Perry orders anti-cancer vaccine for schoolgirls

Houston Chronicle/AP ^ | Feb. 2, 2007 | LIZ AUSTIN PETERSON

[YCTHouston]

AUSTIN — Gov. Rick Perry ordered today that schoolgirls in Texas must be vaccinated against the sexually transmitted virus that causes cervical cancer, making Texas the first state to require the shots.

The girls will have to get Merck & Co.'s new vaccine against strains of the human papillomavirus, or HPV, that are responsible for most cases of cervical cancer.

Merck is bankrolling efforts to pass laws in state legislatures across the country mandating it Gardasil vaccine for girls as young as 11 or 12. It doubled its lobbying budget in Texas and has funneled money through Women in Government, an advocacy group made up of female state legislators around the country.

Details of the order were not immediately available, but the governor's office confirmed to The Associated Press that he was signing the order and he would comment Friday afternoon.

Perry has several ties to Merck and Women in Government. One of the drug company's three lobbyists in Texas is Mike Toomey, his former chief of staff. His current chief of staff's mother-in-law, Texas Republican state Rep. Dianne White Delisi, is a state director for Women in Government.

Toomey was expected to be able to woo conservative legislators concerned about the requirement stepping on parent's rights and about signaling tacit approval of sexual activity to young girls. Delisi, as head of the House public health committee, which likely would have considered legislation filed by a Democratic member, also would have helped ease conservative opposition.

Perry also received $6,000 from Merck's political action committee during his re-election campaign.

It wasn't immediately clear how long the order would last and whether the legislation was still necessary. However it could have been difficult to muster support from lawmakers who champion abstinence education and parents' rights.

Perry, a conservative Christian who opposes abortion rights and stem-cell research using embryonic cells, counts on the religious right for his political base.

But he has said the cervical cancer vaccine is no different than the one that protects children against polio.

"If there are diseases in our society that are going to cost us large amounts of money, it just makes good economic sense, not to mention the health and well being of these individuals to have those vaccines available," he said.

Texas allows parents to opt out of inoculations by filing an affidavit stating that he or she objected to the vaccine for religious or philosophical reasons.

Even with such provisions, however, conservative groups say mandates take away parents' rights to be the primary medical decision maker for their children.

The federal government approved Gardasil in June, and a government advisory panel has recommended that all girls get the shots at 11 and 12, before they are likely to be sexually active.

The New Jersey-based drug company could generate billions in sales if Gardasil — at $360 for the three-shot regimen — were made mandatory across the country. Most insurance companies now cover the vaccine, which has been shown to have no serious side effects.

Merck spokeswoman Janet Skidmore would not say how much the company is spending on lobbyists or how much it has donated to Women in Government. Susan Crosby, the group's president, also declined to specify how much the drug company gave.

A top official from Merck's vaccine division sits on Women in Government's business council, and many of the bills around the country have been introduced by members of Women in Government.

[DalcoTX]

Who have been partially vindicated by having the legal verdict against them vacated. They were not the only manufacturer of COX-2 inhibitors either.

[Smokin' Joe]

I can understand ordering vaccines for contagious diseases like Measles and Mumps..

That, imho, is the salient point. The disease (two strains of over 100 strains of HPV) which the vaccine is supposed to protect against is not transmissable except through optional behaviour. Not something you are likely to catch walking down the hall.

NOR is this an vaccine against cancer, but a virus which appears to lead to one variety of cervical cancer.

[luckystarmom]

Chicken pox can be fatal to people on steroids or have immune problems.

My daughter with asthma used to have to put on steroids to control her asthma, so all of my children got the chicken pox vaccine.

I don't particularly think it should be mandatory, but it was worth it for us.

[Alter Kaker]

I put my daughter's life in the hands of God..

So you don't believe in anti-biotics or appendectomies or insulin?

why do you believe everything they tell you about this vaccine?

Who is this "they" you're referring to?

[Alter Kaker]

The polio pathogen is airborne. You can only get HPV via banging. Big difference.

And you can only contract cholera from eating human excrement. Does that mean you'd be opposed to giving your kid the cholera vaccine if there were an epidemic?

[Alter Kaker]

Your level of concern for others is amazing but shouldn't that be their business instead of yours?

The problem with communicable diseases is that one person's decision not to get vaccinated can affect other people. That's why kids without tuberculosis vaccinations aren't normally allowed to attend public schools in the developed world: because your choice supposedly affecting only your own child can lead to a great many other kids getting sick. If you don't give your daughter the HPV vaccine, not only are you threatening her own life (which I think, as a parent, is utterly irresponsible), but you're potentially threatening other people as well.

[lqclamar]

And you can only contract cholera from eating human excrement

Or ingesting liquid or food that has been tainted by it.

[lqclamar]

If you don't give your daughter the HPV vaccine, not only are you threatening her own life (which I think, as a parent, is utterly irresponsible)

Seriously - cut the hyperbole crap.

Nobody's daughter's life is being "threatened" in any normal sense of the word by not taking this vaccine. There are 150 million women in the United States and less than 10,000 cases of cervical cancer a year. The fatality rate is about 4,000 (40%), and about 9,000 (90%) of the cases are HPV related. Supposing this vaccine has a 70% prevention rate for HPV, that gives us 6,300 preventable HPV-related cervical cancer cases annually and about 2,500 preventable HPV-related cervical cancer fatalities.

IOW, the chance of a female in the United States dying from HPV-related cervical cancer in the next year is 2,500/150,000,000 or only 25 out of every 1.5 MILLION people.

Put another way, you have a better chance of dying from a coconut falling off a tree and hitting you on the head.

[Alter Kaker]

Nobody's daughter's life is being "threatened" in any normal sense of the word by not taking this vaccine. There are 150 million women in the United States and less than 10,000 cases of cervical cancer a year.

But you still have 10,000 people getting a completely preventable cancer each year. Again if you don't vaccinate her, you're putting your daughter at completely unnecessary risk. That's not hyperbole.

[lqclamar]

But you still have 10,000 people getting a completely preventable cancer each year.

Actually 9,000, as roughly 90% of cervical cancer is HPV related. Either way though, it's a miniscule portion of a population of 150 million women. More people die from falling off a ladder every year than that, but I don't see you calling on the government to ban ladders.

Again if you don't vaccinate her, you're putting your daughter at completely unnecessary risk. That's not hyperbole.

Except that the "risk" you describe is so miniscule that it is exceeded in danger by many normal routine daily kids activities such as getting in the car, getting on the school bus, riding a bike, and climbing on the jungle gym. And that is why I say you are engaging in hyperbole.

[af_vet_rr]

Again if you don't vaccinate her, you're putting your daughter at completely unnecessary risk.

Why not leave that decision up to the parents, just as it's the parents responsibility to decide if their children can cross the street or walk down to the playground (both of which carry some risk in and of themselves).

You make some good points, but you fail to address why Rick Perry should be the one making this decision for us, instead of parents. Sure, if you file some papers (nevermind the fact that you are going into a state database as somebody who refused a vaccine) you can opt out now, but it's pretty clear you won't be able to opt out in the future.

As well, this is driven by political cronyism. Perry is doing this because there's money in it somehow for he or his friends (in the case of political donations/support last year, etc.). He's not doing this because he is concerned about every young girl.

[omega4179]

leaving the house is an unecessary risk too.

[luckystarmom]

That is only if she is sexually active. She's not endangering anyone's lives if she is not sexually active.

[stevie_d_64]

All in all its just another brick in the wall...

[newzjunkey]

But the only way somebody can get HIV or HPV is through sexual promiscuity.

That's ignorant bull. It only takes one and sex isn't the only method of transfer.

Suppose your young daughter is raped by the pervert next door or Bill Clinton. Would you feel good about yourself if she gets cervical cancer because you opted her out of this vaccine?

Making it a "mandate" is a good idea and since you *can* "opt-out" it's not really a mandate to begin with.

[newzjunkey]

I believe we send the wrong message to young girls--children--when we assume they need to be protected from what is primarily, if not wholly, a sexually transmitted virus.

Wake up! If she's raped and develops cervical cancer from an HPV infection, you be sure to tell your daughter that you didn't want to send the wrong message about sexual activity.

[newzjunkey]

Unless you have her locked up in your basement you are completely ignoring the outside dangers to your daughter: perverts and rapists. Are they going to not assault her because she's 12 or 14 or still a virgin at 16? Get the vaccine because if she were raped and developed cervical cancer when you could've prevented that further horror, you will find it hard to live with yourself.

[Caesar Soze]

I'm still waiting for the proof that it's as widespread as many people are claiming. Given how rare cervical cancer is (less than 10,000 cases in the entire U.S. last year), either HPV's incidence or its tendency to induce cervical cancer is being SEVERELY overstated.

From HPV Vaccine: A Cornerstone of Female Health. Jonathan L Temte. American Family Physician. Kansas City: Jan 1, 2007.Vol.75, Iss. 1; pg. 28:

HPV is ubiquitous in human populations. Of the more than 40 serotypes of HPV known to cause genital infections, four (types 6, 11, 16, and 18) are responsible for approximately 70 percent of cervical cancer cases and 90 percent of genital wart cases in the United States.2 HPV acquisition occurs rapidly after the initiation of sexual activity. Fifty-four percent of females have been shown to have HPV infection within four years of first sexual intercourse.3 Moreover, sexual activity commences early in the United States: 29.3 percent of ninth-grade girls report prior sexual activity, a number that increases to 62.4 percent by 12th grade.4 Consequently, HPV infection is the most common sexually transmitted disease (STD) in American youth.5

HPV infection has significant consequences. In 2002, there were approximately 14,000 new cases of cervical cancer and 4,000 deaths from the disease, making it the 11th most common cancer in U.S. women.6 In addition, an estimated 300,000 high-grade and 1 million low-grade squamous intraepithelial lesions are detected each year, leading to multiple follow-up visits and invasive procedures (e.g., colposcopies, cervical biopsies). HPV infection accounts for expenditures of more than $2 billion per year and significantly affects patient privacy and comfort.6

The HPV vaccine is extremely effective, especially when it is provided before acquisition of the targeted serotypes. The vaccine prevents over 95 percent of HPV infections caused by serotypes 6, 11, 16, and 18, thus blocking the initial pathogenic step that leads to 70 percent of cervical cancers.2

The "eighty percent by age fifty" figure comes from the CDC, here. I don't know where they got it from, but they provide sources if anyone cares to look.

[YCTHouston]

Got me thinkin' all philosophical-like now...go Colts.

[doc30]

After reading the media reports, I decided to check the CDC for specific information. As you suspected, the 80% figure is media hype and I'm glad I reviewed the information.
From the CDC:

"Approximately 20 million Americans 15 to 49 years of
age (approximately 15% of the population) are currently infected with HPV.[5] Others may have been infected in the past and may no longer have the virus. About half of those who are infected with HPV are sexually active adolescents and young adults 15 to 24 years of age.[5] Between 5% and 30% of individuals infected with HPV are infected with multiple types of HPV.[6] Each year, about 6.2 million people in the U.S. become newly infected.[1]"

Citations:

1. Weinstock H, Berman S, Cates
W, Jr. Sexually transmitted diseases
among American youth: incidence
and prevalence estimates, 2000.
Perspect Sex Reprod Health. Jan-Feb
2004;36(1):6-10.

5. Cates W, Jr. Estimates of the
incidence and prevalence of sexually
transmitted diseases in the United
States. American Social Health
Association Panel. Sex Transm Dis.
1999;26(4):Suppl:S2-7.

6. Revzina NV, Diclemente RJ.
Prevalence and incidence of human
papillomavirus infection in women in
the USA: a systematic review. Int J
STD AIDS. 2005;16(8):528-537.

I also saw this little gem for those who believe that chastity is a foolproof preventative. I don't know if they mean 2% of infections are in virgin girls, or 2% of the virgin girls are infected (my guess). Either way, infections are occurring in virgins, although rare:

"Genital HPV infections are uncommon in women reporting
no previous sexual intercourse, appearing in less than 2% of
this population.[13, 14, 15]"

13. Winer RL, Lee SK, Hughes JP,
et al. Genital human papillomavirus
infection: incidence and risk factors
in a cohort of female university
students. Am J Epidemiol.
2003;157(3):218-226.

14. Rylander E, Ruusuvaara L,
Almstromer MW. The absence of
vaginal human papillomavirus 16 DNA
in women who have not experienced
sexual intercourse. Obstet Gynecol.
1994;83(5 Pt 1):735-737.

15. Kjaer S, Chackerian B, van de
Brule A, et al. High-risk human
papillomavirus is sexually transmitted:
evidence from a follow-up study
of virgins starting sexual activity.
Cancer Epidemiol Biomarkers Prev.
2001;10(2):101-106.

I agree that the use of statistical sampling is important for extrapolating to the whole population. However, these are not social studies, like 1 in 10 are gay or 1 in 4 are molested where it's a matter of personal perspective on a subjective questionnaire. This information is synthesized from physician reports in the way diseases are normally tracked. Now, if you want the specific methodologies, you can pay for the relevant articles and review them yourselves since I don't feel like forking out a couple of hundred bucks for all of them. I'm inclined to go with the peer review process for the publications.