Politics/Law/Government

TX Gov. backs down on HPV vaccine order

By Rori Black

In February of this year, Texas Governor Rick Perry surprised his conservative base by signing an order requiring all preteen girls be vaccinated against human papillomavirus (HPV), the leading cause of cervical cancer. On May 8th, he backed down from his position

The vaccine, Gardasil, targets four of the HPV types believed to cause more than 70 percent of cervical cancer cases and 90 percent of genital warts; it was also shown to be 100 percent effective against two of the most common HPV strains. More than 300,000 women worldwide die each year from cervical cancer. Prevalence of HPV in American women varies from 20 to 45% depending on age.

Social conservatives oppose the use of the vaccine, saying that it will lead to sexual promiscuity and tramples on parental rights, even though the order allowed for students to opt-out. James Dobson, president of Focus on the Family stated, “[I]n a normal classroom setting, no child will contract or transmit HPV. It can be prevented, for the most part, by abstinence until marriage.” The Family Research Council has explained, “Giving the HPV vaccine to young women could be potentially harmful because they may see it as a license to engage in premarital sex.”

The backlash was swift. Last month, the Republican-majority Texas Legislature passed a bill contravening the order, blocking the program for at least four years. Then, last Friday, the unidentified parents of three Texas girls sued Perry for overstepping his authority and illegally requiring the vaccine for preteens. On May 8th, Perry, who has close ties to the religious right, backed down, saying he would not veto the bill. He did, however, issue a scathing statement to the legislature.

“They have sent me a bill that will ensure three-quarters of our young women will be susceptible to a virus that not only kills hundreds each year, but causes great discomfort and harm to thousands more,”

Research on Perry’s decision making quickly shows that he may be answering to two masters. Perry’s former chief of staff is now a lobbyist for Merck, the vaccine’s manufacturer; and his current chief of staff and other aides reportedly met to discuss the state’s immunization program, including the HPV vaccine order, on the same day in 2006 that Merck donated $5,000 to the governor’s reelection campaign.

Regardless of Perry’s true motives, his statement condemning the legislature, was spot-on. Unfortunately, conservatives who still believe in “abstinence only”, over the reality of human sexuality, would rather condemn young women to death that give them the facts and tools to guard against cancer.

29 replies »

  1. I had mixed feeling about Perry’s push to require the vaccine, being unable to parse out his motives.

    BUT –

    Abstinence-only sex-ed isn’t working, teenage girls are having sex and even if a teen girl knew about HPV and the vaccine, how can she get it if she doesn’t have parental support? I will admit, I’m woefully ignorant to the details – cost, regulation, availability, etc. Would a minor be able to get vaccinated without parent consent (provided it would even be affordable)? If not, then it strongly influences how I feel about requiring the vaccination. Parental denial about adolescent sex isn’t new – how do we protect these kids from disease when the people responsible for doing it at the moment don’t actually think the kids are at risk?

    That being said, I’m interested in what you all have to say.

  2. Jeremie

    http://www.latimes.com/news/printedition/asection/la-na-vaccine25feb25,1,3474874.story?coll=la-news-a_section&ctrack=1&cset=true

    At $360 for a series of three shots, it is the most expensive vaccine yet. Medicaid and the federal Vaccines for Children Program will help cover costs. Large private insurers are also expected to pay for the vaccine.

    http://www.guttmacher.org/pubs/tgr/03/4/gr030404.html

    States have traditionally recognized the right of parents to make health care decisions on their children’s behalf, on the presumption that before reaching the age of majority (18 in all but four states), young people lack the experience and judgment to make fully informed decisions. …

    In addition, courts in some states have adopted the so-called mature minor rule, which allows a minor who is sufficiently intelligent and mature to understand the nature and consequences of a proposed treatment to consent to medical treatment without consulting his or her parents or obtaining their permission.

    Moreover, over the last 30 years, states have passed laws explicitly authorizing minors to consent to health care related to sexual activity, substance abuse and mental health care. Although some states give doctors the option of informing parents that their minor son or daughter has received or is seeking these services, these laws leave the decision of whether to inform the parents entirely to the discretion of the physician as to the best interests of the minor.

    The problem with the HPV vaccine proposals is that certain people see this as a sexual issue as opposed to a health issue and react according to their own concept of morality. Unfortunately, they do not view this legislation the same way they do other compulsory vaccinations

  3. This must be a hell of a conundrum for a god-fearing Republican guvner. On the one hand, those who speak for God don’t like it because it promotes sex, which wouldn’t be happening otherwise. On the other hand, Merck very much likes it, for reasons that are plenty obvious.

    God vs Ca$h. And it’s out in the open. This is the Country Club Republican’s worst nightmare.

  4. It amuses me how my god frearing Texas governor has been caught more than once or twice….in a compromising position and his wife was not involved. Its the old “do as I say and not as I do” republican syndrome.

    God, cash and Perry are all very good friends.

  5. I’ve got some fundamental issues with using schools as the place where public health initiatives are implemented, but even so, this seriously sucks. There are precious few vaccines that parents should be allowed to opt their kids out of, and the HPV vaccine isn’t one of them.

    Yo, Texas! Teenagers have sex. It’s a fact of life. Deal with it.

  6. Sounds like South Africa’s approach to AIDS, “If we don’t talk about it then kids won’t figure out what the dangly bits are for. Woops, they did, now we have a runaway problem.”

  7. I have some fundamental issues as to whether I think the HPV vaccine is called for as a mandatory thing, administered in schools, at ALL. Is there a medical threat? Yes. But how large is it? And by the way, in answering that question you’re not allowed to use any numbers provided by a pharmaceutical company.

    I can’t help but observing that I’m a fairly well-informed guy – not omniscient by any stretch, but certainly in the top 10th percentile in terms of paying attention to the news – and a year ago I’d never heard of HPV. All of a sudden the whole damned world has heard of it, though. All of a sudden it’s public health crisis #1. All of a sudden every girl MUST BE VACCINATED.

    Now, how did this happen? Where did this health crisis come from? Folks, I worked in corporate marketing and PR – still do – and we’re seeing one of the greatest media triumphs in business history. Pharma has created a crisis out of thin air and – by coincidence – they happen to be standing there ready to “help” for a fee.

    And these are the same folks behind this and this (please note bullet #2).

    So put me down for “suspicious.”

  8. Sam Smith,
    The reason you never heard of this a year ago is because it didn’t exist!!! It’s a new vaccine that will eliminate cervical cancer. What the f*** does it have to do with sexual activity??? Would you also condemn a vaccine for breast cancer? What about prostate cancer? Would a cure for prostate cancer lead to more underage sexual activity? Stop moralizing and get your heads out of your backside! A vaccine to stop cancer is a GOOD thing, you want to moralize about something? How about all the pharmacutical ads on tv, esp. the ones on erectile disfunction and calling your doctor if you get an erection for more than four hours. Want to explain that one to your teenage daughter? When did these ads start to appear? I’m guessing just around January 20th 2001.

  9. It bothers me that this issue seems to center around the “promiscuity” of teenaged girls, rather than the fact that a lot of people seem to think it’s perfectly okay to force girls to have this new – and potentially dangerous vaccine. Does anyone really think we can trust Big Pharma to disclose risks – after Vioxx, etc.? And we’re suggesting that 100% of our girls be the guinea pig generation here? I’m a strong liberal, and this – like all medical matters – should be an individual decision between a woman (or girl/parents) and her doctor.

  10. My partner has had yearly pap smears. Her insurance only covered paps, not test for hpv, so she never had them. Then she ended up in the emergency room in severe pain. Turns out she had HPV and it had turned cancerous. She had to have a radical hysterecomy – we’re very lucky that’s all that she needed. I quickly had myself tested (yes folks, it’s contagious through other means than sex) and had my daughter get her vaccine.

    My question to anyone who feels that their daughter shouldn’t have this because they should just abstain. Years from now your daughter (still a virgin) gets married. Are you going to risk her life on her husband being honest that he has never had any sexual contact? And since there are over 100 types of HPV virus, and some are even transmitted by shaking hands, what good does virginity do against those strands?

  11. By the way, Sam. HPV is for real. And something like 70-80% of the population is or will be exposed at some time. (Yes, men carry it and should be tested, so they can protect their partners.) It’s reflective of the gender bias in our health care that men aren’t routinely informed about and tested for this disease, which they pass to women, whose lives may be affected.

    Only a few strains cause cervical cancer. The reason the vaccine is news is that there are a lot of painful and scary treatments that have been done up to this point to treat HPV in infected women, based on the fear that it might turn into this deadly cancer. The vaccine would make all of that unnecessary – IF IT WORKS, AND IF IT’S SAFE.

    Interesting that no one seems to be suggesting that MEN, the carriers from partner to partner, be tested and treated with a new drug in their preteen years, isn’t it? Hmm …

  12. You’re kind of all over the place here – the only thing you’re really communicating clearly is anger. I’m pretty sure HPV existed before a year ago, and yet it wasn’t a national health crisis until Merck saw a revenue stream. And if you think I’m dismissing the horrors of cancer you’re not only not reading closely, you’re being presumptuous. I wish there had been a vaccine for the cancer that took my grandfather, who raised from the time I was three years old. And I’m awfully glad that there’s a vaccine against this kind of cancer.

    But the existence of the vaccine doesn’t mean that this is public enemy number one. It doesn’t mean that schools are the best venues for administration of the vaccine. It doesn’t mean the campaign should be mandatory – can YOU provide me with scientific (not pharma industry) stats on the incidence of the disease and the efficacy of the vaccine?

    I’m certain this issue is part fire and part smoke. The question is what percent of each. I’m guessing, based on what I’ve seen of this remarkable pharma public “information” campaign and what I know about how these things work (from BEING a corporate marketing a PR professional) that the ratio of smoke to fire is a lot higher than people suspect.

    That’s what I’m saying. If you have objections to what I’m SAYING that’s fine, but I’m not here to take a beating for the straw man.

  13. Sam,
    Your point is valid. My point is that you didn’t hear about this because the vaccine didn’t exist a year ago, not the disease. My anger is not towards you, but more towards the incestous relationship between this administration and corporations that have no loyalties but to the profit margin. We shouldn’t be arguing about anything but how to get this country back on track, to representing the citizens of the country, not the corporations. My apologies.

  14. Sam,

    Fifteen years or so ago, I was diagnosed with cervical cancer. When I went in for them to do more testing, the first thing they did was check for HPV, even back then they knew that there was a correlation between HPV and cervical cancer.

    I tested negative for HPV, had minor surgery to remove the bad cells, and have had clean paps ever since.

    Was HPV == cervical cancer household knowledge? Not unless it directly affected you. Has big pharma milked the scare? Maybe. But the numbers I get from research and from speaking with a virologist are fairly consistent.

  15. From my perspective (as the virologist in question above) the main reason Merck and physicians in general are pushing the Gardasil vaccine so hard is that the types of cervical cancer caused by HPV can be prevented as opposed to ameliorated. We’re miles away from effective preventative measures for any other cancers, especially those caused by environmental effects, genetic predisposition or simple random mutations.

    Given enough time with PubMed I can probably post the published data on Gardasil’s efficacy. Prevalence data is recent and well-accepted. Without sharing the actual number of positive HPV samples we receive in my lab, I can tell you that they’re higher than one would expect (and this is true for most sexually-transmitted diseases).

    I can’t say why men aren’t screened for HPV. At this point, the FDA have not approved any screening methods for male patients. However, there’s a high incidence of the virus in gay and bisexual men, and HPV may be the cause of some penile and anal cancers. Perhaps, as our general awareness of the virus and its effects expands, useful screening methods will be developed and put into common practice.

  16. Rori,

    Honestly, I don’t doubt for a second that it would probably be a good idea if everyone were vaccinated. Assuming the vaccine is effective and that there aren’t any as-yet-undiscovered side effects, it seems like the sort of thing that can save lives. How many? Hard to say. But still.

    So say, for the sake of argument, that you’ve convinced me on this point. (also you have convinced me to go buy as much Merck stock as I can carry.) How should the vaccinations be administered? I remain pretty opposed to the ideas of pimping out schools AGAIN – we use that captive audience things so much it’s hard to imagine when there’s time for actual teaching anymore.

    IS that the best we can do, or would you propose other strategies for the actual administration of such a program?

  17. (can of worms – opening…)

    As far as Sam’s point about PR goes, PR campaigns have worked great for breast cancer awareness, yet the equivalent male cancer (equilvalant in the sense that, if you live long enough, you will amost certainly get it), prostate cancer, has no PR and is thus very low on the radar. Everyone knows what a pink ribbon means, but if I wore a blue ribbon during the week of September 17-22 (Prostate Cancer Awareness Week), I’d get a lot of weird looks.

    For better or worse, PR determines where the awareness is and thus where the money goes.

  18. Sam,

    I’m really torn, in a way. You know I am against government interference AND the legislation of morality.

    However, like I said above, if one looks at this vaccine as one does the other compulsory vaccinations, its an easier pill to swallow, so to speak.

    Like anything anymore, there are benefits and risks, nothing is cut and dried, and anyone with any critical thinking skills is going to have to stop and really think about it.

    My main motivator for the “pro” stance is rooted in my disgust at way the medical community has historically (not) addressed women’s health. There is still a huge disparity between studies and research for men and women as well as long held biases. That’s an emotional reaction and not empirical, I admit, but there it is. I want the medical community to start caring about women’s health.

  19. Brian,

    Good point. Just look at Lance Armstrong and his contribution to the awareness of testicular cancer .

    I say, wear the blue ribbon and when you get the weird looks, use the opportunity to educate people about prostate cancer.

  20. Brian,

    You’re not really pretending that all PR campaigns are the same, are you? I mean, you just equated legit pro-public health initiatives by non-profits and gummit agencies with for-profit campaigns by corps that are designed to CREATE A NEED. That’s what marketing does.

  21. Lord, I miss Molly Ivins! She’d be having a field day with this…she would point out something like, “Governor Perry is smarter than I gave him credit for. He almost got away with being bought by both sides of an issue; I guess he isn’t only a great head of hair.”

  22. Sam, to some sense, they are all the same. The ends matter, of course, but so do the means. And as far as I can tell, there are precious few people in the PR/marketing biz anywhere near as principled as you are about using effective but unethical means to generate buzz about products. Similarly, in some sense, the goal of all PR is the same – public awareness – because public awareness brings in money, either in form of bought products or in the form of donations.

    There’s a reason I say that there are “lies, damn lies, statistics, and then there’s marketing.”

    Rori, as far as I can tell, prostate cancer finally started to hit the radar when Rudy Guliani started stumping on the subject as a survivor.

    Wow, I guess Rudy’s actually good for something after all. Now we just need to keep him stumping for prostate cancer awareness and out of the White House….

  23. Sam,

    Thank you for that link. If state legislators are going to have a discussion on this issue, they need to look at the studies, the efficacy, and the long term effects of the vaccine…

    Not base their decisions of disingenuous morality issues based on pie in the sky ideals abstinence and ignorance.

  24. Sam:
    Thanks for the link. The SFGate article is exactly what the Texas Legislature was concerned about. They held extensive hearings with our CDC, research scientist and doctors and they came to the conclusion that the drug is still in the experimental stage.

    I applaud them for actually researching what the governor did before they stuck down his executive order. Very few Texans were for the vaccine with limited research and long term known results.

    It was also very clear to us, in very short fashion, that Perry had received favors and/or money from Merck. That has yet to be completely verified, but it was a huge alarm to everyone that the executive order and the drug needed to look at very closely.

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