Lawmakers weigh adding HPV vaccine to immunization list

Opponents question need, cost; advocates say lives saved

Bill Scanlon, Rocky Mountain News

Monday, March 12, 2007

The thought of 12-year-old girls being vaccinated against a virus spread by sexual activity sends shudders through some Colorado parents who can't imagine their daughters needing such protection for years.

But others say you can't be certain what your children will do next month, not to mention five years from now. And that it's better to protect them against the unforeseen than to watch them die at a tender age.

Legislators are trodding difficult territory while trying to decide whether to add the new HPV vaccine to the list of immunizations given to schoolchildren. Human papillomavirus is often transmitted through sexual activity and causes 70 percent of the cases of cervical cancer.

If the bill becomes law, the HPV vaccine would be given to sixth-grade girls starting in 2008. As with other vaccines - for whooping cough, measles, tetanus and the rest - it would not be mandatory. Parents could choose to say "no" to the vaccine for religious or other reasons.

The debate has stirred old passions about whether parents should have the final word, whether offering teens protections against sexually-transmitted diseases encourages promiscuity, and whether there's a limit on how much society should spend to save one person's life.

"I'd encourage my daughters to get the vaccine," Dr. Kevin Davis, a gynecological oncologist from Englewood said. "I see cervical cancer in women in their 20s and 30s all the time. From a health-maintenance perspective, the vaccine is a very good idea."

But Dr. Julian Whitaker, speaking for the anti-vaccine Freedom of Health Foundation, said the big winners won't be American women, but Merck shareholders.

"Evidence of its benefit is so scanty, it may do nothing but make Merck $12 billion," he said.

Merck officials have used connections in Women in Government chapters to push state legislators to sponsor legislation to add its Gardasil HPV vaccine to the list of immunizations.

Under pressure in Colorado and other states, Merck recently decided to stop lobbying efforts in state legislatures.

Opposition to vaccine

Those who oppose the vaccine argue it is unnecessary and expensive.

Whitaker, a nutritionist in Newport Beach, Calif., said it makes no sense to target the vaccine at 12- and 13-year-old girls because "most cervical cancers hit later in life."

He noted that regular pap smears can catch 95 percent of precancerous dysplasia early enough for effective treatment. He worries that the vaccine will give false security to young women who will forgo pap smears.

Most of the time, a woman's own immune system can fight off the virus, he said.

At best, the vaccine will save 3,000 American lives a year, he said. With tens of millions of women getting the virus, that comes to about $5 million for every life saved, he estimates.

"It's very callous to put a dollar figure on a saved life, but let's look at what else we could do with the money," he said.

Wouldn't that money be better used giving vitamins to diabetics or making sure all school children got five servings of fresh vegetables a day, he asked.

Defusing debate

But supporters say the cost isn't as high as critics are calculating. If most girls and young women get the vaccine, it could save 3,000 lives every year - or even more because by then the efficiency of transmission would be greatly lowered. That would lower the cost per saved life to $500,000 or less.

"Any life saved is worth it," said State Sen. Suzanne Williams, D-Aurora.

The Freedom of Health Foundation says some people who've gotten the vaccine have complained of joint pain, seizures and neurological problems.

But Davis said the same complaints about safety were trotted out when the Hepatitis B vaccine first came out. "That's been a very safe vaccine," and has greatly lowered the risk of liver cancer, he said. "In all the studies I've read about HPV vaccine, the only complaint is pain at the injection site - in the biceps or the buttocks. But all in all, that's been mild."

Davis rejects the notion that the HPV vaccine will encourage promiscuity in a generation of young women who suddenly have less fear of cervical cancer.

Dr. Ned Calonge, Colorado's chief medical officer, said the one-two punch of the vaccine and yearly pap smears would be very effective.

The vaccine will prevent 70 percent of HPV infections, thus preventing 70 percent of cervical cancers. It also will prevent most infections that cause all sorts of cervical lesions that require medical treatments.

The great diffuser of the debate is that the vaccine isn't going to be mandatory.

Davis, a proponent of the vaccine, said the vaccine must remain an option.

Williams noted the only mandatory part of her bill would be that parents would be given information drawing the link between HPV and cervical cancer. Whether their girls get the vaccine is up to them.

scanlon@RockyMountainNews.com or 303-442-8729