Those who favor mandating the vaccine point out that cervical cancer will strike about 11,150 women in the U.S. this year and claim an estimated 3,670 lives. (Globally, it is the second most-common cancer among women, according to the World Health Organization.) In short, they say, the vaccine will save lives.
Critics of these legislative efforts have a broad range of reasons for their objections. Some say a compulsory vaccination would tread on the value of abstinence before marriage that they instill in their children. Others fear that the vaccine might encourage promiscuity if youth view the vaccine as a talisman against all sexually transmitted diseases. And some doubt vaccine safety, in general.
The debate highlights the balance between government's obligation to safeguard the health of its people and the rights of individuals to make their own decisions about matters affecting their health and their children's health.
All vaccine mandates pose this dilemma. But the question of an HPV vaccine presents more medical and ethical wrinkles.
"School-based laws began in the 19th century, at about the same time as mandatory education laws," says James Colgrove, a medical historian at the Columbia University Mailman School of Public Health who recently wrote an article for the New England Journal of Medicine about the ethics and politics of HPV vaccination. "People realized that schools were breeding grounds for illness."
Because HPV is not spread through the germ incubator of the classroom, a mandatory vaccine would lack that rationale. Further, for the first time, vaccination policies would affect only one gender. "With a compulsory HPV vaccination, we really are kind of getting into a different territory," Colgrove says.
CDC recommended
The FDA approved the vaccine, Gardasil, in June 2006. An advisory committee to the Centers for Disease Control and Prevention recommended that girls receive the vaccine at ages 11 or 12, and that it be given to girls and women through age 26 who have not received it. The vaccine is most effective if given before a girl becomes sexually active. (Women who have been vaccinated should still undergo routine cervical cancer screening.)
