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Should the HPV vaccine become
mandatory for girls?

Point: Yes, it will help prevent diseases; Counterpoint: No, it was inadequately tested.

Summer 2007
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Should vaccination against human papillomavirus become mandatory for girls?

Jillian Tamaki

POINT: The HPV vaccine will help prevent diseases, which is far preferable to treating them, says Marilyn Tavenner, Virginia’s secretary of health and human resources, a registered nurse and former national president of outpatient services for the Hospital Corporation of America.

Earlier this year Virginia’s legislature became the first in the nation to require sixth-grade girls to be vaccinated against HPV, a virus that can lead to cervical cancer and whose deadliest strains are transmitted sexually. Although inoculation will cost approximately $360 per child for a series of three injections over a six-month period, Virginia will likely save health care dollars in the long run: By inoculating preadolescents, thousands will be spared from surgery, hospitalization or premature death. The Centers for Disease Control and Prevention (CDC) estimates that the cost per quality-adjusted life year saved by vaccinating against high-risk HPV types 16 and 18 is as much as $25,000, which compares favorably with other preventive interventions. (The cost saved by screening for hypertension in 40-year-old men, for example, is at least $28,000.)

HPV infection is a major cause of cervical cancer. An estimated 11,150 cases of invasive cervical cancer will be diagnosed in the United States in 2007, of which about 3,670 will eventually be fatal, according to the American Cancer Society. The CDC also estimates that 6.2 million Americans are infected annually with HPV via sexual transmission.

Merck’s vaccine, Gardasil, helps protect against the two HPV strains—16 and 18—that are responsible for 70% of cervical cancers. Gardasil is also effective against HPV types 6 and 11, which do not lead to cancer but cause roughly 90% of cases of genital warts. In a recent study (published in the Journal of the American Medical Association [JAMA], Feb. 28) of females ages 14 to 59, 73.2% had no detectable HPV infection, 23.4% had a strain not covered by Gardasil and 3.4% carried the four strains it does cover. Both Merck and GlaxoSmithKline (which produces Cervarix, currently under FDA review) are working on improving their vaccines to cover more types of HPV.

Studies on Gardasil’s safety are reassuring. The vaccine contains no potentially infectious live virus. Although safety-study participants in the youngest category (ages nine to 15) numbered only approximately 1,100, the vaccine was extremely effective in that age group: More than 99% developed antibodies after vaccination. And the four studies analyzed by the FDA prior to approval included 21,000 women ages 16 to 26. Even more safety data will be available by the time routine inoculation begins in the fall of 2009.

To address the concerns of parents who believe the decision to immunize should rest with them rather than the state, Virginia offers a good middle ground: It allows a voluntary opt-out and it provides that parents receive materials describing the link between HPV and cervical cancer.

There is no cure for HPV, only treatments for diseases the virus causes. Mandating the vaccine means it will reach sufficient numbers of young women to make a difference in curbing a cancer that claims too many lives.

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