HOUSTON — When Texas Gov. Rick Perry ordered that all of the state's middle-school-aged girls be vaccinated against a sexually transmitted virus that causes cervical cancer, the backlash was swift and sure.
Critics argued that the executive order promoted promiscuity, trampled on parental rights and subjected children to a new vaccine with unknown long-term effects.
Texas lawmakers, unhappy that Perry sidestepped their authority, pushed a bill through committee that would rescind the mandate. Cosigned by 90 of 150 members of the state House of Representatives, it is all but certain to pass.
And on Friday, the unidentified parents of three Texas girls sued Perry for overstepping his authority and illegally requiring the vaccine for preteens.
The hullabaloo is a setback for public health advocates in Texas, which with Perry's Feb. 2 order became the first state to require the vaccine for school admission, beginning in 2008.
But measures introduced by lawmakers in at least 31 states also have triggered negative fallout, said James Colgrove, a medical historian at Columbia University's Mailman School of Public Health.
"I would be surprised to see a lot of bills passed in the coming year," Colgrove said of legislation requiring the vaccine. "The majority public health opinion is we really should be moving a little slower than this."
The vaccine, called Gardasil, protects women against two strains of the human papillomavirus that cause 70% of cervical cancers. At $360 for a series of three shots, it is the most expensive vaccine yet. Medicaid and the federal Vaccines for Children Program will help cover costs. Large private insurers are also expected to pay for the vaccine.
Legislators in Michigan, the first state to introduce bills on the vaccine last fall, narrowly defeated legislation mandating HPV vaccinations in December. A Maryland bill was withdrawn last month over concerns that children have trouble getting the shots already required.
Virginia legislators have passed a bill mandating the vaccine, but Gov. Timothy M. Kaine, a Democrat, hasn't decided whether to sign it.
In California, a bill that would require school girls to get the shots has not been assigned to a committee. Assemblyman Ed Hernandez (D-Baldwin Park), lead author of the bill, said the uproar in Texas hadn't diminished his support for mandating the vaccinations.
"We plan on moving forward with our bill because I believe mandating this vaccination is the right thing to do," he said. "The cervical cancer vaccine provides us the ability to significantly diminish a disease that needlessly kills and permanently maims thousands of women every year."
Merck & Co., the maker of Gardasil, this week suspended its lobbying campaign aimed at getting states to require the vaccine for middle-school-aged girls. "It distracted from the real issue, the importance of the vaccine and the ability to save lives," spokesman Chris Loder said.
Colgrove said Merck's lobbying efforts undermined its cause. "People felt like they were just doing it to make money, and it looked suspicious," he said. "It's such a new vaccine and people hadn't had a chance to be educated about it, but it was really being pushed through. I think Merck's aggressive efforts created a lot of resistance, even from supporters."
Perry's order requires the vaccine for all girls entering the sixth grade beginning in the fall of 2008 -- except those whose parents file an exemption form with the school.
Critics have questioned Perry's ties to Merck. His former chief of staff is now a lobbyist for the drug maker. And his current chief of staff and other aides reportedly met to discuss the state's immunization program, including the HPV vaccine order, on the same day in 2006 that Merck donated $5,000 to the governor's reelection campaign.
A spokesman has said that the timing was coincidental and that the governor was not influenced by anything other than health concerns. One of the highest rates of cervical cancer in the nation is on the south Texas border, probably in part because of a shortage of doctors in the area. Cultural or financial barriers may also keep Latino women from getting regular checkups.
"The governor is standing by his executive order," said Perry spokeswoman Krista Moody. "We certainly didn't anticipate this much commotion for a vaccine that can prevent cancer."
Three weeks after Perry, a Republican, signed the order, fellow conservatives are still incredulous.
"There are a lot of questions about this mandate when you're talking about a virus that's not easily communicable or an epidemic like tuberculosis," said Andrea Lafferty, executive director of the Washington, D.C.-based Traditional Values Coalition. "It's ridiculous. I can't believe Perry would be so stupid."
But Texas state Rep. Jessica Farrar (D-Houston) considers Perry's end-run around the Legislature an unexpected gift. She had filed a bill that would require the HPV shots but didn't expect it to get very far.
"I was totally shocked that the governor did what he did," Farrar said. "Even though there's a controversy and the social conservatives are dominating the debate right now, the information about cervical cancer and the vaccine is getting out there."