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Commentary

Texas HPV mandate not quite compelling
Steve Chapman, Chicago Tribune, 2-15-07

Chapman examines the case for Texas' mandatory HPV vaccination program, and finds that—while supporting the concept of mandatory vaccinations—he has serious reservations in this particular case.

Mandatory immunization, far from being a new development, goes back to the 19th Century. But these days, it's generally imposed on schoolchildren only for serious illnesses that can spread easily by casual interaction, such as measles, whooping cough, diphtheria and polio. HPV is not one of those.

There are sound reasons to immunize preadolescents.

One is that it makes sense to confer protection well before potential victims become sexually active—by which time it may be too late. In a startling revelation, the Food and Drug Administration reports that "at least 50 percent of people who have had sex will have HPV at some time in their lives." Even someone who is a virgin upon marrying and monogamous afterward can be unwittingly exposed to it by a spouse.

Immunization is also useful for girls who will choose not to have sex, since they may be molested by someone carrying the virus. And a clinical study that led to FDA approval found the vaccine is nearly foolproof in preventing two types of HPV that account for 70 percent of all cervical cancers, which kill nearly 4,000 American women each year.

But the inoculation (which has not yet been approved for boys) is new, and it addresses a disease that most people know nothing about. A mandate would force on people something that most of them, in time, probably can be persuaded to accept voluntarily. The first need is public education, in the form of a comprehensive effort to inform Americans and their doctors of the dangers of HPV and the efficacy of immunization.

Even medical experts are wary of forcing it on the unwilling. The Texas Medical Association, which says many of its members are already administering the vaccine, does not favor requiring it. The American Academy of Pediatrics, which recommends the vaccine, has also declined to endorse the mandate.

"We don't know if it will be necessary," says Joseph Bocchini, a Louisiana pediatrician who heads the AAP's committee on infectious diseases. Given sufficient information about this new protection, he believes, "most people would want it for their daughters." But making it a requirement for school admission would risk a backlash against the vaccine before it has even gotten a foothold. It might also prod more parents to reject other immunizations.



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