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. SharkMan2

    Way to leave out that Perry's chief of staff at the time of his signing of the executive order was a former lobbyist for Merck.

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

      Missed this part, did you?

      "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."

      Reading for comprehension is sadly neglected in today's schools as evidenced by many of the comments I read on CNN.

      September 14, 2011 at 6:12 pm | Report abuse |
    • ReadingComprehension

      Seems like you need to re-read the article. It's there.

      September 14, 2011 at 6:18 pm | Report abuse |
  2. Marie

    Wow, Wayne, you're expressing your idiot side, you must be young & ignorant with nothing of value or importance to say. Just keep quiet, will you. Perry did wrong by mandating that children get this vaccine. Parents have rights and they should be able to express those rights. Parents should always be given the option, they should have the right to say what goes into their children's bodies. They are the children's guardians, not Perry nor the state of Texas. I was born in Texas, so glad my family left when I was very young. Perry is a scary man, just like Bush.

    September 14, 2011 at 6:07 pm | Report abuse |
    • Klytus Im Bored

      This entire idea that parents are part of some mini-kingdom wherein the state has no influence needs to go. Under your suggestion (that parents are the be all end all, and should always have the final say), polio would still be rampant in this country. This is a vaccine that can prevent a virus that causes 99% – read that as NINETY-NINE PERCENT – of all cervical cancers. This is for the good of public health, which subsumes your personal little kingdom of . Who cares about power hungry politicians? This is a public health issue, not one for political fodder.

      September 14, 2011 at 6:16 pm | Report abuse |
    • theBlond

      Well said, Marie, i could have not put it better words. Perry is a scary thing to be our next president. that is a no no.

      September 14, 2011 at 7:13 pm | Report abuse |
  3. PAPilot

    It is important to understand that correlation does not imply causation, and while they THINK HPV causes cervical cancer, no causal relationship has ever been proved. It's sad that we as a society have been completely duped into believing that correlation is the same thing as cause, just so we'll spend more money on medicines we do not need to treat a bunch of made-up diseases that they don't even cure.

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

      You're clearly an idiot but last I checked the studies proves that there were significantly lower rates of cancer in those that received the vaccines. Preventing cancer is a pretty good reason to use a drug.

      September 14, 2011 at 6:13 pm | Report abuse |
    • tomtom

      But in this case, people who have taken the vaccine have a dramatically lower incidence of cervical cancer. Women die from cervical cancer. It's not a made up disease.

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

      And you probably believe that there is no causal link between smoking and cancer!

      September 14, 2011 at 6:18 pm | Report abuse |
    • Klytus Im Bored

      "Persistent HPV infections are now recognized as the cause of essentially all cervical cancers."

      September 14, 2011 at 6:20 pm | Report abuse |
  4. Matt

    That just shows you have no idea about this virus and its prominence. So, you are not only a racist but an idiotic racist.

    September 14, 2011 at 6:08 pm | Report abuse |
  5. Drewster1969

    Perry needs to mind his own business on this one. He just wants to make money. Let parents decide about this vaccine!!

    September 14, 2011 at 6:08 pm | Report abuse |
  6. tainomd

    I just saw a case presented in my hospital cancer conference (I am a physician) of an annular cancer in a 28 year old female (just had a baby by C-section) which has a very poor response rate to radio or chemotherapy. The cancer stained positive for HPV. It is just tragic for she will unfortunately die en less than 5 years, and it will be a terrible death (we shall try very hard to make it bearable and dignified). This is the type of cancer that can be prevented by the vaccine. It is just the right and compassionate thing to do! Better to prevent than to treat!

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

      Of course it is better to prevent. The issue is, though, big pharma and medical insurance companies have lost the trust of the American people for the entire medical community. If a politician mandates a vaccine made by a company that has supported his campaign, people will not see the positive in the vaccine. Instead, they will retaliate, and you will likely see more parents shunning ALL vaccines in the name of having choices for their children.

      September 14, 2011 at 6:18 pm | Report abuse |
  7. Joe The Plumber

    Just like Bachmann to cite "parents told her" as proof in the pudding. That's real evidence based decison making. She is not exactly presidential material.

    September 14, 2011 at 6:10 pm | Report abuse |
  8. JonDetroit

    The "issue" here is Michele Bachmann claimed a well-tested anti-cancer vaccine was responsible for "mental retardation", and nobody called her out on it, when they should have.
    There is no link to mental retardation. Not even CLOSE to a link. Not ONE CASE EVER. She pulled that statement entirely out of her @ss, like she does with so much of what she says.

    September 14, 2011 at 6:14 pm | Report abuse |
  9. Where's Dr. Gupta?

    it's funny that during all this debate about this vaccine. Dr. Gupta hasn't given an opinion about this matter when he was a champion for this vaccine and CNN was actually getting some serious cash for advertisement of MERCK drugs using AccentHealth..and apparently still is based on this article.. an article about all this can be found here:

    September 14, 2011 at 6:14 pm | Report abuse |
  10. Beadlesaz

    Rarely do I wish harm on anyone else but to those of you who think that the government shouldn't require vaccination against HPV, I can almost wish that you would have to go through treatment for anal cancer. Two years ago, right about the time Farrah Fawcett was dying from anal cancer, I was diagnosed with it. I had two rounds of chemo and 6 weeks of daily radiation. For about 3 months I had NO SKIN in my groin area. Despite extremely strong pain killers, I screamed every time I defecated or urinated. The vaccine is a life-saver and it should be required for every child. To those of you who want to spout off about conspiracies and come up with all the bizarre "what-ifs" – you shouldn't be responsible for the well-being of any child.

    September 14, 2011 at 6:15 pm | Report abuse |
  11. Lola

    Vaccines work by ramping up your immune system. I am more concerned about developing an autoimmune disorder as a result of being overvaccinated. I would not like to see vaccines as mandatory, one-size-fits all and I'm afraid that's where we are headed with government-controlled healthcare. In Europe, you can't opt out of any of the childhood vaccines or they accuse you of medical neglect.

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

      Vaccines don't "ramp up" your immune system. They allow your body to develop antibodies to a specific contagion by exposing it to very small, "safe" levels of the disease which have typically been rendered inert in a lab. Once those antibodies have been developed, your body has the ability to effectively fight off that disease.

      Autoimmune disorders cause a person's body to attack normal, healthy tissue. They are genetic anomalies and not contractible.

      September 14, 2011 at 6:29 pm | Report abuse |
    • Kari

      As someone who studies microbiology and immunology, I can tell you your concerns are not founded in science or logic.

      September 14, 2011 at 6:30 pm | Report abuse |
    • michelle

      I am a research scientist in immunology, and while my specific field is tumor immunity, I can tell you in no uncertain terms that vaccines do not "ramp up" the immune system willy-nilly. What they do is drive the development of a protective immune response without the dangers of an actual infection. Safe, effective, necesssary. You probably owe your life to them.

      September 15, 2011 at 1:41 pm | Report abuse |
  12. db

    This vaccine only prevents a child from getting that particular problem. We all have taken small pox, pollio, measils and other vacines. Why becasue it is better to avoid the desease than to get it. People today don't hae any idea what any of those can do to a kid. Call them ignorant if you like but I like to say they are uninforment and uneducated. Watching a child suffer is never a good thing to see.

    September 14, 2011 at 6:18 pm | Report abuse |
  13. Benjamin

    Perry did it for the wrong reasons (financial gain for his friends and his own fundraising), but it's the right thing to do. HPV is the most widespread STD and a significantly large portion (we're talking upwards of a half) of Americans will come into contact with it at some point. It's larger threat to women, however, as it increases the likelihood of cervical cancer. Inoculating the populace is simply common sense.

    September 14, 2011 at 6:18 pm | Report abuse |
  14. EBF

    What this article doesn't tell you is that Gardisil only helps prevent a few of the viruses that could lead to cervical cancer. There are other viruses that cause cancer and are not in this injection. If a twelve year old receives this vaccination, how do you keep track if she ever gets cervical cancer? And who did the pharmaceutical company
    test this on? Mice??? I would not want my 12 year old daughter to get this vaccine.

    September 14, 2011 at 6:21 pm | Report abuse |
    • KatyaKatya

      A few viruses cause most of cervical cancer cases, and the vaccine protects against them, that is what it says. The other ones are much more rare.
      And no, not mice. Tests on animals are just the first stage. There are very strict protocols of clinical studies which must be followed if a medicine or vaccine is to be introduced.

      September 14, 2011 at 6:28 pm | Report abuse |
  15. KatyaKatya

    Vaccines don't cause diseases. Vaccines prevent diseases. Just like a certain ignorant part of public, to criticize the medical science for not providing you with a cancer cure – and to refuse prevention when it is available.
    Not even for yourselves, but for your daughters.
    As for the "parents told me" thing – how does a parent know what made the child sick? They don't. Their doctors don't. They barely can read in most cases, let alone diagnose diseases.

    September 14, 2011 at 6:22 pm | Report abuse |
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