Mandatory HPV Vaccination and Political Debate article
When the FDA approved an HPV vaccine in 2006, conservative religious groups strongly
opposed it, arguing it would condone premarital sex and undermine parental rights. Yet an
executive order was signed in 2007 making Texas the first state to make it mandatory but it was
later evoked by state legislature.
HPV is the most common STI in the US with 20 million people currently infected and 6.2
million newly infected each year. The overall prevalence is 26.8% with increasing prevalence
from each age year from 14-24 years followed by a gradual decline through age 59 years. High
risk HPV types are detected only in a very small amount of women.
Nononcogenic HPV types 6 and 11 are associated with genital warts and recurrent respiratory
papillomatosis (a disorder characterized by growth of many warts). Highrisk HPV types are
detected in virtually all cervical, vaginal, and vulvar cancers in women, and HPV types 16 and
18 are associated with 70% of cervical cancers. Human papillomavirus also is associated with
cancer of the penis, as well as cancers of the oropharynx and anus in both women and men.
In June 2006, FDA licensed an HPV vaccine against types 6, 11, 16, 18 (it’s a quadrivalent
meaning this single vaccine targets those 4 antigens) for use among women aged 9 to 26. In Oct.
2009, the FDA approved a bivalent vaccine for types 16 and 18. The ACIP recommends
vaccination of either the quadrivalent or tetravalent with 3 doses that can start from 9 until 11-12.
The ACIP recommends a “catch-up” vaccination for girls and women aged 13 to 26 years who
have not been previously vaccinated. Quadrivalent HPV vaccine may be given to boys and men
aged 9 to 26 years.
Although clinical trial evidence has not demonstrated prevention of invasive cervical cancer
from HPV vaccination, it has shown that the vaccine is almost 100% effective in preventing
infections associated with HPV types included in the vaccine. Adverse effects were minor and
similar to those found with most vaccines, such as dizziness, fainting, and injection site
Only Texas (evoked), Virginia, and Washington DC have enacted HPV vaccine mandates but the
two states offer opt-outs at the participants’ discretion. New Hampshire, South Dakota, and
Washington distribute free vaccines. A lack of mandates may be due to drug company lobbying,
public backlash, gender equity, and cost.
Drug company lobbying: Following FDA approval of the quadrivalent vaccine, the manufacturer
Merch lobbied for compulsory vaccination laws (they donated money to Republican nominees).
This fuels public distrust of lawmakers.
Public backlash: HPV mandates bring about socially divisive implications such as adolescent
sex, bodily integrity, and parental responsibility. However, there is no evidence that HPV
vaccines increase sexual activity among adolescents. Moreover, HPV vaccination is different
from most diseases warranting compulsion because the virus is not airborne and does not pose
immediate risks of transmission through casual contact such as in schools. Gender Equity: People think it’s not fair that young girls are compelled to submit to a new
vaccine when boys are not (even though men have equally high HPV rates and are as likely to
transmit the infection to partners.
Cost: HPV vaccine is the most costly vaccine.
The article suggests that governments should implement a well-funded campaign to increase
HPV vaccination rates as part of a comprehensive sexually tra