VERMONT - A controversial bill that would have required all sixth-grade girls in Vermont to be vaccinated against the human papillomavirus (HPV), the primary cause of cervical cancer in women, appears unlikely to be voted on by state lawmakers before they adjourn this spring. Citing a full plate of "other, very large, complicated public-policy issues," Ann Pugh (D-South Burlington), who chairs the Human Services Committee, said that H.256 will not come up for a committee vote before the end of the year. "And, I don't think we'll be passing it in its present form, which is a mandate with an $8 million price tag," Pugh added.
The HPV vaccine, marketed under the name Gardasil by drug maker Merck & Co., received federal approval from the U.S. Food and Drug Administration in June 2006. Since then, at least 20 states, including Vermont, have introduced legislation to require the vaccine for pre-teen girls. (The vaccine has not yet been shown effective in males.) The vaccine has been proven effective against four forms of the cancer-causing virus, but must be administered before the virus is contracted via sexual contact.
The HPV vaccine has come under intense public scrutiny in recent weeks, especially after Texas Governor Rick Perry ordered on February 2 that all 11-year-old girls get inoculated before they could attend school. That move sparked a major backlash from religious and cultural conservatives, who contend that mandating the vaccine would only encourage sexual promiscuity among young girls.
In Vermont, opposition to the bill has come more from civil libertarians, who oppose making the new drug mandatory, and from public-health watchdogs wary of the vaccine's unknown long-term health consequences.
"I have huge issues when you start medicating a population against a disease which is not communicable in the schoolroom but you're saying they can't go to school unless they get [the shots]," says Susan Premo, a retired social worker from Worcester. "Admittedly, it's a horrid disease, but it's not affecting that many people in terms of total numbers."
Cervical cancer is the tenth most commonly diagnosed form of cancer for women in Vermont, according to state health department figures. Each year approximately 31 Vermonters are diagnosed with the disease; about 10 of them will die from it. Nationally, 12,000 to 15,000 women get cervical cancer annually, and it's fatal in one-third of them.
The Centers for Disease Control and Prevention, the Vermont Department of Health and the Vermont Medical Society have not yet weighed in on legislation mandating the HPV vaccine.
Opponents of the bill say they're suspicious of the pharmaceutical industry's motives for aggressively pushing this new vaccine, especially considering its high price tag - $360 for three injections administered over six months. At stake is a potential $5 billion annually, according to a Feb. 17 article in The New York Times. Questions arose after it was revealed that Merck had provided major funding to Women in Government, a legislative advocacy group of female lawmakers supportive of many such bills.
In response, Merck announced last week it was halting all lobbying efforts on behalf of vaccine-mandate legislation, and turning its attention instead to educating women about the importance of Pap smears and regular cervical exams.
In Vermont, the highest incidence of cervical cancer is among women over 30; it's particularly high among post-menopausal women, many of whom mistakenly believe they no longer need regular cervical exams.
Representative Denise Barnard (D-Richmond), who introduced H.256, was one of dozens of lawmakers who attended a vaccine-educational dinner in Montpelier last week. Barnard emphasized that neither Merck nor Women in Government had paid for the dinner. In fact, the event was sponsored mostly by the Hicks Foundation, a Burlington-based nonprofit founded by cervical cancer survivor Allison Hicks.
Since being diagnosed in October 2004, Hicks has been an outspoken proponent for more public funding and education about this preventable disease. In January, her organization sponsored a free cervical cancer screening day in Burlington and provided 10 free HPV vaccines to the public.
Hicks says that while she respects the views of those who don't want to mandate the vaccine, she points out that Vermont has one of the most liberal opt-out provisions in the country, allowing people to not inoculate their children on moral, medical or religious grounds. Mandating the HPV vaccine would allow women to pay for them through their private insurance carriers or government-sponsored health plans.
Pugh says she hasn't made up her mind yet on the bill, but insists it will eventually get a "thoughtful and deliberative hearing" as part of a more comprehensive look at cervical cancer and women's preventative health in general. "Anything that has sex involved gets people very hot and bothered," she adds. "But this is a very straightforward issue and that won't be a major concern in our committee."