Should HPV Vaccines Be Mandatory?

Posted on | May 7, 2007 | Comments Off on Should HPV Vaccines Be Mandatory?

In a recent Health Politics piece, I reviewed the facts on the new vaccine for the HPV virus. Following that airing, the governor of Texas moved to make the three-shot vaccination mandatory for adolescent girls in the state. A large public debate ensued, which drew in legislators, school officials, public health professionals and parents — not only in Texas, but around the country.

What was clear was that mandating the vaccination (usually reserved for diseases that are communicable by air) charted new ground and involved complex tradeoffs.

Now, a thoughtful editorial in the May 2 issue of the Journal of the American Medical Association (2007;297:1921-1923), penned by JAMA editor Catherine DeAngelis and Georgetown law professor Lawrence Gostin, sheds further light on the situation. The press release about the editorial reads:

“Many states have enacted or are considering making quadrivalent HPV vaccine mandatory for girls entering school. Routine use of the vaccine undoubtedly is beneficial to the public’s health, as it is likely to reduce the incidence of cervical cancers. However, the rush to make HPV vaccination mandatory presents ethical concerns, and is likely to be counterproductive. The vaccine has not been evaluated for safety and efficacy among a large population of younger girls aged 9-15. The use of compulsion, moreover, could have the unintended consequence of heightening parental and public apprehensions about childhood vaccinations.

HPV is not a highly infectious airborne disease, which is the paradigm for the exercise of compulsory vaccination. However, if compulsory powers were justified on classical public health grounds, the same arguments could, and should, apply to vaccination of boys, who are just as likely to transmit the infection to their partners.

Years from now, when additional data and experience better inform clinicians and policymakers about the risks and benefits, states might consider requiring HPV vaccination. But for now, it is preferable to take a deliberative approach and view routine, voluntary HPV vaccination as part of a comprehensive package for preventing sexually transmitted infections and cervical cancer. In the absence of an immediate risk of serious harm, it is almost always preferable to adopt voluntary measures, making state compulsion a last resort.”

I agree. What do you think?