There have been concerns about the vaccine's potential side effects. As of June 30, the FDA had received 9,749 "adverse events" reports from physicians and patients after Gardasil injections. Most involved pain at the injection site, headaches, nausea, fainting or fever.
The 6% of incidents that were deemed serious included 20 deaths as well blood clots and several cases of Guillain-Barre syndrome, an autoimmune disease that can lead to paralysis. The FDA says there is no evidence that Gardasil caused the deaths or led to Guillain-Barre.
Still, some physicians believe that the vaccine's safety has not been adequately proven. Dr. George F. Sawaya, a UC San Francisco obstetrician-gynecologist who specializes in cervical cancer, called the CDC recommendation "premature" because the vaccine is so new.
"We don't know what the long-term effects will be," he said.
The vaccine blocks four strains of HPV, two of which cause about 70% of cervical cancers. The other two cause most genital warts, which can be a painful nuisance.
Hailed by many as a huge breakthrough in women's health, Gardasil is seen by others as only modestly effective. A three-year study published last year in the New England Journal of Medicine found that the vaccine reduced the incidence of precancerous lesions by just 17% overall, in part because many of the young women in the study had already been exposed to the virus.
That caveat is particularly relevant for immigrants.
"Many women will very likely get this only for the purpose of the visa," said Kate Bourne, a vice president of the New York-based International Women's Health Coalition. "Quite likely they will be at the upper end of the age range, which means they are more likely to already be sexually active, and this vaccine is useless to them."
And because only the first shot is required before applying to immigrate, there is no guarantee that applicants will complete the three-shot series, rendering the inoculation "triply meaningless," Bourne said.
Consumer advocates have also complained that the vaccine is too expensive.
The CDC's stamp of approval ensures that some private insurance plans as well as U.S. programs for the poor will cover the steep price -- $360 for the series, plus the cost of office visits. But that's no help to applicants outside the country or not eligible for U.S. aid.
"This is just an additional barrier to coming to America," said Tuyet G. Duong, a senior attorney for the Asian American Justice Center, a civil rights group based in Washington, D.C. "It just adds another layer to what has become a toxic environment for immigrants."
Angelica Salas, executive director of the Coalition for Humane Immigrant Rights of Los Angeles, agrees.
"We don't want to convey that we don't want individuals to make healthy choices or seek out preventive healthcare," she said. "We just don't see why it should be linked to immigration."
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mary.engel@latimes.com
