Cervical-cancer vaccine recommended for preteen girls

Federal health experts recommended Thursday that all 11- and 12-year-old girls routinely get a newly approved vaccine aimed at preventing a sexually transmitted virus that can cause cancer, paving the way for private insurers and the federal government to pay for shots that could save thousands of lives in the United States each year.

The Advisory Committee on Immunization Practices also said females 9 to 26 could receive the vaccine on the advice of their doctors.

"This is a huge breakthrough for women's health," Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases, said after the unanimous vote in Atlanta by the committee.

The focus now moves to individual states, which will decide whether to mandate the vaccine as a requirement for school attendance.

Women's-health experts argue that requiring the vaccine is the most effective way to combat the disease.

"Unless you force people to get it," the number of children vaccinated will be low, said Cosette Wheeler of the University of New Mexico, who conducted clinical trials of the vaccine.

But some educators and conservative groups say decisions about the vaccine should be left to parents.

A first on many fronts

The human papilloma virus vaccine would become the first vaccine:

• against a sexually transmitted disease on the list of immunizations that all children should get.

• whose main purpose is to prevent cancer.

• to target a single sex (although adolescent boys may ultimately be included).

The Washington Post

Early on, some social conservatives questioned whether the vaccine — or its enthusiastic promotion by the government — might indirectly encourage sexual activity by teenagers. But opposition melted.

"The Family Research Council continues to endorse both the distribution and the widespread availability of the vaccine," said Moira Gaul, the coordinator of the organization's Abstinence Project.

She said the council would oppose making the vaccine compulsory.

Peter Sprigg of the council added, "We think this is a matter of parental rights and parental control. Parents have the rights to make these decisions for their kids."

The Advisory Committee on Immunization Practices never recommends that an immunization be mandatory for school attendance. That's a decision states make.

The vaccine, Gardasil, blocks four strains of the human papilloma virus, or HPV. Two of those strains are believed to be responsible for 70 percent of the 15,000 cervical-cancer cases diagnosed in the United States each year. Worldwide, 400,000 women are diagnosed with cervical cancer each year, and half die.

The other types of HPV blocked by Gardasil cause 50 percent of genital warts.

The vaccine is most effective when administered to girls before they have sex. According to the national Centers for Disease Control and Prevention, 26 percent of girls have had intercourse by age 15.

HPV is the most common sexually transmitted disease. According to the CDC, at least half of sexually active people will get HPV at some point in their lives, and by the time they're 50, 80 percent of women will have had an HPV infection. It causes no symptoms, and in more than 90 percent of cases, the body clears the virus.

In some women, however, persistent infection causes slow changes to the cervix that can lead to cancer. These can be detected by a Pap smear; the test has greatly reduced the disease here in the past 50 years.

Before the panel voted, several speakers also called for the immunization of boys, as soon as studies are completed on the vaccine's safety and effectiveness for males. HPV has been linked to penile, anal, and head and neck cancers.

Merck officials said clinical effectiveness studies in males should be completed by 2008.

Health experts said the vaccine could go a long way toward reducing the 4,000 cervical-cancer deaths that occur in the United States each year.

The vaccine, made by Merck, is among the most expensive produced. The full, three-shot series costs $360.

While private insurers and the federal Vaccine for Children program will cover most girls, Claire Hannan, director of the Association of Immunization Managers, said there are thousands who fall between the cracks. They include those whose insurance plans don't cover vaccines or have high deductibles. The federal program also does not cover women older than 18.

To provide the vaccine to everyone who should get it, the states would have to pay for those who cannot afford it.

Dr. Leah Devlin, state health director for North Carolina and president of the Association of State and Territorial Health Officers, said most states don't have the money.

She said the cost of providing Gardasil to all 11- and 12-year-old girls would nearly double her state's vaccine budget at a time it already has trouble paying for other required vaccines.

The federal committee's recommendation will become policy once it is accepted by the CDC, which normally follows the recommendations of its advisory panel. The CDC's approval is expected to come in a matter of weeks.

Two national health insurers, Aetna and WellPoint, said Thursday they would follow the committee's recommendations and begin reimbursing for the vaccine immediately.

Cost isn't the only problem standing in the way of widespread adoption of the vaccine. In California legislation is required to mandate a shot.

Some school officials have objected, noting that only three vaccines — those against polio, diphtheria and measles — are required in all 50 states.

"This is not a communicable disease that would keep kids out of school, like mumps or rubella," said Gerald Tirozzi, executive director of the National Association of Secondary School Principals, whose members include middle-school and high-school administrators.

Material from The Washington Post and The Associated Press is included in this report.