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Parents vs. Prevention: Illinois lawmakers weigh whether to require preteens to get STD vaccines

Though there is widespread support of the HPV vaccine, there will be opponents to the idea of requiring inoculation for preteen girls.

Lawmakers could face a dilemma this spring: whether the state should play guardian angel to Illinois' preteens.

A proposal is in the works to require vaccinations for 11- and 12-year-old girls that are designed to stop certain types of the human papillomavirus, the most common sexually transmitted disease. The virus, HPV for short, also is linked to cervical cancer.

Sen. Debbie Halvorson, a Democrat from Crete and her chamber's majority leader, has a personal interest in cervical cancer prevention. After her pap smear came back with abnormal cells in 2002, she was given a high-risk diagnosis for the disease. For Halvorson, the choice is simple. 

"When you know there's a vaccine that prevents cervical cancer and you look at your child, it is your responsibility to save their life," she says.

She plans to introduce legislation to add the HPV shot to the state's list of 10 required childhood vaccinations against diseases.

Her proposal likely will generate opposition. Mandatory vaccines for children have stirred controversy in the past. In 2002, opponents argued that chicken pox isn't a severe enough disease to force parents to have their children inoculated. In 1997, safety concerns about hepatitis B shots mounted as parents feared their children might have adverse reactions to that vaccine. 

The push for HPV shots likely will renew the tension between parental rights and the public's interest in prevention. 

If Halvorson's proposal reaches the floor, legislators would be asked to decide whether the state should intervene, a move that could reduce the costs of treating cervical cancer and other HPV-related conditions. 

Illinois would join 28 other states that are considering ways to improve access to the HPV vaccine.

In early February, Republican Gov. Rick Perry of Texas issued an executive order for girls 11 and 12 to receive the HPV shots, making Texas the first state to mandate the vaccination. Texas parents can opt out for medical or religious reasons. 

Halvorson's proposal also would allow exemptions for medical and religious reasons, and she plans to consider the possibility of pushing fifth-grade physicals up a year so girls could receive the vaccine during their mandatory doctors' visits in sixth grade.

A spokeswoman for the Illinois Department of Public Health says it's too early to tell what financial impact an HPV vaccine policy would have on the state. But Halvorson says a state initiative such as hers could carry a $4 million price tag, which "is a drop in the bucket when you consider that it will save lives."

Meanwhile, Democratic Rep. Naomi Jakobsson of Urbana is calling on the Illinois Department of Public Health to take the lead in educating physicians and parents about the dangers of HPV. The goal of legislation she has introduced is to incorporate the vaccine into 11- and 12-year-old girls' inoculation schedules.

Unlike Halvorson, Jakobsson would not require the vaccination. However, parents would have to sign a form stating they were educated about HPV and documenting whether they allowed their children to get the shots.

Stopping the disease with preventive care in adolescent years might save the state from spending treatment dollars later. About 80 percent of women will acquire HPV by age 50, according to the U.S. Centers for Disease Control and Prevention. Nationwide, 20 million cases were documented last year, and 6 million more are expected annually.

However, Curtis Allen, spokesman for the Atlanta-based CDC, says that while the HPV vaccine is important for women's health, it is not a cure-all. 

"Fifty percent of all women who develop cervical cancer have not received a recent pap smear," he says. 

Nationwide, mortality rates for black, Hispanic, Asian/Pacific Islander and Native American women are higher than for white women. These groups also fall behind on access to screening. Although studies show the HPV virus clears itself in 90 percent of women within a two-year period, women who have an untreated infection from a certain type of the virus are at risk of cell changes in the cervix that can cause cancer. 

Reaching these women early with such preventive care as an HPV vaccine might have an impact on future cervical cancer deaths.

Women in Government, a Washington, D.C.-based bipartisan group of women state legislators, issued a report earlier this year that rated states in their fight against cervical cancer. The report, Partnering for Progress 2007: The State of Cervical Cancer Prevention in America, looked at data on cervical cancer for each state using the number of deaths, the number of cases and the accessibility of screening. 

The report puts Illinois second behind Minnesota in percentages of uninsured women: 9 percent in Minnesota compared to 17 percent in Illinois.

Halvorson says legislation that launched the Illinois Cervical Cancer Elimination Task Force in 2004 is one reason this state has had success in battling the disease. But she says there's more to be done. 

"This is our chance to eradicate a certain cancer in our lifetime." 

Last year, the U.S. Food and Drug Administration approved Gardasil, a vaccine developed by Merck and Co. Inc. to prevent four types of HPV, including two that are linked to most cases of genital warts. The company has launched two media campaigns, "Tell Someone" and "One Less," warning about HPV and cervical cancer.

The vaccine is thought to be 95 percent to 100 percent effective when used properly, according to the FDA. After women get the first shot, they need a second dose two months later. A third dose is needed within six months after the first.

The CDC's Advisory Committee on Immunization Practices says the vaccine can be given to girls ages 11 and 12. A series of three shots, the immunization can be started in females as young as 9 years old. There also is a "catch-up" series for females ages 13 to 26 who haven't been vaccinated. 

The vaccine costs about $360 for the three-shot series and is covered by the federal Medicaid health insurance for children. Females under the age of 19 whose private health insurance won't cover costs also can get the vaccination under this plan. According to the CDC, most large insurance plans will pay for the HPV shots. 

A second vaccine, Cervarix, which was developed by GlaxoSmithKline, is still undergoing testing and is scheduled to be reviewed by the FDA next month. 

Jennifer Armstrong, spokeswoman for GlaxoSmithKline, says the company also will work to educate people about the seriousness of the disease. Cervarix is being studied in females ages 10 through 45. 

Meanwhile, national groups are recommending the HPV vaccine. The American Cancer Society, the American Academy of Pediatrics and the Women in Government Cervical Cancer and HPV Task Force suggest that girls 11 and 12 receive the shots. However, the groups have not endorsed a state mandate. 

According to Halvorson, about 180,000 Illinois girls fall into the 11- and 12-year-old age range, and 10 percent of those girls are uninsured or under-insured. She says most should be eligible to receive the HPV vaccinations under All Kids, the state subsidized health insurance program that rolled out last year. 

Halvorson says she believes it would be irresponsible to require vaccination immediately. Instead, she favors a two- to-four-year phase-in period after legislation wins approval. She says this would give the state a chance to work with drug companies to figure out the availability of the vaccine and to set up an effective plan. Halvorson says her affiliation with the two drug companies is for educational purposes to ensure that this is what's best for Illinois girls.

Last August, the senator held a golf outing fundraiser that Merck couldn't attend. She says instead the company donated $1,000 to her campaign.

"Campaign contributions don't and never will buy my support for something," she says. 

She says she also met with obstetricians, gynecologists and pediatricians and attended educational seminars on cervical cancer and HPV.

"Merck is absolutely not behind my legislation," Halvorson says.

The Associated Press reported that the governor of Texas received $6,000 from Merck and is connected to Women in Government. His spokeswoman, Krista Moody, says she is unaware of those reports.

"Any assertion that this is a political issue is incorrect. This is a public health issue," Moody says. She adds the only reason Perry issued the order is to ensure girls have access to the vaccine and to expedite the issue in the legislature. 

Women in Government has received donations from Merck, as well as from other corporations, the group said in a statement. However, the group says its relationship with the drug company is strictly based on educational purposes and it doesn't lobby for any company or policy.

Though there is widespread support of the HPV vaccine, there will be opponents to the idea of requiring inoculation for preteen girls.

Linda Klepacki, the analyst for sexual behavior for Focus on the Family, a Christian not-for-profit organization, is one of them. 

Klepacki says she's concerned about how well parents have been educated about HPV so they can make informed decisions. "We are supportive of a vaccine, but we also support parent rights," she says. 

Because the vaccine is fairly new, Klepacki says she doesn't want parents to be misguided about how long the drug stays effective, which is still under study.

So far, studies show that vaccinated females are protected for about five years. But because the vaccine is new, more research will have to be done to see if girls need another dose as adults, according to the CDC's National Immunization Program. Research also is being conducted to see whether the vaccine will work in males, who don't show symptoms but can spread the virus. 

The Family Research Council, a Judeo-Christian-based nonprofit group, supports an opt-in policy that would allow parents to make the final decision. The council also argues abstinence is the only absolute way to prevent such sexually transmitted diseases as HPV. Still, the group supports the vaccine because it recognizes people can contract HPV in other ways, including sexual assault. 

While the council doesn't correlate use of the vaccine to sexual promiscuity, it encourages future studies to determine whether the vaccine has any impact on sexual behavior. 

Klepacki and Halvorson agree on one point. They believe there is no proof that vaccines designed to prevent sexually transmitted diseases, such as hepatitis B, cause promiscuity.

"HPV is not transmitted through casual contact; therefore, there is no justification to mandate this vaccine as a requirement for school attendance," says Moira Gaul, policy analyst for the Family Research Council in Washington, D.C.

But Halvorson says mandatory HPV vaccinations are simply about the state protecting girls against another potentially deadly disease. "I will continue to work towards girls receiving this vaccination because it's my responsibility."

 The arguments against the HPV vaccine have been used before to oppose other mandatory vaccine measures in the General Assembly. Yet chicken pox and hepatitis B shots are now part of the routine vaccination schedules, with medical or religious exemptions. This spring, preventive care and parental rights might come head to head once more. 


Illinois Issues, March 2007

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