The five things you need to know about the HPV debate
Gardasil is one of the FDA-approved vaccines to protect against the types of HPV that cause most cervical cancers.
September 14th, 2011
02:18 PM ET

The five things you need to know about the HPV debate

The U.S. Centers for Disease Control and Prevention has suggested that parents have their middle-school-aged daughters vaccinated against a sexually transmitted disease closely linked to cervical cancer.

The human papillomavirus is the most common STD, according to the Centers for Disease Control and Prevention, and the second leading cause of female cancer mortality worldwide, according to the World Health Organization. There are currently two FDA-approved vaccines - Gardasil and Cervarix - to protect against the types of HPV that cause most cervical cancers.  While each vaccine uses different substances to rev up the immune system, both are given as shots and must be received in three doses over a six-month period, according to the manufacturers.

That's nothing new.

1. So, why is there such a debate swirling around the issue? Well, politics.

You've probably seen headlines about the HPV vaccine for years now, so what's new? A bigger spotlight, essentially, and the vaccine has come up amid jockeying for the GOP presidential nomination.

The debate over the use of the HPV vaccine - and specifically how it is given and who can mandate it - became a hot topic after some tense exchanges during Monday’s CNN/Tea Party GOP debate.

GOP presidential contender Rep. Michele Bachmann challenged one of her rivals for the Republican nomination, Texas Gov. Rick Perry, on his 2007 executive order that would have required Texas schoolgirls to receive vaccinations against HPV. Bachmann suggested the governor acted for political reasons, noting that the maker of Gardasil - the only Food and Drug Administration-approved HPV vaccine at the time – contributed to his campaigns, and that his former chief of staff lobbies for the company. She also said the drugmaker, Merck & Co., stood to make millions of dollars because of the order.

Truth Squad: Was Bachmann's claim about Perry's mandate for political reasons true?

Bachmann’s challenge came as candidates discussed the pros and cons of executive orders, and when and how the president should use one.

Perry said during the debate that if he could do it over again, he wouldn’t use an executive order, but would work with the legislature.

2. OK, wait. What actually happened in Texas?

Since 2006, 19 state legislatures have attempted to pass legislation that would mandate HPV shots for school, after the CDC recommended that parents be advised that the shot was a good idea and a way of preventing cervical cancer.

Perry took that one step further. In February 2007, he signed an executive order directing the state Health and Human Services commissioner to mandate HPV vaccinations for all girls before admission to the sixth grade. Perry at the time released a statement saying that the vaccine "provides us with an incredible opportunity to effectively target and prevent cervical cancer.”

Texas' rules were to take effect in September 2008. However, the Texas Legislature passed a bill overturning Perry's order in April 2007. Perry declined to veto the bill, which went into effect in May 2007, killing his order.

3. Politics aside, what are the health concerns?

We've been vaccinating kids - by mandate - for school for years.  And for all of those vaccines, parents have the ability to opt out. Again, that's nothing new.

But public perception is changing.

The debate over vaccinations picked up steam after concerns and arguments over whether childhood vaccinations were linked to autism or other diseases became another hot topic. Some were quick to warn of harmful side effects. And then, some medical journals retracted studies linking the two.

Many advocates against vaccinations still said that not enough was known and stood by the idea that there was a connection.

During Monday’s debate, much of the brouhaha over the HPV vaccine centered more on how Perry approached the issue than the vaccine itself. After the debate, Bachmann did touch on whether the vaccine was safe: She said parents told her that the vaccine had made their children sick.

But when it comes to the HPV vaccine, the CDC breaks it down pretty easy: It is safe and can go a long way in preventing a deadly cancer. The CDC says studies of the vaccine "showed no serious side effects," but "common, mild side effects included pain where the shot was given, fever, headache, and nausea." The CDC has said that if you get sick after the shot, it's a coincidence, not cause and effect, CNN's Senior Medical Correspondent Elizabeth Cohen reports.

Then there's the issue about the age of vaccination.

Middle school children are the targets of the vaccine, and there are some concerns about whether they should be vaccinated at an age when many may not be sexually active. And in some conservative areas, there is concern that the vaccine might encourage children to have sex at an earlier age.

4. So what do the vaccines do?

The FDA has licensed two HPV vaccines recommended by the CDC: Cervarix and Gardasil.

So what are the similarities? According to the CDC:

■ Both vaccines are very effective against HPV types 16 and 18, which cause most cervical cancers. So both vaccines prevent cervical cancer in women.

■ Both are very safe.

■ Both are made with very small parts of the human papillomavirus (HPV) that cannot cause infection

■ Both are given as shots and require three doses.

And what are the differences? According to the CDC:

■ Only one of the vaccines (Gardasil) protects against HPV types 6 and 11 - the types that cause most genital warts in females and males.

■ Only Gardasil has been tested and licensed for use in males.

■ Only Gardasil has been tested and shown to protect against cancers of the vulva, vagina and anus.

■ The vaccines have different adjuvants, substances that are added to increase the body's immune response.

(You can read more about HPV and the vaccines from the CDC here.)

5. Where do things currently stand across the country with regard to the vaccine?

Of the 19 states that tried to pass legislation mandating vaccination for children to attend school, only two passed the legislation. (You can see a full list of the attempted bills in each state here.)

Only Virginia and Washington, D.C., have passed measures to require the mandate. In Virginia, the legislature tried to reverse the mandate. The state's House passed the reversal, but the bill was killed in a Senate committee, so the mandate still stands.

Even there, where this is a mandate, it appears that more families are choosing to opt out of the program than to take part in it.

"Just 17.3 percent of eligible girls had received the first of three vaccinations, as envisioned by the law, at the start of this school year," according to Rosalind S. Helderman, writing for The Washington Post in February. "Only 23 percent of this year's eligible sixth-graders in the District have received the vaccine."

soundoff (736 Responses)
  1. Bimbo the Birthday Clown

    Recognize this for what it is – a money grab by the drug companies.

    The vaccines protect against human papillomavirus. All well and good. If that is what you are getting the vaccination for, and you have made an informed decision, fine. But they do NOT make a woman immune to cervical cancer. Their own data shows a statistical link between human papillomavirus and cervical cancers, but not ALL cervical cancers are thought to be caused by human papillomavirus.

    As a STD immunization, the vaccines are worth millions marketed to women who feel it is a good idea. As a cancer immunization (which it is not) it is worth billions, sold to younger girls with their parents' permission.

    September 14, 2011 at 2:42 pm | Report abuse |
    • DrUM

      I am a Pathologist and study and diagnoses gynecologic cancers regularly. About 99% of cervical cancers are caused by HPV . So "Bimbo" you are wrong. This vaccine DOES prevent cancer. Please protect your kids. If you don't, for moral or political reasons, you'll live to regret it later if you child suffers from this preventable disease.

      September 14, 2011 at 3:19 pm | Report abuse |
    • TWLSCS

      I tend to believe Bachmann on the effects of the vaccine cuz, well – it takes one to know one.

      September 14, 2011 at 4:00 pm | Report abuse |
    • Informed

      This vacine only prevents a couple of the HPV infections. And most people will clear the virus on their own. They have no idea how long the effects will last. This alone may incourage unprotected activity that may lead to infection in years to come. Pap smears are still available with no side effects. I would never give this vacine to my daughter. Google Gardasil controvery and read the report by abcnews from 2009 and decide for yourself.

      September 14, 2011 at 4:16 pm | Report abuse |
    • GOP Logic

      Mr. Informed is not very informed. His entire post is centered around the "vaccines are bad, m'kay" mindset. He even tells you to google "tell me lies about gaurdisil". You would be better to just google gaurdisil, maybe look at the studies, maybe ask you doctor, maybe ask yourself if preventing cervical cancer is important. Does cervical cancer run in my family??? maybe i should vaccinate my kids???

      September 14, 2011 at 4:53 pm | Report abuse |
    • Bimbo the Birthday Clown

      Really, DrUM? As a pathologist, I'm sure you are aware of the reservations expressed by one of the vaccine's development team, Dr. Diane Harper. If not, check it out. I worked in pharmaceutical research for a while, and I can sympathize with her.

      September 14, 2011 at 5:56 pm | Report abuse |
    • Johan S

      Making the vaccine mandatory with an opt out makes far more sense than opt-in .. how can irresponsible parents who ignore multiple notifications and news reports be expected to have taught their kids "moral values" .. those kids are probably out having ss.e.x and spreading cervical cancer .. they're the ones who need it. Opt out makes sense!! Opt in means those who need it won't get it!

      Also having moral values won't save people from getting HPV via accidental blood exposure and forced ra,pe.

      September 14, 2011 at 6:05 pm | Report abuse |
    • zamboni

      Sorry Bimbo – Drum is right. I have worked in an adolescent medicine department at a children's hospital and at a cancer hospital in the past 8 years in research. This vaccine is important and can prevent cervical cancer in women. It is imperative that females begin getting this vaccine before they engage in risky behavior (which to be safe is around the age 11-12). More than 80% of adults have HPV and while not all HPV causes cancer – the strands that do are enough reason for our CDC to want this vaccine in all women. Save the "oh its all a ploy for drug companies to get more money" This country is disgusting and everyone is out for making money – don't use capitalism as an excuse to overlook something important. Instead look at the facts and make decisions based on good fact checking.

      September 14, 2011 at 6:11 pm | Report abuse |
  2. Jj

    Anyone notice that weiners dem seat got taken by a republican? sign of things to come...

    September 14, 2011 at 3:00 pm | Report abuse |
  3. Wallace

    how about a "sixth" thing...

    September 14, 2011 at 3:13 pm | Report abuse |
    • IggyDad

      Your 6th thing is a whole lot of nothing.

      September 14, 2011 at 4:19 pm | Report abuse |
  4. sean

    "Side effects such as paralysis, Bells Palsy, Guillian-Barre Syndrome and seizures have been reported." Of course the FDA will allow this, but won't allow other every day medications pulling routine items off the shelf (like Medrol)...give me a break. I think it should be up to the parents/children to decide and NO Mandates, it's not contagious!!!

    CNN don't try to link this push back to the push back against the vaccine to children believed by some to cause autism, the only similarity between these two is that they both are called "vaccines" nothing else.

    September 14, 2011 at 3:19 pm | Report abuse |
    • Mommarooni

      Actually, HPV is indeed contagious. And that list of side effects appears for virtually any vaccine out there. Not much in life is risk free, but as a mother I'd rather a minute (and it IS minute) risk of serious side effects from a vaccine than the diseases they protect against. HPV is rampant, and rapidly spreads in the teen and young adult population.

      September 14, 2011 at 3:41 pm | Report abuse |
    • Dana

      What are you talking about "not contagious". Do you not understand what that word means? HPV is caused by a virus - that is, a CONTAGION.

      September 14, 2011 at 4:03 pm | Report abuse |
    • Anomic Office Drone

      Sean is what happens in states that only teach abstinence.

      September 14, 2011 at 4:13 pm | Report abuse |
    • AM

      I bet Sean believe HPV is created by the pharmaceutical companies just so they can develop a vaccine to make money.

      By the way – the industry actually makes little money from vaccinations. Yes, little money when you factor in the cost of development. Get a grip people. I despise Perry. I think he's an absolutely evil person, but this was not the reason he mandated the vaccine.

      September 14, 2011 at 4:17 pm | Report abuse |
    • michelle

      The serious adverse effects were not reported more frequently in vaccinated people than in non-vaccinated people. Therefore, the vaccine in all likelyhood did not cause the serious problems.

      September 14, 2011 at 4:27 pm | Report abuse |
    • Johan S

      Those side effects are extremely rare .. much rarer than cervical cancer from HPV. Also a lot of the paralysis cases were temporary .. whereas cervical cancer is devastating.

      September 14, 2011 at 4:41 pm | Report abuse |
    • Johan S

      Every drug has side effects. There is no medicine that doesn't have side effects.

      Making the vaccine mandatory with an opt out makes far more sense than opt-in .. how can irresponsible parents who ignore multiple notifications and news reports be expected to have taught their kids "moral values" .. those kids are probably out having ss.e.x and spreading cervical cancer .. they're the ones who need it. Opt out makes sense!! Opt in means those who need it won't get it!

      September 14, 2011 at 5:16 pm | Report abuse |
  5. bobcat2u

    Remember too, Rick Perry has been pushing this in Texas, even though he now denies it, and he has a large monetary stake in the company that produces this drug. Choice should be left to the parent and daughter. If she's brought up with morals, there won't be a worry.

    September 14, 2011 at 3:21 pm | Report abuse |
    • Guest

      What does being brought up with "morals" have to do with contracting HPV? This isn't going to go away by just raising our girls with "morals". I vaccinated my daughters, because although I raised them with "morals", they will still grow up and marry. What then? Morals won't protect a wife from contracting HPV from her husband.

      September 14, 2011 at 4:26 pm | Report abuse |
    • Kodiak

      Morals? And suppose the man she marries has it? Or contracts it during his lifetime and gives it to her? HPV is one of the fastest spreading body contact viruses (not blood/fluid borne, like HIV), and it is estimated that eventually virtually everyone will have it. There are thousands of HPV strains and this vaccine protects against only a handful, but it is better than nothing. One thing not mentioned is that HPV has now been recognized as a major cause of head and neck cancer...much harder to detect than cervical cancer and usually not discovered until it is too late. This is a dangerous virus and I will not be surprised when other cancer links are announced.
      Oh...and the knowledge that HPV causes cervical cancer is nothing new. I knew about it in the early 1980s, so researchers have probably known even longer. The information just wasn't released to the public until a treatment was developed. Makes you wonder what else they know.

      September 14, 2011 at 4:37 pm | Report abuse |
    • user37

      Bobcat4u... how can you be so willing to gamble your childrens' lives/health on your ability to teach morals? I can imagine that many youth who are 'brought up with morals' end up in a situation in which they may contract HPV. If you do the math on serious side effects vs. number of vaccines administered, and factor in that many of the side effects and even deaths are possibly coincidental (32 out of 25 million is a very small number), you can see that the odds of death are safer from this vaccine than many popular activities kids engage in, like riding in a car.

      September 15, 2011 at 12:08 am | Report abuse |
  6. Jordan scene©

    I believe its good to be aware of HPV and cervical cancer and the available precautions. I don't believe, however, that our government should be able to mandate that all middle school girls need the shot. Since when does the government reserve the right to tell us what goods and services we have to buy? Just more government meddling, because they know better than these girls parents..

    September 14, 2011 at 3:53 pm | Report abuse |
    • AM

      I know. How DARE the government try to prevent the spread of deadly disease. The NERVE.

      September 14, 2011 at 4:14 pm | Report abuse |
    • realist

      One could argue that the government has a well established precedent for insuring the health and welfare of children (child support, child protective services, etc) and has decided that it is important to protect children from the risk of getting infected with a virus that may ultimately cause cancer regardless of the parents preference. One might equate it with mandating blood transfusions for children against the parents religious wishes.

      September 14, 2011 at 6:00 pm | Report abuse |
    • Joan

      Thank you for being a voice of reason in a world filled with those who want big brother to do their thinking for them. Even doctors are foregoing the shots because the side effects are WORSE than the 'protection'.

      "Dr. Scott Ratner and his wife, who's also a physician, expressed similar concerns as Dr. Harper in an interview with CBS News last year. One of their teenage daughters became severely ill after her first dose of Gardasil. Dr. Ratner says she'd have been better off getting cervical cancer than the vaccination. "My daughter went from a varsity lacrosse player at Choate to a chronically ill, steroid-dependent patient with autoimmune myofasciitis. I've had to ask myself why I let my eldest of three daughters get an unproven vaccine against a few strains of a nonlethal virus that can be dealt with in more effective ways.";cbsnewsLeadStoriesPrimary

      September 26, 2011 at 11:04 am | Report abuse |
  7. Susan

    I want to get my daughters vaccinated – just hoping insurance will cover it. How could you NOT want all girls to get this vaccine? Now that is crazy.

    September 14, 2011 at 4:00 pm | Report abuse |
    • footbol

      Susan, seems you have an Internet connection. I suggest you put it to good use and do just a tiny bit of digging. One stat is less than 8k people in the us get it annually – BUT tween girls is a dream demographic for the machine. Side effects are very serious. Please come back here to post your results after you vaccinate you daughters. Best of luck~

      September 14, 2011 at 4:18 pm | Report abuse |
    • michelle

      The adverse effcts are mild (injection site reaction, feeling cruddy the next day). The serious adverse effects do not occur more frequently in vaccinated people than in unvaccinated people. That's the science, anyway. Also, if you have sons, they should be vaccinated too since HPV is becommming an important cause of head-and-neck cancers in men.

      September 14, 2011 at 4:33 pm | Report abuse |
    • Kodiak

      footbol, are you crazy? 8K a year? From what fundy whacko site did you hear that insanity? The CDC estimates that by the age of 50, 80% of American Women will have contracted at least one strain of HPV. With numbers that high among women, the rate for men would almost certainly approach 100%. And, since it is a bodily contact virus, condom use does not protect against it (although it does cut your risk in half). Millions contract this virus annually.

      September 14, 2011 at 4:47 pm | Report abuse |
  8. Dana

    We literally developed a vaccine for cancer, and the Republican party line is against it.

    September 14, 2011 at 4:04 pm | Report abuse |
    • Jess

      The raging inner war they must be having must be making them lose sleep at night. Moneymoneymoney or spouting "family values" rhetoric that wins over the votes?

      September 15, 2011 at 11:20 am | Report abuse |
    • Loren


      September 15, 2011 at 12:43 pm | Report abuse |
  9. GOP Logic

    If there were a proven vaccine for AIDS that had to be taken in middle school, parents would still opt out because their little one is NEVER going to be at risk for this.

    September 14, 2011 at 4:10 pm | Report abuse |
  10. AM

    Shame on CNN for implying that all research (resounding, by the way) confirming that vaccines actually are NOT linked to autism might not be the whole story because some parents still think their child's autism was caused by a vaccine. Bad journalism, CNN. The debate is over. Why waste any more effort on looking at the wrong cause?

    September 14, 2011 at 4:12 pm | Report abuse |
  11. BigBill8517

    Speaking as a Conservative Christian to Conservative Christians......Even good Conservative Christian girls become vulnerable when they fall in love. Get the shot.

    September 14, 2011 at 4:13 pm | Report abuse |
    • checi

      Then why not demand that good christian conservative BOYS keep their hands off the girls? We have to dose the girls because boys are seducing them?

      September 14, 2011 at 4:24 pm | Report abuse |
    • Michelle

      Good advice, Bill. And maybe advise that boys get the vaccine, too. Those viruses cause more problems than just cervical cancer, including head and neck cancer.

      And checi, don't delude yourself into thinking the girls are innocent flowers being led astray by naughty boys. I was in high school. I know full well that the girls wanted "it" just as much as the boys in many cases. I've even seen girls pressure their boyfriends into physical intimacy before the boys wanted it.

      Also... for the record. I'm 31 years old, remained a virgin by choice until I was 21, am married and monogamous, and have never had an STD. I'm also a liberal gay agnostic. Cheers!

      September 14, 2011 at 5:52 pm | Report abuse |
    • BigBill8517 a perfect world. Unfortunately our boys and girls are being exposed to pressures that were not there when I was growing up, when just increasing hormones were difficult in themselves to deal with and remain faithful to God.'re right. Even boys would benefit from this vaccine according to my R.N. wife. It prevents std's other than cervical cancer.

      September 15, 2011 at 6:50 pm | Report abuse |
  12. steve

    Gardasil, the human papillomavirus (HPV) vaccine made by Merck [a US pharmaceutical company]." The suspension was made after four deaths and more than 120 complications were reported by young women who had received the Gardasil vaccine.

    Concerns have surrounded the use of Gardasil in the US for years, with more than 18,000 adverse events and 72 Gardasil related deaths in having been reported in the US since the vaccine's release in this country in 2006.

    September 14, 2011 at 4:16 pm | Report abuse |
    • AM

      Steve – appropriate citations? 72 Gardasil-related deaths in the U.S.? Are you joking? That's not true. However, let's assume it was. How many women have died from cervical cancer in the U.S. since 2006? I rest my case.

      September 14, 2011 at 4:19 pm | Report abuse |
    • LogicNotHysterics

      No, you are completely wrong. The fact that someone dies of a drug overdose, or a car accident, after receiving Gardasil, does not mean the Gardasil killed them. You need to actually read the CDC data not just look at the numbers of deaths (can you imagine if you blamed the flu vaccine for the death of every person over age 70 who died within 1 month or 1 year of receiving a flu shot? Same thing here.) - "As of June 22, 2011 there have been a total 68 VAERS reports of death among those who have received Gardasil® . There were 54 reports among females, 3 were among males, and 11 were reports of unknown gender. Thirty two of the total death reports have been confirmed and 36 remain unconfirmed due to no identifiable patient information in the report such as a name and contact information to confirm the report. A death report is confirmed (verified) after a medical doctor reviews the report and any associated records. In the 32 reports confirmed, there was no unusual pattern or clustering to the deaths that would suggest that they were caused by the vaccine and some reports indicated a cause of death unrelated to vaccination."

      September 14, 2011 at 4:38 pm | Report abuse |
    • mranthrope

      re Logic... 3 cases of debilitating transverse myelitis in a patient population of 300 separated in time by a period of months occurring within a month after recieving Gardasil bears consideration, not a knee jerk HAVE IT I find it particularly interesting that not causing myelitis is addressed in the clinical trials. Why was that specifically addressed?

      September 18, 2011 at 9:10 pm | Report abuse |
    • mranthrope

      I do admit that my previous comment is strictly anecdotal, but one of the girls is my neice. I am only addressing this specific vaccine, in general vaccinaion is one of he greatest achievements of mankind

      September 18, 2011 at 9:13 pm | Report abuse |
  13. linda

    Parents should have choices to mandate is wrong.
    The most important thing is to be informed, and then make the decision.

    September 14, 2011 at 4:16 pm | Report abuse |
  14. yada

    By the early 50's, three of my cousins had contracted polio. Thankfully my sibblings and I were vaccinated. Get the shots! We're talking about cervical cancer here! Good Grief! What's the problem?

    September 14, 2011 at 4:18 pm | Report abuse |
  15. generalissimo

    Backman is fear-mongering. She sounds like the child of the parent she allegedly met after the debate: Retarded, to use Bachman's words. Perhaps there is more "retardation" in her family than she lets on, which would explain her hysteria. Unfortunately, there is no vaccine against shrieking bloody nonsense.

    September 14, 2011 at 4:18 pm | Report abuse |
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