Sunday, February 04, 2007

On the Texas HPV Vaccine Law

Texas has passed legislation to require all girls ages 11-12 to receive the HPV vaccine before entering 6th grade. Some have responded to this by claiming that the government is taking control away from parents, and that this is simply a money-making venture for Merck, producer of the Gardasil vaccine, the only currently approved HPV vaccine. Merck certainly has a financial interest in having as many girls as possible vaccinated, and this New York Times article suggests the company is actively lobbying state legislatures to require vaccination. However, the executive order signed by the TX Governor makes no specific mention of Merck; it refers only to "HPV vaccine." When other companies get their vaccines (which are already in development) approved, Texas parents and doctors would be able to choose among them. Likewise, parents may opt out of the program on behalf of their children, by this provision: "The Department of State Health Services will, in order to protect the right of parents to be the final authority on their children's health care, modify the current process in order to allow parents to submit a request for a conscientious objection affidavit form via the Internet while maintaining privacy safeguards under current law." I can understand the concerns about the vaccine from a long-term effects standpoint (it's a new vaccine) - that, to me, would be the primary concern, along with keeping an eye on the company's lobbying efforts. However, "taking control away from parents" hysteria is a bit overblown, as parents clearly have a provision for opting out and not vaccinating their children, which is not restricted to religious reasons. The parents may simply have to be informed of risks and benefits before making the decision, and I don't think that's such a bad thing.

See Update, 2/6/07
More Updates, 2/7/07

Complete text of the Executive Order:
Executive Order RP65 - February 2, 2007
Relating to the immunization of young women from the cancer-causing Human Papillomavirus.
BY THE
GOVERNOR OF THE STATE OF TEXAS
Executive Department
Austin, Texas
February 2, 2007

WHEREAS, immunization from vaccine-preventable diseases such as Human Papillomavirus (HPV) protects individuals who receive the vaccine; and

WHEREAS, HPV is the most common sexually transmitted infection-causing cancer in females in the United States; and

WHEREAS, the United States Food and Drug Administration estimates there are 9,710 new cases of cervical cancer, many of which are caused by HPV, and 3,700 deaths from cervical cancer each year in the United States; and

WHEREAS, the Texas Cancer Registry estimates there were 1,169 new cases and 391 deaths from cervical cancer in Texas in 2006; and

WHEREAS, research has shown that the HPV vaccine is highly effective in preventing the infections that are the cause of many of the cervical cancers; and

WHEREAS, HPV vaccine is only effective if administered before infection occurs; and

WHEREAS, the newly approved HPV vaccine is a great advance in the protection of women's health; and

WHEREAS, the Advisory Committee on Immunization Practices and Centers for Disease Control and Prevention recommend the HPV vaccine for females who are nine years through 26 years of age;

NOW THEREFORE, I, RICK PERRY, Governor of Texas, by virtue of the power and authority vested in me by the Constitution and laws of the State of Texas as the Chief Executive Officer, do hereby order the following:

Vaccine. The Department of State Health Services shall make the HPV vaccine available through the Texas Vaccines for Children program for eligible young females up to age 18, and the Health and Human Services Commission shall make the vaccine available to Medicaid-eligible young females from age 19 to 21.

Rules. The Health and Human Services Executive Commissioner shall adopt rules that mandate the age appropriate vaccination of all female children for HPV prior to admission to the sixth grade.

Availability. The Department of State Health Services and the Health and Human Services Commission will move expeditiously to make the vaccine available as soon as possible.

Public Information. The Department of State Health Services will implement a public awareness campaign to educate the public of the importance of vaccination, the availability of the vaccine, and the subsequent requirements under the rules that will be adopted.

Parents' Rights. The Department of State Health Services will, in order to protect the right of parents to be the final authority on their children's health care, modify the current process in order to allow parents to submit a request for a conscientious objection affidavit form via the Internet while maintaining privacy safeguards under current law.

This executive order supersedes all previous orders on this matter that are in conflict or inconsistent with its terms and this order shall remain in effect and in full force until modified, amended, rescinded, or superseded by me or by a succeeding governor.

Given under my hand this the 2nd day of February, 2007.

RICK PERRY(Signature)
Governor

Attested by:
ROGER WILLIAMS(Signature)
Secretary of State


See Update, 2/6/07

Technorati Tags: ; ;
MeSH Tags: Adolescent; Papillomavirus Vaccines; Texas; Uterine Cervical Neoplasms;

7 Comments:

Blogger ibelieve said...

I wonder what your position is on abortion. I'm guessing you think you should have the right to do what you want with your body. Yet you think it's no big deal that parents have to ask permission from the State to avoid having some vaccine injected into their children. Do we have a right to do what we want with our bodies or not? Make up your mind.

12:03 PM  
Blogger Rachel said...

ibelieve - The State does require numerous vaccinations, almost all with exemptions for religious or other reasons. I can understand if you believe that no vaccines should ever be required, although I would be interested in how you would propose to mitigate the public health effects of such a decision. I do support a woman's right to have an abortion. I also believe the HPV vaccine is a special case, as it is most effective before sexual activity begins. It's true that the young woman is not truly consenting to this vaccine, as it is left in the hands of her parents (which is done for all manner of medical care on minors). On the other hand, if we waited until the girl was 18, we'd likely lose the opportunity to prevent many cases of a lethal cancer.

Laws mandating all manner of vaccination attempt to strike a balance between protecting public health and the rights of individuals, which is why those exemptions are in place. Are you truly opposed to all mandatory vaccines (bearing in mind the opt out clauses), or is it simply the HPV vaccine that has caught your eye?

Finally, ibelieve, while I welcome private emails from readers, I would ask that you refrain from sending me messages telling me I shouldn't have children.

12:31 PM  
Blogger TCP said...

The difference IMHO between the HPV vaccine and a vaccine for something like Polio, Chicken Pox, Whooping Cough, etc - HPV is not communicable through casual contact, and you don't run the risk of a student with the disease infecting the entire classroom. So the "for the public health" argument is not as valid as it is for those diseases that are transmitted via casual contact.

Do I support a vaccine? Absolutely. I believe that there ought to be incentives to encourage people to get it, but that the final decision still remains with the individual on whether or not to get vaccinated against a disease that they may or may not ever contract (only 50-60% of women contract some type of HPV in their life).

8:21 PM  
Blogger Sprite said...

I am a former TAMU VAPH student whose primary focus in education was epidemiology. The order of Texas Governor Rick Perry for school girls here to receive the HPV vaccine is an insane effort to repay a campaign contributor and provide a larger sample size for an experimental vaccine. Make no mistake, the risks associated with vaccination, in this case, far outweigh any possible benefit. While Merck instists there are no serious side effects, the side effects listed in studies of girls include what sound like the symptoms of anaphylactic shock. Moreover, the miniscule rates of cervical cancer among women in this country, and the even more microscopic death rate reveal that this is simply an effort on the part of Merck to make money. The shots are given in a series of three injections. It does not confer immunity in all of the recipients, and the studies conducted have not involved a sample size large enough to be assured that the vaccine will not harm more women than cervical cancer afflicts in this country annually. Please read the following post and I hope The Austin Stateman can be the voice of reason in this state.
Post: First, do no harm.
I am not trying to turn this into a medical forum, but I have huge concerns that Texas' young school-girls will be turned into guinea pigs for Merck and Glaxo-Welcome. I am not opposed to vaccination. I am a firm believer in the need for vaccination against dangerous childhood diseases. That is not what HPV is. Here are a few FAQs and a link for women who may be concerned for their health and confused with all the publicity.
I will try to be clinical, non-disgusting, and keep the post as sterile as possible.
1) HPV is the virus that causes genital warts. It is very common and usually causes no problem in women who contract it. In a microscopic number of women, the virus may remain active long enough to be implicated in the formation of abnormal cells.
2) There are 15 types of HPV. The vaccine, created by Merck, which has received so much media attention, protects against 2 types of HPV. These two types are implicated in causing 70% of the cervical cancers that develop. 30% are caused by the 13 other types of HPV which this vaccine is no protection against.
3) This vaccine will not protect all women against contracting even the two types of the virus it is supposed to protect against. Many women will contract the virus, even having had the vaccine.
4) The projected number of women in the UNITED STATES (about 300,000,000 people live in the United States) expected to get cervical cancer in 2006 was 9,710. The number of those expected to die of their cancers is 3,700. That's in the entire country. What that means is, .00032% of Americans were projected to contract cervical cancer in 2006. .00012% were projected to die of it. Since the population of the U.S. is roughly 50% male, we can tell the rates for women only. Those rates are, .0006% of women in the U.S. projected to contract cervical cancer in the U.S. in 2006. .0002% expected to die of it.
I have found no published rates of complications with the Merck vaccine and there are always rates of complications, no matter how harmless the vaccine is. For example, the smallpox vaccine is considered to be one of the safest vaccines, because it's complications rate is low. Less than 1% of people who received the smallpox vaccine had mild, severe, life threatening, or fatal complications. We are talking about giving our young girls a vaccine that may well have a much higher rate of complications than the rate of cervical cancers in this country, and much much higher than the rate of deaths from cervical cancer in this country.
5) Merck does not know whether annual booster shots will be required to maintain immunity against the 2 types of HPV the vaccine is supposed to protect against.
FDA approval was granted in June 2006 for this vaccine. I am going to double check that against the CDC site info, since I was under the impression that a contract license for the vaccine had been issued and that is NOT FDA approval. I will check, but I'm guessing they got the approval, at least 2 years before it really should have been granted.
Women who take this vaccine are still advised to have regular HPV tests and their regular female health testing done when they are past 30. Women over 30 are at the highest risk of cervical cancer.
For women who may be concerned for their health, you can visit this site:
http://www.thehpvtest.com/
I hope everyone can get a better idea of the risk vs. reward issue with this vaccine. Simply having your regular testing done is the best way to avoid problems and catch things early enough to prevent greater problems.
If we vaccinate 1 million school girls and see even a small rate of complications, it could translate into millions in cost paid by Texas taxpayers in the form of health services and lawsuits.
Please read about the Swine Flu Distaster when Gerald Ford urged every American to be vaccinated with swine flu vaccine in 1976, fearing that 1 million Americans might perish in a resurgence of the 1918 flu. The thing was a disaster and by May 1980, 3,917 legal claims against the government had been filed, asking for $3.5 billion in damages. The vaccination campaign had lasted only 2 weeks. If you want to see a disaster of that magnitude in Texas, keep letting Perry call the shots!
By the way, the FDA published information stating they would be watching this vaccine, to assess it's safety. We are asking Texas school-girls to be guinea pigs so that Merck can make money and the FDA can be sure that the vaccine is safe. Perry is going to "erre," but our daughters should not pay for his mistakes with their health.

10:43 PM  
Blogger Rachel said...

Thank you for your comments. I've updated with a list of my own concerns in this new post.

8:51 AM  
Blogger saywhat said...

Rachel,

The U.S. Constitution is NOT a "cafeteria plan" where YOU or the GOVERNMENT pick & choose when our rights apply or not. OUR RIGHTS UNDER THE CONSTITUTION ARE FIXED AND NOT ADJUSTED FOR YOUR WHAT YOU THINK IS BEST OR WHAT THE GOVT LEADERS THINK IS BEST. WE ARE GUANTEED THE CONSTITUTIONAL RIGHT TO MAKE OUR OWN CHOICES.

You seem to be overlooking the Constitutional infringement this bill has on the "people's" right against government interference.

The most powerful argument is that a young woman's medical decision, something so personal, should be free from government interference. Government should not address any disease in a legislative bill UNLESS and ONLY UNLESS the disease is communicable at school. . It is a medical fact that HPV can only be transmitted through genital or anal contact not covered by a condom Therefore, it would unconstitutional to put HPV in a legislative bill because the government has no power to interfere with the medical choices of the "people" or the "people's children."


All illnesses/diseases currently "mandated" for vaccines right now are ALL illnesses that are communicable in schools. Hep B and tetanus could be transmitted in the school yard - Diphtheria, Poliomyelitis, Pertussis, Measles, Rubella, Mumps: are all highly contagious and pass person to person at school. The virus HPV is NOT communicable at school
Therefore, as is the case with ALL MEDICAL CHOICES: the "people" should be free from government interference when it comes to deciding if this vaccine is right for us or our children.

Constitutional rights are not meant to be a "cafeteria plan." Either our Constitution prevents government from interfering and passing laws telling us what religious, educational, doctor, job, child rearing, or medical choices we should make for ourselves or for our children - OR NOT. Either YOU believe in the Constitution for any and all matters OR NOT. YOU CANNOT PICK AND CHOOSE FOR "WE THE PEOPLE" WHEN THE CONSTITUTION IS GOING TO BE UPHELD - AND WHEN IT'S OK FOR GOVERNMENT TO VIOLATE OUR CONSTITUTIONAL RIGHTS.

Anything else would be hypocritical.

10:25 AM  
Blogger Rachel said...

saywhat - You may be surprised to learn that I don't totally disagree with you. I've added an updated post that expresses some of my concerns about the vaccine. I appreciate your sharing your thoughts (please, though, no all-caps "shouting"). The more I think about the issue, the more I think that making the vaccine mandatory is unnecessary governmental interference.

10:30 AM  

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