The AP/Miami Herald on Sunday examined reasons why state proposals to mandate human papillomavirus vaccination for middle-school age girls have not passed in most states where such legislation has been proposed. According to the AP/Herald, 24 states and Washington, D.C., have considered HPV vaccination mandates, but Virginia is the only state to have passed such a measure (McCaffrey, AP/Miami Herald, 5/20).

Merck's HPV vaccine Gardasil and GlaxoSmithKline's HPV vaccine Cervarix in clinical trials have been shown to be 100% effective in preventing infection with HPV strains 16 and 18, which together cause about 70% of cervical cancer cases. FDA in June 2006 approved Gardasil for sale and marketing to girls and women ages nine to 26, and CDC's Advisory Committee on Immunization Practices later that month voted unanimously to recommend that girls ages 11 and 12 receive the vaccine. GSK last month announced that it has filed for FDA approval of Cervarix (Kaiser Daily Women's Health Policy Report, 5/8).

The debate over whether to require HPV vaccination involves "some of the nation's most politically charged issues," including parental control, state mandates, teenage sex, and a "backlash against vaccines and a suspicion of drug companies," according to the AP/Herald. Some people also were concerned about Merck's lobbying for state mandates. In addition, some people were concerned about long-term health effects of the vaccine, the AP/Herald reports (AP/Miami Herald, 5/20). According to the Hartford Courant, there also has been concern over insufficient reimbursements for physicians who administer the vaccine (Waldman, Hartford Courant, 5/20).

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Cantu Hinojosa, assistant director of government relations for Planned Parenthood Federation of America, said that many of the HPV vaccine mandate proposals, including the Virginia law, include provisions allowing parents to opt their daughters out of the requirement, adding, "It's really a shame that politics and ideology are getting in the way of saving lives." Moira Gaui, director of women's and reproductive health at the Family Research Council, said the group does not oppose the vaccine but added, "We think parents ought to be given a choice about what is best for their children."

Alina Salganicoff, vice president and director of women's health policy at the Kaiser Family Foundation, said the debate "encapsulates so many issues that are at the core of politics and health policy right now" (AP/Miami Herald, 5/20). Salganicoff said that people are "excited and feeling very positive about the possibility of preventing cervical cancer," adding that they are "not ready to move so quickly" on mandating HPV vaccination (Hartford Courant, 5/20).