the outset, the idea of HPV vaccine mandate has created a fierce debate due to scientific, religious, cultural and morality issues associated with this vaccine. Furthermore, financial interest of a large pharmaceutical company adds fuel to this debate. As this post describes clearly, there are some valid public health and scientific bases to support mandatory vaccination. However, mandatory healthcare policies always generate significant controversy due to religious, moral, cultural and individualistic diversity of the U.S. population. For example, a study by Perkins et al (www.ncbi.nlm.nih.gov/pmc/articles/PMC3032271/) indicated that in the U.S. “most Caucasian parents opposed mandatory HPV vaccination because they believed the HPV vaccine should be an individual decision as the virus could only be spread by sexual contact. African-American, Afro-Caribbean, African and Latino parents generally viewed mandates as the most effective way to protect their daughters from cervical cancer”. Long term adverse side effects of HPV vaccine are not clearly understood. Since the utility of HPV vaccine is based on life style choices, there are alternatives to avoid HPV infection through safe sexual practice. Thus appropriate sex education at schools or by parents is a viable alternative to HPV vaccination. Finally, a person who does not get vaccination will not expose others to the infection unless they decide to practice unsafe sex. Therefore, I disagree with the conclusion of this post which supports mandatory HPV vaccination policy. Your thoughts will be appreciated.

  5. jacquelinewoodrum Says:

    Vaccination against HPV is also recommended for males, not just for girls! And it targets more conditions than just Cervical Cancer. Whether against or in favor of adding another vaccine to the current immunization schedule, fragmenting the medical guidelines can create lopsided opinions.

  6. drnsacharya Says:

    I understand that some anti HPV activists base their arguments on an alteration of sexual behavior due to the vaccines. Just wanted to point out that there is a lot of evidence in published journals which concludes that there is no effect of HPV vaccination on either sexual behavior or risk perception of STIs. A few of those are :

    Mayhew, Allison, et al. “Risk Perceptions and Subsequent Sexual Behaviors After HPV Vaccination in Adolescents.” Pediatrics 133.3 (2014): 404-411.
    Bednarczyk RA, Davis R, Ault K, Waller J, Omer SB: Sexual activity-related outcomes after human papillomavirus vaccination of 11- to 12-year-olds. Pediatrics 2012, 130(5):789-805.
    Marchand, Erica, Beth A. Glenn, and Roshan Bastani. “HPV Vaccination and Sexual Behavior in a Community College Sample.” Journal of community health 38.6 (2013): 1010-1014.

  7. shtsa Says:

    History has proven that vaccines save lives and are effective in disease eradication. The smallpox vaccine wiped off smallpox from the “face of the earth”. Many can aruge that getting cervical cancer is a “personal choice” and does not affect anyone else. Yet, in this case, the cancer is caused by a virus that can spread from one person to another. The virus can remain undetected and asymptomatic for years, which places us at a false sense of security. People don’t protect themselves against something that they cannot see.
    Studies have proven that Gardasil is more effective, the earlier it’s being administered. This also correlates to the assumption that teenagers and “twenty-somethings” are sexually more “liberal”. Thus, Gardasil adds an additional layer of protection. Ironically, many opponents use the same argument to fight Gardasil: That it may lead to early, “reckless” sexual behavior.
    I think, it’s so difficult to achieve consensus, because anything hinting at sexual activity, “raises eyebrows”. Yet, HPV is like any other virus. It does not discriminate, infects anyone and can cause life-threatening consequences. I think, the real question should be, whether we can make this vaccine financially accessible to the general population. Currently, medical plans will only cover the vaccine up to a certain age. Perhaps, the financial burden of the 3 vaccine series is a deterrent for many families that further adds to their misconception of promiscuity.
    It may sound very harsh, but HPV is no different than HIV. Both are sexually transitted viruses. Both can remain undetected for a long period of time. Both can become epidemics and kill. Still, almost everyone will be willing to receive the HIV vaccine.

  8. rahasan2014 Says:

    HPV vaccination is a very important public health topic in United States. I actually oppose any kind of mandatory vaccination program even though I understand the importance of HPV vaccine. A recent study published by CDC (based on 2006-2010 data) shows 24.9% of teenagers between 15-17 years of age had sex in last 12 months. Among non-Hispanic black this number goes up to 49.3%! We really need to focus on providing more education regarding early sexual activity and prevention of sexually transmitted disease. Another CDC study shows, for each year the 3-dose HPV vaccine series coverage remains near the current level of 33 percent instead of achieving the Healthy People 2020 goal of 80 percent coverage, an additional 4,400 women will be diagnosed with cervical cancer and 1,400 cervical cancer-attributable deaths will occur in the future.

    Even though HPV vaccination will save a lot of lives but I think any health related decision has to be a person’s own decision. As there are still a tons of confusions among people regarding the safety and efficacy of many vaccines, any mandatory vaccination program will make people more skeptical. Some critiques of vaccine will be more encouraged to speculate about the imaginary conspiracy theory how vaccine is a way of making tons of money for pharmaceuticals companies or HPV vaccine causes mental retardation! I think we can focus on educating parents and young teenagers through schools, primary care physicians and media regarding the risk of cervical cancer and how HPV vaccination can help them. If people can make educated conscious decision regarding their health I am sure they will be more than happy to receive HPV vaccine.

    http://www.cdc.gov/nchs/data/series/sr_23/sr23_031.pdf

    http://www.cdc.gov/media/releases/2013/p0725-HPV-vaccine.html

  9. songyhwa Says:

    International Women’s Day (8 March)(http://www.internationalwomensday.com/) is a global day celebrating the economic, political and social achievements of women past, present and future. However, even though women’s position is higher than before, women’s health is still threatened by cancer, especially cervical cancer. I would like to inform you about HPV vaccination in Korea. In Korea, three women a day are dying by cervical cancer because the vaccination rate is still low. Last year, the Japanese government withdrew its recommendation to use HPV vaccines in girls due to adverse effects, and CDC(http://www.cdc.gov/vaccinesafety/vaccines/HPV/index.html) announced that the most common side effects of the HPV vaccine are the same as with other vaccines this year: However, parents are still concerned about safety of HPV vaccine, and the rate of vaccination is still low in Korea. Therefore, we should educate parents about HPV vaccine because they only focus on risks of vaccines rather than risks of diseases: While the risk of diseases is greater than the risk of vaccines, people tend to focus on the risk of disease. For example, due to certain unverified concerns (such as Vaccine/Autism Hypothesis), people prefer not using the relevant vaccines even though it is confirmed that those vaccines can effectively prevent severe diseases. Imprudent access to unverified information is one of the reasons to be concerned about HPV vaccine. With easy accesses to information from various sources, people tend to believe stimulating information from untrusted sources (such as personal websites) than scientifically verified and refined information from verified sources (such as government publications). At the end, I think that only education about HPV vaccination is the best way to increase HPV vaccination.

  10. reetuverma11 Says:

    There is no doubt that HPV vaccine is the need of the hour, given the persevering rates of cervical cancer in women. For current HPV related cervical cancer rates in US, please visit: http://www.cdc.gov/cancer/hpv/statistics/cervical.htm
    Each year about 12000 new cases of HPV associated cervical cancer are diagnosed. This is too many of our women being lost to a preventable disease.
    Getting more and adolescents (both men and women) vaccinated will definitely cut down the rates not only in those who get vaccine but in others too, who do not get vaccinated because of the herd effect of vaccination. So, in order to produce this herd effect, it is very important to vaccinate the males as well and the importance of getting males vaccinated can not be overemphasized.
    I disagree with the claim that this vaccination can lead to more risky sexual behavior among adolescents as parents and schools can and should educate the kids about the risks of such behavior. If parents are not sure about the facts, the cdc provides the relevant information in clear terms, as given at: http://www.cdc.gov/vaccines/vpd-vac/hpv/vac-faqs.htm
    In order to encourage parents, to vaccinate their children against HPV, the Vaccines for Children (VFC) program helps families of eligible children who might not otherwise have access to vaccines. The program provides vaccines at no cost to doctors who serve eligible children. Children younger than 19 years of age are eligible for VFC vaccines if they are Medicaid-eligible, American Indian, or Alaska Native or have no health insurance. “Underinsured” children who have health insurance that does not cover vaccination can receive VFC vaccines through Federally Qualified Health Centers or Rural Health Centers. Information about this program is available at: http://www.cdc.gov/vaccines/programs/vfc/index.html
    Given all this support, there should be no reason for parents to deny vaccination and put their kids at risk of such a deadly disease!

  11. jennifertrumbore Says:

    Unfortunately, I think if the HPV vaccine is added to the mandatory vaccine schedule, it would create unwarranted controversy and I worry that it will backfire. It would give more ammunition to people with an anti-vaccination agenda, if parents are being “forced” to vaccinate their children against HPV. I think more resources should be spent educating people about HPV and vaccines first, before focus is put on making it mandatory.For example, very few people I have spoken to even known that the HPV vaccine should be given to boys as well. Since HPV is spread through sexual contact, it adds another wrinkle to the vaccination debate. There is an element of shaming to the debate, like a “good girl” wouldn’t get HPV, so, in essence, you deserve HPV if you aren’t a “good girl” and have unprotected sex.

    The HPV vaccine has been shown to drastically reduce HPV rates (See http://www.nytimes.com/2013/06/20/health/study-finds-sharp-drop-in-hpv-infections-in-girls.html?_r=0) and has been shown to not increase sexual activity (Thank you, drnsacharya, for providing those articles above). I think everyone should get the HPV vaccine. If we slowly work on changing the public’s beliefs about the HPV vaccine, I think (maybe, naively) that we can increase the vaccination rates without having to make it a mandatory vaccination.

    http://newsnetwork.mayoclinic.org/discussion/parental-perceptions-are-preventing-hpv-vaccination-success-277322

  12. Nahla Enany Says:

    I am not a parent yet, so I will have to look at this health issue from a different perspective. I think health education is the key in everything. You can’t force someone to eat healthy foods or to exercise even if this will prevent him from getting diabetes for example. I think providing early sexual health education and awareness might be a better solution.

  13. briankurzeja Says:

    As a parent of a 19 y/o son and 12 y/o daughter, this seems like a “no-brainer” for girls and I think it should be made mandatory for males as well. Unfortunately, most issues involving sex become politicized in this country. I believe the argument that HPV vaccination will increase the likelihood that children will become sexually active at a younger age to be flawed. Making the vaccination mandatory for boys as well as girls may help reduce this linkage. Hepatitis may be sexually transmitted, yet children are vaccinated, both girls and boys. I have yet to hear an argument that vaccinating youth for Hepatitis is contributing to earlier sexual activity. Having just lived through being a parent of an adolescent, with a second round forthcoming, in today’s society, you will never know everything your children are up to. We should give them every protection available to protect their health in the event that they don’t obey every rule that we mandate as parents.

  14. japelsumpter Says:

    Great discussion! I think the most important point is EDUCATION! Oftentimes, parents are not educated about the pros and cons of vaccines and their decisions are influenced by the opinions of others–so creating a program that will help educate people about vaccines will help tremendously. Additionally, I will have to agree with many of my colleagues in that a mandatory program depreciates autonomy. Yet, I disagree that an HPV vaccine will increase sexual activity…would the same viewpoint be relevant if there was a vaccine to prevent HIV? Or would more people be prone to get the vaccine because more people are educated about the detriments associated with the disease… I’m just playing devils advocate ☺

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