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:

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

â–  Both are very safe.

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

â–  Both are given as shots and require three doses.

And what are the differences? According to the CDC:

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

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

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

â–  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. GOP Logic

    kevin, HPV is carried by men, that is how it is spread to women.

    i give up.

    September 14, 2011 at 4:41 pm | Report abuse |
  2. Mr Polio

    Back- when the world was trying to get rid of Polio, we had Bachmann-type people against it.
    Parents long-ago were ranting that they were being told your kids had to get a Polio shot or they can't go to school.
    Whine whine whine. Glad to see things haven't changed.
    Luckily parents gave in and we got rid of Polio for the most part...

    September 14, 2011 at 4:43 pm | Report abuse |
  3. Whammybar

    Okay, Perry should not have mandated it and Bachmann used a partial truth to make him look bad in public. So what else is new. Agreed, it is not polio or measles. Leave it to the doctors not the politicians.
    Leaving using half truths, scare tactics and fingerpointing to the politicians.

    September 14, 2011 at 4:43 pm | Report abuse |
    • GOP Logic

      it's not polio or measles... just cancer. but the ones who get the STD deserve it anyways. amiright?!?!?

      September 14, 2011 at 4:46 pm | Report abuse |
  4. GOP Logic

    .... but my 6th grader might catch autisms and stuffs!

    September 14, 2011 at 4:44 pm | Report abuse |
    • Captain Nemo

      "Oh Noes! Will no one think of the poor innocent little children! Don't listen to the doctors they are all EEEEEVIL!"

      My view? Any parent who doesn't vaccinate their kid should be hammered by our culture (legally, morally, any way possible) when the kid (innocent and dependent) comes down with a desperate, deadly, and CLEARLY PREVENTABLE disease because they were intentionally not vaccinated by a parent.

      You decide to opt out, you must deal with the consequences; no doubt you child will!

      September 15, 2011 at 10:07 am | Report abuse |
  5. Lauren

    I got the vaccine and since then, I got terribly sick, seizures (in the same area of my brain that vaccines go to), lost 30 lbs due to not being able to digest food, had life threatening surgery and was a perfectly healthy athlete before then. Doctors can't link it to the vaccine....I certainly can.

    September 14, 2011 at 4:46 pm | Report abuse |
    • GOP Logic

      "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."

      Me thinks you r not 2 smart...

      September 14, 2011 at 4:48 pm | Report abuse |
    • amy

      Gardisil is NOT safe. The doctor that helped developed it has been lecturing all over about the many very severe, and common, side effects.

      September 14, 2011 at 5:07 pm | Report abuse |
    • Logic

      Vaccines don't "go to your brain."

      They circulate in your immune system, in B cells, which exist in almost every part of your body.

      September 14, 2011 at 5:08 pm | Report abuse |
    • GOP Logic

      amy... where did you read this? http://www.vaccines-are-bad.com?

      September 14, 2011 at 5:10 pm | Report abuse |
    • ILLINI04

      I had the vaccine as well I didn't get sick but I still got cervical cancer... so was it work the shots and the money???.... NOPE just gave more money to my Dr's and insurance companies for the shots then for the cancer treatment.

      September 14, 2011 at 5:18 pm | Report abuse |
    • BMstagger

      Post Hoc Ergo Propter Hoc... one of the most common logical falures. Because thing B happened after thing A – that MUST mean that thing A caused thing B.

      I got sick after X therefore X caused my sickness.

      I got fired from my job after eating a burrito. I sure will never eat burritos again.

      September 14, 2011 at 5:21 pm | Report abuse |
    • Captain Nemo

      >I certainly can [blame it on the vaccination]

      First, I am truly sorry you've been sick. Nobody deserves that.

      Full disclosure: son of a physician, worked many years as a hospital lab tech and ER worker. Not all doctors are clowns or dupes or "bought and paid for" by Big Pharma. Please believe that.

      But no, you can't "certainly" know what happened to you. You have what is known as an anecdotal report, not proof of causation. You may have been cooking a flu or other illness that hadn't become obvious, and the synergy of the vaccine and the illness may have kicked your immune response into overdrive. You may be sensitive to some adjuvant or other ingredient of the vaccine. Unless you are a highly trained specialist you can't make the assertion that you know what happened to you. Even the doctors who treated/are treating you probably don't know, right? Ask them to get you involved in further study, or follow that up on your own with the appropriate government agencies.

      Get yourself studied as a possible bad vaccination outcome. Maybe you'll add to the knowledgebase and save somebody else. Maybe you DID have an adverse response. But maybe they'll say, "Next time, don't do X before you get vaccinated." But I'm willing to bet they won't pin it on the vaccine as quickly as you have.

      I'm so sorry you got hurt. But you just plain don't know what happened to you, so please pleae PLEASE don't add to the madness about vaccination. Children't lives are at stake and there are those who will use any excuse, however flimsy, to avoid saving their kids from avoidable horror and agony.

      Truly, I am sorry you've been ill.

      September 15, 2011 at 10:18 am | Report abuse |
  6. Lauren

    I read that, I've studied it for years, I know what the CDC says, I also know what VAERS reports say for hundreds of girls that have had the vaccine, gotten Guillain Barre Syndrome, Seizures, died, etc. after receiving the vaccine. Just because one article says the CDC says "Yay for Gardasil" doesn't make you know everything about it.

    September 14, 2011 at 4:52 pm | Report abuse |
    • slider

      But GOP Logic does know everything about it. Liberals like him know everything about everything. They can tell you how to live your life, what to think and that is only his politically correct thoughts, what to eat, what to drive, how to vote, god the list would fill up an entire hard drive. He knows it all and will have NO problem with telling you so. He has a 'god like" complex and everyone else in the world knows nothing. He is THE MAN!!!!

      September 14, 2011 at 5:02 pm | Report abuse |
    • GOP Logic

      sliders is brilliant, offer no counter point, no evidence, just a pure ad hominem attack. what a debate!

      September 14, 2011 at 5:13 pm | Report abuse |
    • A Doc

      Lauren, it's unfortunate what happened to you. However a lot of cases of Guillain Barre Syndrome (GBS) will happen anyway However 35,000,000 (that's 35 million) doses of gardasil have been given out. You expect GBS to happen to teenage girls at a rate of 1-2 per 100,000 in the general population, so out of 10 million girls who get the vaccine you EXPECT anywhere from 50-100 of them to contract GBS. See this article that showed the VAERS analysis which you refer to in fact does NOT support that this vaccine causes GBS.

      http://www.medscape.com/viewarticle/588510

      September 14, 2011 at 5:33 pm | Report abuse |
    • Captain Nemo

      >Guillain Barre Syndrome

      A possible outcome of almost any injection or medication. Please don't be too quick to blame it on this vaccine.

      You can inject 1000 people with clean needles bearing saline solution and a significant number will have adverse outcomes. Please, please, please don't add to the madness about vaccination.

      September 15, 2011 at 10:22 am | Report abuse |
  7. WL

    alllanhowls–unless males are vaccinated as well, I can't see how herd immunity would apply; men would still be infected with HPV and could spread it to unvaccinated females. And from what I see, the mandates only apply to females.

    Athensguy–you make a good point, but then the question is, when should a government act to madate a vaccination? This is not a vaccination for an infectious disease that can be spread by casual contact, which is a legitimate public health concern, nor is it a vaccine against a particularly deadly disease, as HPV infection does not inevitably lead to cancer in the same way as, e.g., polio diphtheria infection does, it merely increases the chance to later contract a serious and potentially fatal disease. Does this warrant the government telling someone they MUST have the vaccine? Much as i hate to agree with Bachmann I anything, I don't think so. Does it make sense for individuals, especially females, to be vaccinated? Sure. But I see no reason for the government to forcibly medicate anyone here.

    September 14, 2011 at 4:53 pm | Report abuse |
    • Bill

      No one is being forcibly medicated...Parents have the right to opt out, but if it isn't included on the vaccination schedule millions will never even be offered the vaccine.

      September 14, 2011 at 6:30 pm | Report abuse |
  8. WL

    One additonal point, allanhowls; I would guess significant vaccination of the female population could protect males through herd immunity, but then it seems the real interest is to prevent females from getting it because of the cancer link. for men it would just be an inconvenience.

    September 14, 2011 at 4:56 pm | Report abuse |
    • Kristen

      @WL, what nobody is telling us about Gardasil is that it only prevents 4 strains of HPV and there are almost 40 other strains that can cause warts or cervical cancer. Even if everyone got vaccinated with Gardasil there are still almost 3 dozen other strains that would continue to spread and would eventually become just as prevalent as the ones we vaccinate against.

      September 14, 2011 at 6:27 pm | Report abuse |
    • Captain Nemo

      penile cancer kind of pushes the envelope on "inconvenience", don't you think?

      September 15, 2011 at 10:24 am | Report abuse |
  9. Bijouandbucky

    Interesting that in the state where the vaccine is mandated, only 17% of girls got it. I agree that this should be a choice for parents, not mandated by government. But given the knowledge of how helpful this vaccination is, why in the world would a parent refuse this for their daughter unless it is just a knee jerk reaction to an order. The parents are acting like teenagers whereas the teenagers are far more mature about the subject.

    September 14, 2011 at 4:56 pm | Report abuse |
  10. Blunttalk

    The vaccines have been shown to 'help' prevent the specific cancers but do not ensure it. That is where the real question resides.

    September 14, 2011 at 4:56 pm | Report abuse |
    • Captain Nemo

      Do I understand you to be saying that since there is uncertaintly you will (or advocate) avoiding something?

      Please tell me you aren't saying that. Please.

      Life isn't perfect. Life isn't simple. Expecting either case to be true makes you clueless (and potentially dangerous to others in your blithely dangerous actions). You can do everything right and get screwed, you can do everything wrong and rise to amazing heights.

      There are literally hundreds of different types of cancer. Not getting vaccinated against a few types because that vaccine doesn't protect against other types is bad logic and quite simply a dangerous course.

      Good luck to you.

      September 15, 2011 at 10:31 am | Report abuse |
  11. Chad

    If you research HPV vaccine side effects you will find that there has been quite a few deaths associated with the admistration of these drugs. Simple math taking into account the number of doses reported to have been given and the number of deaths and other serious side effects reported have me quite concerned. The odds of my daughter reacting to or dying from these drugs is better than my chances of winning the lotto......and I'm still playing the lotto thinking I might win someday. Forcing my daughter to "roll the dice" seems terribly irresponsible. When she is old enough to make an informed decision on her own she can make her own choice.

    September 14, 2011 at 4:58 pm | Report abuse |
    • Chad

      Here is a link to the CDC website with the information that I was talking about.
      http://www.cdc.gov/vaccinesafety/vaccines/hpv/gardasil.html

      September 14, 2011 at 5:05 pm | Report abuse |
    • jytlm

      Reading that same link, it mentions that the data doesn't show any significant increase in the rates of serious side effects compared to the regular population.

      September 14, 2011 at 5:30 pm | Report abuse |
    • Bill

      By then, she'll probably already have contracted the virus asymptomatically and the vaccine will be useless.

      September 14, 2011 at 6:32 pm | Report abuse |
    • Captain Nemo

      >better than my chances of winning the lotto

      So now you're gambling with your child's life? Can you live with the reality of what losing that bet means?

      September 15, 2011 at 10:33 am | Report abuse |
  12. mil

    the GOP want smaller government control, but they are okay about forcing the entire population to take drugs even if they don't need it? They don't want unborn babies to die, but they are willing to let living people die because they can't afford health insurance? they say they are pro-life, but they happily enforce the death penalty? How is that a "Pro-Life" party or the party of "small government"?

    September 14, 2011 at 4:59 pm | Report abuse |
    • slider

      Hummm....love the DNC talking points, enjoy watching CNN do you?

      September 14, 2011 at 5:07 pm | Report abuse |
    • GOP Logic

      slider... once again, no counter point at all, just an ad hominem attack. can't beat that teaparty logic!

      September 14, 2011 at 5:14 pm | Report abuse |
    • mil

      nice assumption, but wrong.

      September 14, 2011 at 5:19 pm | Report abuse |
    • newton

      Perry is between the devil and the deep blue sea on this. He tries to appeal to Christians but he, like most GOP, support non-Christian social policies at the same time. It will be an interesting juggling act. Then again, the so called Christians that are hooting and hollering with the Tea Party agains immigrants, gays, health care etc aren't really true Christians, are they? They've distorted the word of Christ to fit their bigotry.

      September 14, 2011 at 6:52 pm | Report abuse |
  13. Debbie

    Unfortunately, if vaccinations are not "required", health insurance companies usually won't consider it a covered benefit. So having parents "opt in" means they need the $230 dollars for the three shots.
    In other words, only those that can afford it can opt in.

    September 14, 2011 at 5:01 pm | Report abuse |
    • M

      My insurance covered the vaccine. I still had to pay my copay for the visit, so it ended up costing me $60. Not too prohibitively expensive if you're covered, but I see your point if you only have major medical or no insurance.

      September 14, 2011 at 6:36 pm | Report abuse |
  14. WL

    Well rather than force individuals to take the vaccine, one would think the insurers could be forced to cover it for those who choose to have the vaccine, and the cost would be borne through the premiums. Many states have such mandates for tests like mamograms. Or the states could choose to undewrite the costs and offer free/reduced cost vaccines as part of their public health initiatives. Mandating the individuals to be medicated so that those who choose to take the medication can get it free/at reduced cost seems to be the least sensible way to accomplish that goal.

    September 14, 2011 at 5:06 pm | Report abuse |
  15. 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!

    September 14, 2011 at 5:07 pm | Report abuse |
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