Texas has become the first state to require girls to be vaccinated against the human papilloma virus. HPV is a generally asymptomatic sexually transmitted infection that about half of Americans contract. It's even more common among women; scientists estimate that 80 percent or more have had HPV by age 50.
Last summer, the Centers for Disease Control and Prevention recommended that girls be vaccinated, starting at age 12.
The move to require the HPV vaccine for adolescent girls began right after the CDC made its recommendation. Within months, a bill was introduced in the Michigan assembly. It was defeated. A watered-down version was introduced again this year. Now 18 states and the District of Columbia have followed suit.
That has focused attention on the manufacturer's campaign to promote the vaccine.
David Catania, a Washington, D.C., City Council member, says there's a simple reason — protection against cervical cancer.
"For 14,000 women per year, it means cervical cancer, and for 4,000 it means death," he said. "The District has a particular reason why this is important. It is important because we lead the nation in cases of cervical cancer. We have the highest instances of cervical cancer in the country."
But as in most states where there have been proposals to require the vaccine, Catania had to take a lot of heat. A local newspaper columnist worried that the measure suggests that girls in the District of Columbia's public schools — most of whom are African American — are sexually promiscuous. Catania insists that the legislation doesn't target any particular group and the vaccination wouldn't exactly be mandatory.
"What we are doing is we're forcing the conversation. Either you are going to have your child vaccinated, or you will make an informed decision to opt out," Catania says.
In the District, parents would not have to provide a reason for their objection. Catania says he wants the District to move fast and stay in the lead nationally on childhood immunizations. By all accounts, Merck, the first manufacturer of an HPV vaccine — Gardasil — wants to move fast, too. Drug maker GlaxoSmithKline is close on Merck's heels with its own HPV vaccine. So Merck has initiated a massive ad campaign that is part public education and part hard sell. The ad says, in part:
"I want to be one less woman who will battle cervical cancer. One less."
But Merck has not just bought air time, it has funded initiatives in states which would require girls to get the vaccine. The money was directed through an organization called Women in Government.
Dr. Richard Haupt, a company medical director at Merck, says the company supports vaccine mandates because they ensure that all girls get the vaccine.
"Through school requirements, you reach under-served populations, certain ethnic and socio-economic groups that wouldn't be reached otherwise," Haupt said. "And that's why we support state initiatives that improve immunization rates."
If the vaccine became widely used, analysts estimate that Merck could make from $2 billion to $4 billion on Gardasil.
Most public-health experts support requiring immunizations in general. But Dr. Neal Halsey, a pediatrician and vaccine expert in the School of International Health at Johns Hopkins University, would prefer a campaign to build acceptance of the HPV vaccine before it is required. There are a lot of hurdles. For one, Halsey thinks it's going to take time to teach parents why young children need to be vaccinated against a sexually transmitted infection.
But there are some objections that public education won't easily overcome. Some conservatives object to the vaccine because they fear it will encourage early sexuality, and some parents object to vaccines because they think kids are already subjected to too many as it is. And the HPV vaccine is not cheap or simple to administer. It's $120 a shot. The girl would have to get three shots over a six-month period.
Still, the question that most parents will have to resolve is whether the fear of a potential cancer later in life trumps inhibitions about sex in adolescence.