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. Jacksonfram

    What the GOP does not get is the simple business function of risk mitigation. They are the party representing business – right?
    Cost of immunization to health care as opposed to treatment to cancer. Add them and compare!
    Thats right , we can't do arithmetic anymore.

    September 14, 2011 at 6:23 pm | Report abuse |
  2. jefscott

    @Da2.....actually a lot of parents ARE too stupid or simply don't know enough about the benefits to make sure their child get this vaccine. And to be honest you can still be a smart person and simply not know much about this vaccine.

    We live in a world where where things like child negligence and abuse happen EVERY day. So is it REALLY that much of a stretch to realize these are the same type of parents who don't give a damn about getting their child vaccinated against an obviously terrible disease?

    Probably the biggest problem is that you can't think about things past the way a small child does. You think to yourself "oh this is silly the government doesn't trust parents to do this themselves" and then shut your brain off. Yes, there are a LOT of ways in which the government protects children all the time from parents who might abuse their children – either intentionally or unintentionally.

    September 14, 2011 at 6:24 pm | Report abuse |
    • WhiteSites

      I know many kids who had very serious side effects to vaccines. My own son ended up in the emergency room after getting his vaccines. Bachman just got my vote today, and before this I was a Ron Paul Supporter. Those of you who's kids never had any side effects are lucky, but there are plenty of kids who are not so lucky.

      September 14, 2011 at 6:45 pm | Report abuse |
  3. CanadianColin

    HPV is likely preventable with this vaccine. Why is this even a topic of debate?. I live in Ontario, Canada and my daughter received this vaccine free of charge with all the other 13yr olds. You could opt out but overwhelming numbers did not. Yes Merck will make some money from this but my kid might avoid cervical cancer by this measure. Prevention is better than cure and paranoia about vaccines is just that.

    September 14, 2011 at 6:26 pm | Report abuse |
    • ejav

      Colin, I agree; my daughter has had it also; my aunt died of cervical cancer, and it could have been prevented; she was not promiscuous, her husband had "experience". A huge percentage of the population is exposed this same way, and anyone who would not want their daughter protected cannot truly love her. There is no harm to protecting someone you love from something no one does. It's preventable. End of discussion.

      September 14, 2011 at 6:37 pm | Report abuse |
    • Leafonthewind

      Doesn't Merck deserve to make some money off of this? They came up with a vaccine that actually prevents a form of cancer. Isn't that awesome?

      September 14, 2011 at 6:41 pm | Report abuse |
    • Bill

      @Leaf, unfortunately we only applaud capitalism when we aren't the ones funding it. But clearly, this is a huge step in the advancement of medicine.

      September 14, 2011 at 6:52 pm | Report abuse |
  4. Lola

    I think it's ironic that people view drug companies as "evil", yet they believe everything they are told about vaccines (that are manufactured and promoted by drug companies to make a profit). Many diseases are autoimmune disorders (overactive immune system). Vaccines ramp up your immune system. You should be able to select which vaccines are worth the risk.

    September 14, 2011 at 6:26 pm | Report abuse |
    • acdMD


      If you are making this statement then clearly you are not someone who actually knows anything about the immune system. Your immune system is very specific reacts very specifically to a each and every threat. In autoimmune diseases the body is unable to tell the difference between the body and outside materials. Giving a vaccine in no way increases the body's response to attacking its self. In a healthy immune system the body can tell the difference between the vaccine and itself. A vaccine is just like you getting a cold. Getting more colds doesn't make you more likely to get an autoimmune disease. Even people who have known autoimmune diseases can get vaccines safely.

      September 14, 2011 at 6:41 pm | Report abuse |
    • knievel m.d.

      if you know absolutely nothing about immunology or vaccinations, please do not post like you do.

      September 14, 2011 at 6:48 pm | Report abuse |
    • knievel m.d.

      of course that was directed at lola, not the fellow md

      September 14, 2011 at 6:49 pm | Report abuse |
    • Jacksonfram

      Your logic is confused. I have Crohns, ant autoimmune disease and it has no vaccine, neither does HIV. However, Polio and TB have vaccines.

      September 14, 2011 at 6:53 pm | Report abuse |
    • acdMD

      No one said there are vaccines for autoimmune diseases. I just said that if you have an autoimmune disease you can receive vaccines-whether that be the flu, polio, etc.

      September 14, 2011 at 6:59 pm | Report abuse |
  5. amanda

    mandating vaccinations like this is dumb, this is a great vaccine, if you CHOOSE to get it for yourself or your child, but it should not be mandatory

    September 14, 2011 at 6:28 pm | Report abuse |
    • paintpaintpaint

      Right, honey, then we all have to feel bad for you and take care of you when you come down with the disease.... GET THE VACCINE.

      September 14, 2011 at 6:33 pm | Report abuse |
    • JT

      You and your child do not have to get the shot. Your child also does not have to attend a public school. That is your choice. This would only mandate the vaccine to be given to enter a public school system just like the MMR shots.

      September 14, 2011 at 6:46 pm | Report abuse |
  6. JohnRJ08

    There's no debate here. This all came up because a couple of anti-science, right-wing ideologues and an Alaskan windbag have used the issue to draw attention to themselves.

    September 14, 2011 at 6:31 pm | Report abuse |
    • c

      The debate is about personal choice, when a vaccine becomes mandatory, there is no longer a choice.

      Why would someone choose not to get a vaccine?

      people believe everything the CDC states. Why?

      people believed the EPA at Ground Zero, stating the Air was Safe. Why? today first responders are dying of cancers.

      Vaccines are not without risk, and every parent should have the right to say NO.

      September 14, 2011 at 6:51 pm | Report abuse |
  7. lukw

    god won't let this happen to my daughter so she doesn't need the vaccine

    September 14, 2011 at 6:31 pm | Report abuse |
    • jkld

      Are you REALLY that delusional? A woman can get cervical cancer by being completely chaste within her marriage. For you to EVEN think that God will protect her shows how truely ignorant you really are. My daughter is 21. I had her vaccinated when she was 12 and am dam glad of it. If I can possibly save her life, I'd do it 100x over.

      How STUPID you really are to risk your child's life!

      September 14, 2011 at 6:47 pm | Report abuse |
  8. RonPaul2012

    If you have seen a young patient with cervical cancer, you would tell that crazy Bachmann to STFU.

    September 14, 2011 at 6:31 pm | Report abuse |
    • Joey

      Yeah, you could tell her that but she will only "obey" if her husband tells her too.

      September 14, 2011 at 6:40 pm | Report abuse |
  9. Mihoda

    5 things?

    I'll give you one: It's not a "debate" unless you are religious.

    September 14, 2011 at 6:32 pm | Report abuse |
  10. Kerry

    There are a lot of ignorant parents out there.

    September 14, 2011 at 6:34 pm | Report abuse |
  11. Leafonthewind

    In those two places where these vacinations are mandated, parents have the choice to opt out? So, what's the big problem, then?

    I can see requiring vacinations for infectious diseases like small pox or polio, where it could become a public health issue, but HPV is not acquired through casual contact. It's an STD, and since parents often don't want to admit that their child is old enough to engage in such activities, there's a resistance to this vacine. I get that. But whatever happened to the concept of "it's better to be safe than sorry"? Tell your child what HPV is, how it is contracted, and what it could potentially cause. Have them vaccinated, but parents do have the power and the sway to convince their children that they are too young for s e x. Are we such a prudish society that we can't even talk to our children about this?

    September 14, 2011 at 6:38 pm | Report abuse |
    • Steve

      Unless you want your child to never have unprotected "s e x" (i.e. to never try and have a child of their own), then the vaccine will help protect them against HPV.

      September 14, 2011 at 6:49 pm | Report abuse |
  12. Anomic Office Drone

    Much like the theory of evolution, global warming and the separation of church and state, there was no legitimate debate over the HPV vaccine until the far-right decided to politicize it to try to win an election.

    September 14, 2011 at 6:38 pm | Report abuse |
  13. Doc

    You want to mandate that we vaccinate against measles running rampant in the schools? Fine. Measles is airborne and you don't get a choice about getting exposed. But there is NO reason to mandate vaccination against HPV in K-I-D-S since you have to CHOOSE to engage in the activity that gives it to you. If parents want to CHOOSE to take the risk of using a virtually untested vaccine on their kids, fine. I wouldn't do it – teach your kids to keep it in their pants instead. But it shouldn't be mandated, not for this.

    September 14, 2011 at 6:39 pm | Report abuse |
    • Leafonthewind

      It's all well and good to tell kids to "keep it in their pants" but a teen who manages to avoid that activity all the way into adulthood is the exception rather than the rule. Ask any woman who has cervical cancer if she doesn't with they'd had this vaccine when she was a teen. Better still, if you have a young daughter, don't get her vaccinated. If she ever contracts HPV and the resulting cervical cancer, then ask HER if she wishes you'd had her vaccinated.

      September 14, 2011 at 6:47 pm | Report abuse |
    • knievel m.d.

      Your children under 18 do not have the legal ability to CHOOSE to protect themselves with vaccinations. therefore an educated parent must CHOOSE to do the right thing and get the vaccination even if it is against their unimportant political views.

      September 14, 2011 at 6:51 pm | Report abuse |
  14. krist hochburger

    according to the CDC website....68 people have died and 18,727 people have had very negative side effects. i suppose those people dont matter? there are also a few hundred types of HPV and this only prevents a couple. it it simply not worth the risk, unless the manufacturer gives you a little money to force it on trusting people. this story is SICK!

    September 14, 2011 at 6:40 pm | Report abuse |
    • Justin

      yea and how many people around the world have recieved the shot? tens of millions... yes I will take a .01% failure rate any day for the greater good for the people.

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

      well the CDC said that 35 million vacs were distributed but did not mention how many people actually took it...and your right if all 35 million took it then your numbers are right...the point is about we the people having a choice....and making it mandatory is simply wrong....on a more serious note, is your fiance back to normal?

      September 14, 2011 at 6:47 pm | Report abuse |
    • krist hochburger

      @justin....i wish you and your fiance all the best! peace

      September 14, 2011 at 6:52 pm | Report abuse |
    • knievel m.d.

      Your stats are wrong. Simple as that.

      September 14, 2011 at 6:54 pm | Report abuse |
    • Captain Nemo

      it isn't that those poor afflicted people don't count, it is the reality that nothing in medicine * (or life!) is 100%.

      get over it.

      September 15, 2011 at 11:41 am | Report abuse |
  15. Justin

    My fiance has cancer that is caused from HPV... This shot should be one those REQUIRED by law.

    But hey since we are talking about female rights and all... The morning after pill should be free, abortion should be allowed etc. the woman has to live with THEIR decision for the REST OF THEIR LIFE!!!! Our governent and we the people have no right in making decisions on abortiona nd stuff. But when it comes to a shot that helps prevent catching HPV, which does cause CANCER in some forms of HPV, this should be REQUIRED to stop the SPREAD of the STD!!!!!

    September 14, 2011 at 6:40 pm | Report abuse |
    • krist hochburger

      we could all get vaccinated OR we could not sleep around...I choose the latter

      September 14, 2011 at 6:42 pm | Report abuse |
    • knievel m.d.

      yea kris but that isn't by choice on your part. also, why should we be subjugated to dark age religion where the religious nuts can just opt out and commit child abuse?

      September 14, 2011 at 6:55 pm | Report abuse |
    • acdMD

      It doesn't matter if you sleep around or not. It only takes you sleeping with one person who has HPV.

      September 14, 2011 at 7:01 pm | Report abuse |
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