George Warren didn't mind getting his 9-year-old daughter vaccinated against chickenpox. He didn't object to any of the 10 or so inoculations that California requires.
But a vaccine to prevent cervical cancer and genital warts? For a preteen girl?
"She's not gonna need it," said Warren, a 30-year-old land surveyor from Rescue, Calif., about 28 miles from Sacramento. "I'm a good parent. I tell her what's right and wrong."
A bill in the state Legislature would require such shots for girls entering the sixth grade. And parents such as Warren are decrying what they consider an incursion on parental rights.
"I'm insulted by them trying to tell me what's right for my children," he said.
Written primarily by Assemblywoman Sally Lieber (D-Mountain View), the bill mandating vaccinations against the human papilloma virus, a sexually transmitted disease that causes 70% of cervical cancers, is still in its infancy.
Its prospects are uncertain, but one thing already is clear: This is a controversial issue.
Texas' Republican governor, Rick Perry, angered social conservatives in his party recently when he mandated HPV vaccines for girls by executive order. Parents there can opt out of the requirement for reasons of conscience -- as they would be able to do in California.
Since the vaccine was approved by the U.S. Food and Drug Administration last year, states have been wrestling with the questions it raises. According to the National Conference of State Legislatures, 26 have initiated legislation.
Parents or their advocates have raised a chorus of objections, saying that mandating the vaccine may encourage promiscuity and that it is too early to tell whether the vaccine is safe, particularly for young girls.
Last month, Maryland's Democratic state Sen. Delores Kelley withdrew her vaccination bill, saying she was responding to parents and teachers worried about excessive inoculation requirements.
In California, the bill is still in a legislative committee. Lieber, who recently drew criticism for introducing an anti-spanking bill, has since dropped her sponsorship. She cited a potential conflict of interest because her husband's family trust includes about $14,000 of stock in Merck and Co., the maker of Gardasil, the only available HPV vaccine.
Edward Hernandez (D-Baldwin Park), a freshman assemblyman who sits with Lieber on the Health Committee, agreed to carry the bill.
"What brought me to the table is the fact that I have a 16-year-old daughter," he said. "I'm looking at it from the public health standpoint of reducing cancer."
At least 50% of sexually active people will get HPV at some time in their lives, according to federal statistics.
Among women with HPV, the vast majority do not develop cervical cancer. But the American Cancer Society estimates that this year, about 11,150 women will be diagnosed as having HPV and 3,670 women will die from the disease. As a result, many public health experts endorse vaccinating girls before they become sexually active.
Scott Folsom, president of the Los Angeles 10th District Parent-Teacher-Student Assn., said mandating the vaccine makes it more likely to be widely used.
"PTA was a great advocate for the polio vaccine in the '50s," said Folsom, who has encouraged his own 16-year-old daughter to get the HPV shot. "This is another opportunity to perhaps make that difference."
But opponents say HPV is not like polio, or most other diseases prevented by vaccines. State Sen. George Runner (R-Lancaster) said HPV is the result of lifestyle decisions, not contagion.
"Is there a more productive way for us to spend the money that may help someone who's in a health situation that has nothing to do with their personal choices?" he asked. "Where do you want to focus your resources?"
The vaccine is relatively expensive. It requires three doses within about six months, each dose costing about $120. It is covered by some major insurers and, in the case of women between the ages of 19 and 26, Medi-Cal will pick up the tab. Girls as young as 9 can qualify for free doses under the federal Vaccines for Children program.
Gov. Arnold Schwarzenegger has not taken a public stand on the bill, which could change before reaching his desk, but his proposed budget for the 2007-08 fiscal year includes $11.3 million for HPV vaccines.
The California Department of Health Services has already distributed 60,000 doses of the vaccine to healthcare providers, and it is in the process of providing 45,000 more this month.
The Los Angeles Unified School District already offers the vaccine at its clinics. Female students are eligible to receive Gardasil with parental consent.
Ron Prentice, director of the California Family Council, said he does not object to having the vaccine on the market. But he wants a bill that would grant parents the greatest possible latitude for exemptions.
"Am I concerned that people may suffer from cervical cancer? The answer is yes," he said. "But the ultimate decision should remain with the parents, not the state."