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. SadlySensible

    Think the vaccine is safe? Fine. Time to give it to the ENTIRE middle school population, and not just females. The vaccine touts that it protects against certain types of HPV–those types which also cause cancer in MALES. If one is going to insist on vaccinating for protecting against cancer then let's protect all of them, not just the girls.

    September 15, 2011 at 9:34 am | Report abuse |
    • momtoboys

      Actually, it can be given to boys, is recommended and often is. My 14 year old son got it, as did my girls when they were in middle school and it first came out.

      September 15, 2011 at 10:02 am | Report abuse |
  2. angrynotmad7


    September 15, 2011 at 9:36 am | Report abuse |
    • momtoboys

      yeah, because those doctors are making the big bucks off the administration fee for a vaccine...about $10.00. The state I live in requires a yearly physical, as well as other vaccines for school, and they don't pay for that, why do you think it's the government's job to pay for it? It's your job as a parent to take care of your children or don't have any. FWIW, the government did pay for my son's vaccine because my husband is in Afghanistan, serving in the military, and therefore our insurance and medical expenses are paid for by the government. Medicaid also covers it.

      September 15, 2011 at 10:05 am | Report abuse |
    • katie LPN

      most vaccines are made of synthetic viruses not live ones. and the government in most states does provide them for free. in Virginia we have the VVFC program, that virginia vaccines for children. they pay for all vaccines required and otherwise for children that are uninsured or under-insured. most doctors will not sign a religious or medical exemption either. you really should read up on vaccines before you run you mouth, all vaccines have a package insert with the exact chemical composition of every vaccine as well as risks and appropriate usage.

      September 15, 2011 at 12:19 pm | Report abuse |
  3. RTfromIL

    I thought the point of “mandated” vaccinations, for children, was to eliminate highly communicable childhood diseases. Mandating this vaccine would cause me to wonder what is going on in the Texas schools.

    Having said that, I think it is great that parents are aware of the vaccine and can choose to get their children inoculated if they want.

    September 15, 2011 at 9:41 am | Report abuse |
    • Kristin

      As a former high school teacher, I am sure that the same things are going on in Texas that are going on in the rest of the country. It is not uncommon to see kids in middle school that are pregnant. When I was pregnant while teaching 9th grade, I had many students that wanted to compare pregnancy notes with me. Many of them already had 2+ kids themselves.

      Should schools be responsible for keeping kids safe from STDs? In a perfect world, I would say it's the parents' responsibility. The bottom line though is that A LOT of parents are dropping the ball on this one. I also taught AP (Advanced Placement) kids. Most of them come from really great two-parent homes. You would be amazed (and their parents would be horrified) to know what those "good" kids were doing. Of course, it wasn't happening AT school, but the results are the same!

      September 15, 2011 at 11:00 am | Report abuse |
  4. stringtheory

    This article entirely missed the core debate in government mandate of this vaccine.

    The inoculations children are required to receive to attend public school stop the spread of contagions like measles and chicken pox in the school environment. As HPV is transmitted s@xually, there is absolutely NO REASON for this vaccine to be required for school attendance. HPV can not be transmitted between students through coughing or touching a doorknob.

    September 15, 2011 at 9:51 am | Report abuse |
    • RTfromIL

      Thank you for making this point much more succinctly than I was able to. 

      September 15, 2011 at 10:06 am | Report abuse |
    • angrynotmad7

      to stop contagious diesease, measles, mumps etc. does not come with getting your child vaccines. Those shots have a live virus and gives you the disease and it dont prevent you from getting the disease. Wake up people............why is it so many think the healthcare professionals are the care givers when they are only doing what is told to them to do..........Use your best judgement, think about what you put into your body..........that is anything from foods, medications and even what is in our environment.

      September 15, 2011 at 10:50 am | Report abuse |
    • ellid

      Thank you for putting morality ahead of children's health.

      September 15, 2011 at 11:06 am | Report abuse |
  5. dzerres

    Fine, let parents opt out of all vaccines but then if the child dies of some easily preventable disease charge the parents with manslaughter and child endangerment. Now that's personal responsibility. Same with health insurance: don't buy it, fine, but don't require hospitals to treat you for free either (it's not "free" – taxpayers are supporting hospitals, even private hospitals, in all communities thru local taxes).

    September 15, 2011 at 9:54 am | Report abuse |
    • JOE

      This is great information

      September 15, 2011 at 10:30 am | Report abuse |
    • angrynotmad7

      that is what your lead to believe about vaccinations................if you opt out of them. ITS A SCARE TACTIC:)

      September 15, 2011 at 10:52 am | Report abuse |
    • Rstlne

      And if the child becomes ill or dies after a vaccination (which DOES sometimes happen), who will you charge then? I believe that the CDC has made mistakes before, and no matter what they say, all vaccines are not safe for all children. Who are you to say that the parents should be charged with manslaughter if their child gets ill because they did not have a particular vaccine?

      September 15, 2011 at 10:54 am | Report abuse |
    • kmcg

      to RSTLNE: You're right, vaccines are not safe for every individual child. However, vaccines are safe for children.

      Opt out's originally exist because some children have allergies or are severely immuno-compromised. For the average child out there, this just isn't an issue.

      September 15, 2011 at 12:27 pm | Report abuse |
  6. Ray

    Wow, what misinformation. I personally know a woman who's daughter had seizures shortly after being vaccinated with Gardasil. This is not an uncommon reaction to this vaccine. Additionally, the effectiveness of HPV vaccine is questionable. The vaccine is only effective against a limited number of various of HPV. Additional, a lawsuit has been filled challenging the studies used to claim the effectiveness of Gardasil. Science has proven that not all HPV infections lead to cervical cancer but the lawsuit claims that Merck included all HPV infections it works against when calculating and promoting its impact on cervical cancer in the population. This means they are crediting Gardasil for preventing cervical cancer from occurring in infections that would have resolved themselves naturally. On top of all this, compare the number of diseases American children are vaccinated against to any other country. Something isn't right and the FDA and CDC are a part of it.

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


      September 15, 2011 at 10:12 am | Report abuse |
    • JOE

      September 15, 2011 at 10:32 am | Report abuse |
    • mel

      And think about all the countries where children die of preventable diseases.

      September 15, 2011 at 10:37 am | Report abuse |
    • Rand in UT

      Always glad to see comments with zero scientific facts to support them. You dont file lawsuits to challenge studies. You do more studies. So where are the studies that show the CDC is wrong about this? With 300,000,000 million people in the US and more than half of them women IF 10% of them were teens and 10% of them were vacinated and 1% of those had a reaction that's still 15,000 people. In the world of medicine I think that would be considered safe.

      September 15, 2011 at 10:47 am | Report abuse |
    • faith

      Rand- unless it was YOUR daughter that died from it! Not safe in my eyes.

      September 15, 2011 at 11:04 am | Report abuse |
    • Rstlne

      @ Rand in UT – What if your daughter was one of the 15,000 who had a seriously bad reaction? Would you be satisfied with the CDC saying the vaccination was safe then? Extra studies are unlikely to be done in this "science is bad" and the economy is in dire straits climate. Therefore I believe that a parent should have every right to opt out of giving their daughter this vaccine. There is ample proof that the medical community can be extremely arrogant about the safety of drugs and vaccines, and there is ample reason to question whether many involved have a decided bias toward using certain drugs and/or vaccines.

      September 15, 2011 at 11:05 am | Report abuse |
    • ellid

      Coincidence is not causation. Sorry.

      September 15, 2011 at 11:06 am | Report abuse |
    • VET

      I did take this vaccine, with no side effects at all. Not taking this vaccine, as a young woman, is putting yourself at risk unnecessarily. I'd rather have the mild effects named by CDC for a day or two than cancer for the rest of my shortened life.

      September 15, 2011 at 11:10 am | Report abuse |
    • jeffrey

      This kind of anecdotal evidence is the kind of ignorance that will cost lives. Look at the evidence people! It is proven safe.

      September 15, 2011 at 11:10 am | Report abuse |
    • Capt Nemo

      What if my daughter were crippled by the vaccine? Prescinding from any obvious neglicenge in administration or creation of the vaccine, I'd accept it as one of those things that can go wrong in life. Nobody likes it, but nothing is perfect. For God's sake, you can die from taking an asprin, too: try to get some sense of proportion. And I'm not just blowing smoke here, I come from a family that has had major medical problems (lifelong disability from a congenital disease) from a medical condition, so I know what I'm talking about regarding living with life's harsh realities.

      Life isn't simple, and not everybody is lucky all the time. Get over it.

      September 15, 2011 at 2:05 pm | Report abuse |
  7. justanotherchildofgod

    This has simply not been tested thoroughly. Years ago they gave a shot to women they thought would be high risk for miscarriage. They said it was safe. It was safe – for those mothers. For their daughters it was a nightmare. Women whose mothers had the shot were often sterile. There was an abnormally high rate of birth defects in cases where the "daughters" did conceive. This drug supposedly was tested 'for 10 years' in Texas before we were told it was going to be forced on our children. That means no woman could have had it, gone through puberty, and had a child who also had it and went through puberty. My mother was given a chemotherapy that ended up causing her cancer to spread more quickly. The week she died they discovered this fact and apologized to us and to her. Pushing drugs out quickly is one thing. FORCING them on people is another.

    September 15, 2011 at 10:00 am | Report abuse |
    • Capt Nemo

      Diethylstilbestrol (DES) damage to daughters of those given the drug and the thalidomide disaster caused a worldwide and complete reworking of how drugs testing is carried out. If you knew that, you'd stop making alarmist statements about situations that have been corrected. It's a lot harder (but still possible) for drug companies to falsify results or bury studies that show danger or lack of effectiveness in drugs. And regulating agencies move a lot faster now than they used to.

      Nothing is perfect, and life is about making decisions about potentially risky options (fly vs drive, vaccinate vs not, eat well vs junk food, aspirin vs tylenol [which boils down to balancing Guillan-Barre syndrome vs liver failure]) based on the best data you have. It's hard, it's scary, and there is no way around those facts. Only simpletons and their dupes believe life is simple, safe, and guaranteed a happy ending.

      Given that a HUGE majority of the population has the HPV virus in adulthood, you weigh a less-than-half-one-percent risk of vaccination-caused trouble against a much higher liklihood of debilitating, deadly disease and then you make a decision.

      Or you can stick you head in the sand and decide to be informed by hysterical paranoia about doctors, big pharma, and the gummint. Your call...

      September 15, 2011 at 2:16 pm | Report abuse |
  8. sortakinda

    Lest we forget, Bachmann was complaining not that there wasn't an opt out for parents in what never took effect in Texas, but that the parents didn't know enough to opt out of what didn't happen. My, my. She IS the DEEP THINKER, she is.

    September 15, 2011 at 10:09 am | Report abuse |
  9. infected

    as a 48 year old mother of 3 grown children and just diagnosed with cervical cancer I believe we need to take a look at the big picture and educate the population about this virus and vaccinations. It's my understanding, from my doctor, that there are 100s of strands of this virus. Some that have not been identified yet. Once contracted, this virus can lay dormant for a lifetime or present itself at anytime during your lifetime. Is it up to the Government to play God with their mandates? And, why just vaccinate the middle school aged girls? Shouldn't it be the boys also?

    September 15, 2011 at 10:21 am | Report abuse |
    • LaLa

      It's offered to both girls & boys where I live. I have a daughter who will get her 3rd shot soon & next year my son will start his series. If it only prevents a few strains of the disease – so what ? It's better than doing nothing. It's not encouraging promiscuity any more than a tetanus shot is encouraging children to run around a barnyard looking fro rusty nails to step on.

      "Nobody made a greater mistake than he who did nothing because he could do only a little." ~ Edmund Burke

      September 15, 2011 at 10:53 am | Report abuse |
    • labrat08

      As another person who recieved an HPV+ from her doctor a few years ago, I'm right there with you that more education about this particular virus is needed. I didn't know a d*mn thing about it till I was diagnosed, and I did get the vaccine, but it wasn't until AFTER I'd contracted some strain of the virus. People need to know that as of right now, there is no screening test for this, especially in men, so even if you're responsible and ask your partner to get tested for things, this one will get missed.

      September 15, 2011 at 11:09 am | Report abuse |
  10. kazport

    What the hell?? Why are you spending so much damn time on this.. The U.S. is being brought to its knees with unemployment and the housing crisis. CNN wants to make an issue out of a damn vaccine that Rick Perry already said was a mistake and Michelle bachman is trying to score points. I wish they would do a debate with average americans and the so called Main St. Media. Let us ask the damn questions and have you answer.

    September 15, 2011 at 10:22 am | Report abuse |
  11. kazport

    CNN is making it a debate. Out hear in the real world its is a flea on a dog... Come on cover the important issues

    September 15, 2011 at 10:24 am | Report abuse |
  12. keith beard

    It just fired me up when he said "no evidence" with the child right behind him, those pictures were a thousand words.

    September 15, 2011 at 10:24 am | Report abuse |
  13. Disbelief

    My daughter has been sick since the day of her first HPV shot- 4 yrs ago

    September 15, 2011 at 10:30 am | Report abuse |
    • Capt Nemo

      correlation is not causality.

      What have you done to ensure that this was a bad outcome? Have you pursued this not only for your daughter but also to (hopefully) provide data that will prevent other such outcomes? Did you report the possible adverse outcome? Did you get your daughter checked out by the FDA-provided system to review such cases? By specialists? Have you moved heaven and earth to uncover what happened? Or did you just complain to your local medical doctor and then start telling the world your half-baked story?

      Do what it takes to find out what happened, don't assume it was the vaccine. If you have done no follow-up, your kid may be suffering from an unrelated and treatable condition...

      September 15, 2011 at 2:24 pm | Report abuse |
  14. Neal56

    Our real problem is the consumption of junk food. Bread, cereals, chips, caffeine, alcohol, pretzels, cookies, candy and most everything from a box. It's processed. Made to taste great and it steals our health away. Vaccines are more poison and are not required and those consuming the before mentioned foods are most at risk. Because they lack the nutrition to be healthy and move the toxins out that are contained in the vaccines. A healthy body doesn't need medicine. Food is medicine. Real food. Good Luck.

    September 15, 2011 at 10:41 am | Report abuse |
  15. Nimnim

    Does anyone know why this vaccine cannot be given to 12 year old boys to prevent the spread of this virus–I guess when it comes to anything about reproduction, the full responsibility always falls 100% on the woman–you guys never change.

    September 15, 2011 at 10:44 am | Report abuse |
    • Capt Nemo

      At first, the vaccine was not authorized for use on young males; not enough testing had been done on males.

      Now, after more testing, the vaccine IS authorized for use in males, and it CAN and SHOULD be provided to both male and female children, ideally before they are exposed to HPV.

      September 15, 2011 at 2:26 pm | Report abuse |
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