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. Michelle

    Why should the government mandate that children get a vaccine before coming to school when the disease prevented by that vaccine is not contracted by normal classroom interaction. It's not like the other diseases for which vaccines are required; this is not something that is going to spread by a child sneezing on another student, or touching their hands, mouths and/or noses. Therefore, I don't think the government should mandate that school children be vaccinated. Rather, they should leave the decision to parents to individually decide if their child is at risk or if the benefits of the vaccine outweigh the potential risks. The government could certainly educate parents and make the vaccine available, but what is the purpose of pushing it on people?

    September 14, 2011 at 5:43 pm | Report abuse |
    • Susan

      Ummm, saving lives and preventing cancer?

      September 14, 2011 at 5:49 pm | Report abuse |
    • leeintulsa

      @michelle: I'm with you on this. It's all about money for cronies.

      September 14, 2011 at 5:53 pm | Report abuse |
    • WL

      Susan–those are certainly good reasons for one to have the vaccine, but is it sufficient to allow the government to mandate it? I just don't see it. Otherwise, how do we keep the governmentout of medical decisions? Certainly there are many things that could save lives that people have a chouce about–why is this different?

      September 14, 2011 at 5:54 pm | Report abuse |
    • Bozobub

      So, we shouldn't mandate people be vaccinated against, say biurd flu (to steal a movie plot) to prevent a known pandemic risk? We should allow polio to reestablish itself? Aw, pertussis builds CHARACTER in a young kid...just before it kills them. Luddite idiot.

      September 14, 2011 at 6:02 pm | Report abuse |
    • Katie

      Why should anyone be forced to accept an injection of anything? Remember the Gulf War syndrome? Now they think all the mandatory vaccines played a part in men and women coming down with a whole range of problems, including cancer, auto-immune disorders, and birth defects in their children. Lancet (medical journal) published a very detailed study on the rise of diabetes in children and questioned the possible link to the multiple vaccines that are considered routine – too much bombardment on a developing immune system in too short a time. Babies have been known to show up in the ER with congestive heart failure after a round of vaccines. In the early sixties, Dr Jonas Salk, inventor of the polio vaccine, testified before Congress that all new polio cases in America after 1961 were caused by the vaccine and he urged them to pull it from the market so it could be refined. Congress declined, and the vaccine wasn't changed until the 1990s. No vaccine is 100% safe for everyone (neither is any vaccine 100% effective) and all come with side effects, which are horrendously under-reported. Parents who insist on reporting side effects are usually told "it's a coincidence" or "this isn't related" and the complaint never makes it farther than their doctors. Everyone should read up on vaccines and make an informed choice before allowing vaccines to be given to themselves of their children. And don't read what the pharmacies put out – dig a little. The info is there, but you have to look for it.

      September 14, 2011 at 6:03 pm | Report abuse |
    • da2

      Well said. The fundamental issue here is whether parents should be trusted to get their children vaccinated to prevent a deadly disease. If you are on the Left, you believe parents are too stupid to make those decisions and that the government, as run by the Left, should make them for you. Those on the Right have a little more faith in parents, and think that education about the benefits will result in most people making the right decision.

      September 14, 2011 at 6:04 pm | Report abuse |
    • Jimbo

      Good argument for no mandate.

      September 14, 2011 at 6:06 pm | Report abuse |
    • Bozobub

      Whether or not you believe people are "too stupid" to vaccinate their children voluntarily, the bald facts are is that a VERY large pool of them don't, for whatever reason. This does NOT just risk their children, it puts the entire population at risk when the disease spreads from the ready pool of unvaccinated victims. All this hysteria about vaccination, yet I bet none of you would like to pick a case of smallpox, hm? SIlly gits.

      September 14, 2011 at 6:06 pm | Report abuse |
    • da2

      Well said Michelle. The fundamental issue here is whether parents should be trusted to get their children vaccinated to prevent a deadly disease. If you are on the Left, you believe parents are too stupid to make those decisions and that the government, as run by the Left, should make them for you. Those on the Right have a little more faith in parents, and think that education about the benefits will result in most people making the right decision.

      September 14, 2011 at 6:07 pm | Report abuse |
    • Vickio

      No, again it's all about saving lives. If every girl aged 12-13 in the US were vaccinated, it would save 2,500 lives a year. Isn't that a good enough reason right there?

      September 14, 2011 at 6:08 pm | Report abuse |
    • Mavis

      @WL – if you want the government to pay for expenses – like treatment of cervical cancer, or college tuition wasted when a young graduate dies, you need to let the government mandate protection against that.

      Also – there are other mandated vaccines that have nothing to do with diseases being spread in the classroom. Tetanus and polio are two.

      September 14, 2011 at 6:09 pm | Report abuse |
    • Juan C

      I totally agree with you.
      This is not about saving lives and preventing cancre it's more about making and selling drugs.

      September 14, 2011 at 6:09 pm | Report abuse |
    • Bozobub

      I'll bet not one of the people against vaccination here would like a case of smallpox, wouldn't everyone agree? Therefore, they are automatically hypocritical fearmongers, nothing more, who threaten the public health. Or, simply get rid of *ALL* mandatory vaccinations, and revel in the lovely gamut of diseases. Blech.

      September 14, 2011 at 6:10 pm | Report abuse |
    • da2

      Actually, speaking as someone who has been in the drug business for 30 years, I would point out that it is NOT critical for everyone to get vaccinated. So called "herd immunity" protects "the herd" since the disease is not transmitted as long as a significant majority are vaccinated, and therefore resistant (and don't transmit)...

      September 14, 2011 at 6:11 pm | Report abuse |
    • Amanda

      I never thought I would agree with Bachman on anything, but I agree on this. There are certain vaccines that are so important, vaccines for things more easily communicable, things that could make many people sick quickly. Those are the vaccines that should be mandated. If I had a daughter, I would want her to receive the HPV vaccine. However, it is overwhelming how many vaccines children are required to have nowadays. For every new required vaccine, there are going to be a certain number of parents that then opt out on ALL vaccines.

      September 14, 2011 at 6:11 pm | Report abuse |
    • Eric Brennan

      I disagree. The government mandates us to buy insurance for cars, houses and business. While I've never been in a car accident, it's mandated just in case of an accident. Even though my kid might never get HPV, it's good to know it will be mandated so that her generation will most likely not get the most common STD of all and the second leading cause of cervical cancer.

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

      I would only note that in all cases parents have the choice to opt out. What the states can do is be sure that the vaccine is available and given to those who want it. There are reasons to be concerned about government intrusion into personal lives – everything from following anti-war protestors to torture. However, making sure that girls get a shot that will prevent cervical cancer is not one of them.

      September 14, 2011 at 6:15 pm | Report abuse |
    • da2

      Indeed, I would not want smallpox, and would therefore make the decision to get vaccinated myself, if there was an outbreak of smallpox and the vaccine was still available (its not). Personally I dont need the government to order me to do it... I can figure that part out myself.

      September 14, 2011 at 6:17 pm | Report abuse |
    • Mavis


      "vaccines for things more easily communicable"

      more than 80% of American women will have contracted at least one strain of HPV by age fifty.

      September 14, 2011 at 6:20 pm | Report abuse |
    • ryan

      Bozobub... Interesting that you bring up smallpox.. they stopped that immunization in 1972.....

      September 14, 2011 at 6:43 pm | Report abuse |
    • Michelle

      Some of you are missing my distinction. I do believe the government should mandate vaccines where the underlying virus is likely to be spread in a certain setting. I.e. If "X" virus can be easily spread in a classroom setting, then I would wholeheartedly support the government requiring the "X" vaccine before a student is permitted to enter a classroom. But I believe the government would be going too far by mandating an HPV vaccine in a classroom setting because, at least as much as I am aware, it is not a virus spread by sneezing, nose wiping, spit flying or hand touching. The activities that spread HPV, as far as I am aware, are not part of the daily routine in a classroom. Any doctors out there that may have more information on this, I would love to be fully informed if I am misunderstanding the methods of this virus' transmission.

      September 15, 2011 at 1:55 pm | Report abuse |
  2. The Decider

    One more thing you need to know....................Rick Perry's parents are Henry Kissinger and Anita Bryant.

    September 14, 2011 at 5:48 pm | Report abuse |
  3. Andy

    @Informed: Informed your not.

    September 14, 2011 at 5:49 pm | Report abuse |
    • David


      September 14, 2011 at 6:06 pm | Report abuse |
  4. Mr. Sunshine

    At the parents choice and the parents choice only, period

    September 14, 2011 at 5:54 pm | Report abuse |
    • Walter

      Ask Ron Paul what should be done if those children get cancer and their parents don't have insurance. I am sure their neighbors and the church will cure them right away.

      September 14, 2011 at 5:58 pm | Report abuse |
    • john

      you are right! children should be slaves to their parents! the parents shall mandate what the child DESERVES!

      you are full of crap. the child has a voice, but people like you want to repress it. beatings used to be common in the 80s... we corrected that with government intervention.

      September 14, 2011 at 6:25 pm | Report abuse |
  5. Ryan

    @Michelle, I presume the logic in pushing it on people is that there's substantial benefit to be gained without substantial science proving that it's risky. Let's face it–most parents are not scientifically minded and in not a good position to make sound decisions like these. They tend to get wrapped up in rhtetoric like "Omg, if my daughter has this vaccine she'll believe that it's okay to be promiscous!"

    I don't know about you, but if I developed something like testicular cancer and then found out that my parents had the opportunity to give me a vaccine for it when I was young and decided not to, I'd be pretty upset.

    September 14, 2011 at 5:56 pm | Report abuse |
  6. leeintulsa

    As long as alcohol and cigarettes are legal, the government doesn't care about saving lives. No matter how much you want to think they are, the truth is something else.

    September 14, 2011 at 5:58 pm | Report abuse |
    • Dan L

      Bad analogy, banning alcohol and tobacco (and marijuana) doesn't work. People keep doing it, more concentrated forms show up (easier to smuggle), it's harder for people to get treatment, organized crime takes over, and increased prices cause more petty crime by addicts. No lives are saved and many are lost. So those who care about lives advocate for legalization.

      September 14, 2011 at 6:25 pm | Report abuse |
  7. Craig from Pa.

    Isn't Perry getting kickbacks from the pharmaceutical company for this program???

    September 14, 2011 at 5:58 pm | Report abuse |
    • Mavis

      @Craig – read the article. The "program" was never put into effect.

      September 14, 2011 at 6:11 pm | Report abuse |
  8. Gate

    So the Tea Partiers don't mind if their daughter's die of cancer? Big surprise given they cheer for executions and the death of the uninsured. There is nothing Christian about these people.

    September 14, 2011 at 6:01 pm | Report abuse |
  9. Gells

    Does anyone else get tired of reading these comment sections? It's sad to see how many morons this country really houses. Freedom of speech leads to idiots trying to act like they have knowledge when really all they have is a head full of hot air that's shoved up their own butts. I don't even know why I bother to look at comment boards anymore...

    September 14, 2011 at 6:03 pm | Report abuse |
    • Captain Nemo

      grow up

      "I disagree with what you say but will defend to the death your right to say it." – attributed to Voltaire but likely not him

      September 15, 2011 at 11:27 am | Report abuse |
  10. Rebekah

    Sadly, what this article did not say is that this vaccine was tested on an older age group not young girls under 13.

    September 14, 2011 at 6:03 pm | Report abuse |
  11. tigtoo30

    After watching a co-workers wife just die of cervical cancer (55), and having a very dear friend successfully battle cervical cancer (45), I just can't imagine why anyone would not want to protect their child from cancer. Whether or not they think their child will be abstinent or not.

    September 14, 2011 at 6:04 pm | Report abuse |
  12. Luce

    I was vaccinated with gardasil in middle school, no issue. Almost all the females in my age group and many of the guys I know were vaccinated as well, no issue. This fear mongering BS must stop. If you give two twigs about your kid, get them vaccinated that INCLUDES the boys as they are carriers!

    September 14, 2011 at 6:05 pm | Report abuse |
  13. Josh

    Debate? Better safe than sorry, just sayin'.

    September 14, 2011 at 6:05 pm | Report abuse |
  14. biff

    Just pray to jeebus and you'll never get sick

    September 14, 2011 at 6:06 pm | Report abuse |
  15. Lenny

    I am loathe to defend Perry but it is proven beyond a reasonable (although not a paranoid subjective) doubt that this reduces the risk of cancer and costs much less than treating cancer in many people. Why should children's lives be exposed to risk because a parent's belief system refuses to accept medical science? This is not about the basic nature of morality. Whether or not God exists will not be determined by whether or not a child is immunized.

    In fact, the main argument that was used to oppose the vaccination is that it would encourage children to have s3x as the consequences of HPV are lessened. Do Texas teenagers even know about HPV and the risks? Without mandatory s3x education and the unwillingness of the average American parent to discuss the subject with their kids I am highly skeptical of this as valid.

    September 14, 2011 at 6:06 pm | Report abuse |
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