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. ardis

    Will someone from Texas enlighten us? Does the state of Texas pay for the vaccine?

    September 15, 2011 at 4:35 am | Report abuse |
  2. hallie

    I was older when I got the vaccine and a few months after I got the vaccine I came down with herpes which has haunted me ever since. I believe that it affected my immune system, and that I may have had the virus from a relationship long ago, but it caused it to become active and now it's constant. I really regret getting this vaccine.

    September 15, 2011 at 4:41 am | Report abuse |
  3. jarod47

    Michelle Bachmann: "She said parents told her that the vaccine had made their children sick."
    If this is the way MB makes her decisions, America might not want her in the White House.

    September 15, 2011 at 4:45 am | Report abuse |
    • patti28

      Since Sept 2008 there has been a national campaign to vaccinate 12 to 13 year old girls in Britain against HPV. There has been additional effort to vaccinate 14 to 17 year olds. 4 million doses of the vaccine used and no evidence of it causing illness For information on the vaccine's impact look to other country's who have used it widely. Ms Bachmann used very poor judgement in her off the cuff comment about this vaccine causing illness – if she can't support it with medical evidence she should withdraw it.

      September 15, 2011 at 9:29 am | Report abuse |
    • Aezel

      The future if Michele Bachmann becomes president: "I talked to a mom in a parking lot somewhere and she said she heard from a friend that their kid's best friend visited some country and they were all really bad and so I started a war with them."

      September 15, 2011 at 9:33 am | Report abuse |
  4. STS

    It is seriously screwed up that the Republican party seems to think that the price for pre-marital intimacy should be cancer and death. I wonder how many of them would pass the buck by saying "it was a different time then" when asked about their own early encounters of the backseat variety...

    September 15, 2011 at 4:57 am | Report abuse |
    • ML

      Uhhhh, Rick Perry said at the debate it should be mandated. Bachmann didn't agree. I'm a democrat and agree with Bachmann for once. I declined from this vaccine after doing some research. I don't like to take unnecessary risks, and people do seem to have gotten sick from these vaccines. I don't need the government forcing them on me. Whether it is Rick Perry or a democrat, I don't think this should be mandated.

      September 15, 2011 at 9:09 am | Report abuse |
    • Bill the Cat

      Pg 7

      Repeated sequential transient HPV infections, even when caused by "high-risk" HPVs, are characteristically not associated with high risk of developing squamous intraepithelial lesions, a precursor of cervical cancer .

      It is the persistent infection, not the virus, that determines the cancer risk .

      September 15, 2011 at 9:18 am | Report abuse |
    • Alexis

      Have people gotten seriously ill? Besides the nausea that they say can happen? I wonder if they are squeamish or afraid of needles. I only ask because I got it, along with the majority of my friends and it hurt about as much as any other shot, but afterwards no sickness from me or anyone I know. Just curious what kind of real side effects people have dealt with on a broader scale.

      September 15, 2011 at 9:28 am | Report abuse |
    • Sick

      I have been sick for 3 years since I got the shot. I went from working full-time, being a full-time student, and volunteering as an EMT to completely homebound and unable to care for myself. I developed a condition know as dysautonomia and I know of many other girls that have developed this condition shortly after getting the vaccine. I am unable to stand up without passing out, have a port in my chest, and am taken to the doctors office at least twice a week for IV fluids. I have spent at least a week every month for the past 3 years admitted to the hospital.

      September 15, 2011 at 10:58 am | Report abuse |
  5. James

    How do we actually know that this vaccine actually works o_O , there is no evidence yet that it does over the long run, there is no evidence that it is SAFE on the long run. How do we know that this is not another BigPharma scam to make another $100Billion (which will never go into Cancer research, but into pockets of ultra wealth)...What if you are already infected by HPV. My mother suffered from Cervical Cancer and she NEVER had any warts, genital warts, etc. Her biopsy showed NO CANCER, yet 1 year later her cancer grew to stag2B , the doctors coudlnt explain it.

    September 15, 2011 at 5:15 am | Report abuse |
    • pineapple888

      James there in fact over 100 types of HPV. The vaccine prevents 2 of the types known to cause HPV. Genital warts on the other hand are a different strain of the virus-different types than the ones that cause cancer. This vaccine prevents 4 types of HPV-2 that cause cancer, and 2 that cause genital warts. They are the 4 types most commonly seen in patients.

      September 15, 2011 at 5:53 am | Report abuse |
    • DAW, NC

      let me guess you still question whether smoking causes cancer!!!!!

      September 15, 2011 at 8:31 am | Report abuse |
    • SBird

      If I never get it then I'll let you know. BTW I got the shot and so did a number of my friends. The only thing that happened to us? Just pain in the arm where they gave us the shot.

      September 15, 2011 at 8:47 am | Report abuse |
    • Bill the Cat

      SBird, and $1500 apiece into Merck's pockets.

      September 15, 2011 at 9:19 am | Report abuse |
    • angrynotmad7


      September 15, 2011 at 9:41 am | Report abuse |
  6. Chris

    Movies notwithstanding,the CDC and NIH cannot be entirely trusted to provide the truth, and that was long before Julie Gerberding hoped from head of CDC to head of vaccines at Merck. An "antivaxer's" rather interesting analysis of the Gardisal trials and further conflicts of interest when DHHS stands to profit from its own drug patents is here:

    A key point: there were five "placebo" categories, but only one, the child group, was really placebo. The other four lacked the viral-like particles, but contained the adjuvants (immune response boosters). It's hardly the first time this has been done. His analysis shows that (1) the death rates of the Gardisal group and the four adjuvant groups were higher than the expected age-range norm, and (2) were about equal to eachother – only the true placebo group's rate was near normal or zero. What this allowed the government to do was say Gardisal's adverse effects didn't differ from so-called "placebo," thereby claim Gardisal is safe.

    September 15, 2011 at 6:40 am | Report abuse |
    • ShakinHead

      Chris sez, "His analysis shows that...". Uh, no. His analysis THEORIZES that... It doesn't show squat.

      Chris sez, "What this allowed the government to do was say Gardisal's adverse effects didn't differ from so-called "placebo," thereby claim Gardisal is safe." Chris is right. This did allow the government to say it, and they were correct in doing so.

      Sign me,
      Tired of Junk Science in Missouri

      September 15, 2011 at 6:54 am | Report abuse |
  7. Anon

    That's actually pretty progressive for Perry.

    September 15, 2011 at 6:43 am | Report abuse |
  8. DAS

    The problem with Guardasil is that there has been some much lobbying behind this puppy that I believe nothing beyond the fact that widespread use is good for the drug companies. The American medical industry is so full of hucksters trying to bleed us finacially that it has no credibility from the CDC on down.

    After all, we, the people, are not even allowed to have our government negotiate prices on medications.....

    What a joke

    September 15, 2011 at 8:17 am | Report abuse |
    • Captain Nemo

      >not even allowed to have our government negotiate prices on medications

      Blame Bush II and deLay, who rolled over for Big Pharma by making it illegal to negotiate price discounts for Medicare drugs. DeLay was handing out favors or hammer blows on the floor of the House to get it passed, and that is one of the reasons why DeLay is looking at jail time.

      Congress could fix this if they wanted, funny how they haven't...

      September 15, 2011 at 9:35 am | Report abuse |
  9. Brown eye

    I believe Perry was going to make money off the deal. Why would he mandate it when all he talks about is less goverment. Why shove this down womens throats.

    September 15, 2011 at 8:46 am | Report abuse |
    • Robert

      Um ... responsible government

      September 15, 2011 at 9:29 am | Report abuse |
    • Captain Nemo

      actually, it doesn't go down their throats...

      September 15, 2011 at 9:36 am | Report abuse |
  10. JB

    Shame on you for continuing to promote the now debunked connection between vaccines and autism! The papers were retracted. Whatever the parents think, they are sadly mistaken. You also completely ignore the male cancers that are also prevented by use of this vaccine. This is an important health issue, not "hucksters" in the medical industry as some of your uninformed readers believe. Scientific understanding of these problems is very important. Personal opinion and religious belief zealotry should not have a role in informed health policy-making!

    September 15, 2011 at 9:03 am | Report abuse |
  11. zengirlnyc

    52 deaths were attributed to unintended acceleration in Toyotas, and THAT triggered a $2 billion recall.
    But as of June 22, 2011 there have been a total 68 VAERS reports of DEATH among
    those who have received Gardasil® No recall in sight.

    As of June 22, 2011, VAERS received a total of 18,727 reports of adverse events
    following Gardasil® vaccination.

    September 15, 2011 at 9:04 am | Report abuse |
    • Listen to Science

      So let me get this straight out of over 4 Million people who received the vaccine ~ 19 thousand reported some sort of side effect. I rounded up the number of reported side effects for good measure and it still only comes down to 0.475% experiencing some kind of side effect which is actually a really good number, I think I will get this vaccine first chance I get.

      September 15, 2011 at 9:52 am | Report abuse |
  12. mdocdoc

    Yikes! It is irresponsible to present a statement declaring, "Some still blame vaccine for autism"!! This has been disproved many times over. Why not state "some doubt holocaust" or "evolution still doubted by some" .... Come on. It those who blame vaccine for autism cannot move on , you are not helping them by recognizing their thick headed denial.

    September 15, 2011 at 9:04 am | Report abuse |
  13. Rod

    So the modern day Republicans would prefer to bancrupt your country and let your daughter die a horrible death for the sake of what? The next sound bite or the next accolade from Fox news?

    September 15, 2011 at 9:30 am | Report abuse |
  14. angrynotmad7

    I don't believe in any of that garbage. Those vaccines are deadly, but ironicly it amazes me how people seem to believe that those or any vaccines will help you not contact any disease. Remember, the vaccine your given does not say how live the germ is within that shot or any shot. Its up to like the rest of those WOMEN who seem to be taken in by the medica field. They are lying to you, and remember its a business they are making profit off you. Also, those mamography's same thing. When was there more breast cancer........yeah, after they started doing the test using radiation..........WOMEN, BE SMART

    September 15, 2011 at 9:31 am | Report abuse |
    • Listen to Science

      You need to go back to school and study, because you are woefully ignorant about science and the nature of cause and effect. You should look up what anecdotal evidence is, because your argument that the rate of cancer increased when people started getting tested for said cancer is ridiculous. Let me use that same logic, More people are praying to god today then in previous history and more bad things are occurring in the world today then before so God must be causing the bad things to happen... Doesn't make much sense does it you Helminth

      September 15, 2011 at 9:59 am | Report abuse |
    • Teebs22

      Yes all vaccines are deadly. Amazing what the polio vaccine and the smallpox vaccine has done. We are all crazy for letting the government create those vaccines and save lives. Vaccines are created with different parts of a virus that trigger an immune response so that your adaptive immune response can develop memory cells against that particular virus. Most vaccines are done with an attenuated viral strand that is not technically viable. Also, I've had all 3 Gardasil shots and I'm still alive. Whoa deadly...

      September 15, 2011 at 10:04 am | Report abuse |
    • Capt Nemo

      >When was there more breast cancer........yeah, after they started doing the test using radiation

      Please, for the love of God, shut up. You are dangerously clueless and somebody might believe this nonsense.

      Why is there more cancer in females now? Because (among other things) in the last 50 years or so the rates of smoking and workplace exposure to carcinogens has skyrocketed in the female population. Also, life expectency has gone up, and the longer you live, the greater the chance you have for contracting cancer (or anything else for that matter).

      Please, just shut up unless you have a clue. You are DANGEROUS because you spread NONSENSE.

      Please, ladies, get your mammograms!

      September 15, 2011 at 2:00 pm | Report abuse |
  15. Jamie

    Republicans like to get involved in women's health issues, but this time it's totally contrary to what I would expect (on Perry's end).

    September 15, 2011 at 9:31 am | Report abuse |
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