No one will argue cervical cancer isn't deadly. The disease, which killed 30 percent of the 11,000 U.S. women it affected last year, ranks as one of the nation's top causes of death. Any doctor is glad to roll out those statistics.
For years, nothing short of abstinence and maybe luck could have prevented the human papillomavirus, or HPV, one of the leading causes of cervical cancer. The new magic bullet is a vaccine. Developers claim the drug is 100 percent effective in preventing four strains of the virus, and promises to prevent strains that cause 70 percent of cervical cancer and 90 percent of genital warts.
It sounds like a wonder drug, and no one argues with the vaccine's potential. But not everyone is sure about the speedy move by Florida lawmakers to force parents to vaccinate or file a waiver by the time their daughters turn 12.
Legislation requiring vaccination is being considered in 20 states, including Florida; and in Texas, Gov. Rick Perry zipped right past Congress by signing an executive order mandating the vaccine for enrollment into sixth grade. The most contentious aspect of the brewing debate? Not only the effort to force it into law, but the rush to do it now.
The Food and Drug Administration approved the drug just last summer. But some vaccines — such as the chicken pox vaccine — are tested for years after FDA approval before states make them mandatory. Not so this time.
Rep. Ed Homan, R-Tampa, a physician, introduced the House bill with lightning speed after the vaccine was FDA-approved because of "dire heath concerns and the ability to save thousands of women."
"Nobody dies from chicken pox. There's a huge difference between kids missing a few days of school versus someone dying," Homan says.
The polio vaccine is an example. It quickly found its way onto required vaccination cards despite a short test period.
During the 1940s and 50s thousands died of polio, predominantly during the broiling summer months. In 1952, at the height of the epidemic, 58,000 were infected with the virus. Parents began informally quarantining their own kids, convinced that every dirty- fingered neighborhood child was carrying the deadly disease. By the time a vaccine was introduced, no one could get hold of it fast enough.
The polio vaccine was tested in 1954 before moving on to mass distribution the following year. It ultimately led to the modern movement of mass inoculations.
"They couldn't make the vaccine soon enough," says Homan, who notes this effort is akin to the polio vaccine in that "the rush is about saving lives."
He adds that influenza vaccines, often given to the sick and elderly, are only tested for about a month.
Still, he says there is no blanket mandate to force parents to vaccinate their children against HPV. He also lets out a hefty sigh over the new catchphrases "opt in" and "opt out."
Referring to the move as "parental choice," Homan says parents have the option of bringing in one of two items — a stamped vaccination card or an easy-to-obtain slip of paper signed by a parent noting they elect not to vaccinate their daughter, no reason required.
Mandating, he says, would force families to ensure their daughters are vaccinated; while under the proposed bill, parents could decline to have their daughter vaccinated for any reason. Waivers would be easy to file, he says. If that's true it would be a change from the current system, which requires parents to jump through a lot of hoops to opt out of vaccinations.
Merck, the only maker of the vaccine, dubbed Gardasil, backed off an aggressive marketing campaign two weeks ago when it became clear that mandatory vaccinations were controversial, especially among conservative Christian groups. If girls were taught abstinence, they argued, they wouldn't contract HPV. A number of doctors and health officials also expressed concern about the move to push the vaccine through the Legislature.
Merck, which stands to rake in a bundle as the only producer of the vaccine, announced plans to roll it out gradually. Florida lawmakers may also push back the HPV vaccine requirement until next year because of the fiery debates, though they had hoped it would be in place this year.
"Public health-wise it makes sense, but parents should still be able to choose. I don't think the vaccine needs to be mandated," says Orlando gynecologist Jennifer Hamm.
The FDA has recommended that girls be vaccinated between the ages of 11 and 12, before entering middle school. (Requirements have long been in place to vaccinate for hepatitis B, which, like HPV, is sexually transmitted. Hepatitis B also can be transmitted through sharing dirty needles.)
Michael Sheedy, associate director for health of the Florida Catholic Conference, says he recognizes the benefits the vaccine could offer, but that requiring parents to either vaccinate or "opt out" simply isn't justified because HPV spreads through sex and those who are not sexually active aren't at risk.
"Parents should be able to opt in. This is not spread casually," Sheedy says.
Sheedy says another dilemma is that the vaccine would not protect against HIV or other sexually transmitted diseases. He says the vaccine could encourage casual sex and make young girls more promiscuous, while suggesting that abstinence is the preferred method for avoiding such diseases.
Homan scoffs at the idea that girls who receive the vaccine will become more promiscuous, as some religious leaders have asserted.
"When you wear a seat belt, you don't expect to get in a wreck just because you have your seat belt on," he says. "It's all about emotions and catchy headlines."firstname.lastname@example.org