Should Oregon require cervical cancer vaccinations?

According to the Oregonian, over a hundred Oregon women will be struck with invasive cervical cancer this year, and about forty will die.

But it doesn't have to be that way. From the O:

In June, the Food and Drug Administration approved a revolutionary vaccine that, over time, can save the lives of thousands of Oregon women. It's called Gardasil, and it guards against two viral strains that cause 70 percent of all cervical cancers.

Oregon's immunizations manager calls it a "powerful tool" against cancer. The head of the FDA says it will have a "dramatic effect" on the health of women worldwide.

Right now, the vaccine costs over $300. To be most effective, the vaccine should be administered "in early adolescence, since the virus is transmitted sexually."

Legislators in other states have introduced bills that would mandate the vaccination for girls as young as 11 or 12. Most of these bills have an opt-out provision for parents who disapprove. We're not sure if Oregon lawmakers are ready to require this new vaccine, even with the opt-out loophole, but they should get ready. And for now, at least, they should commit to universal access for all Oregon girls. After all, what child doesn't deserve a vaccine against cancer?

Questions: Should Oregon mandate vaccination, with or without a parental opt-out provision? Should Oregon require insurance companies to cover it, if they don't already? Should Oregon's low-income health programs cover the vaccination?


  • (Show?)

    It seems to me that if we have requirements for things like chicken pox shots, we should definitely do this to help prevent cervical cancer.

    For women to die every year, or to have to go through having cancer, when it could be prevented with a few simple shots is just wrong.

    Unfortunately, women always have to fight for coverage of womens' health issues. We have to fight for birth control to be covered by insurance, while Viagra was already covered.

    We have to fight to have early and regular mammograms covered so that we can catch cancer before it's too late.

    I think at a minimum it should be something covered by insurance and low-income health clinics should have it available.

    There's few things worse than losing a loved one to cancer. While in high school, a very good friend of mine had cervical cancer. She didn't tell any of us -- she kept up a brave face, all the while knowing her life was going to be cut short. However, before she could start wasting away from the cancer, she was killed in a car accident. As much as we all hated losing her so soon, being killed in an instant while you slept on the way back from a road trip was a hundred times better than watching her slowly and painfully die from cancer. She hadn't even begun her senior year in high school.

    How many teenagers and women have to die from it before it gets the attention it deserves?

    If we found out tomorrow that most cases of prostate cancer could be gotten rid of through a series of shots as an adolescent, wouldn't you want it readily available and affordable?

  • Michael M. (unverified)

    I think Oregon should do whatever it takes to make sure the vaccination is available to anyone who wants it, short of making it mandatory. There's absolutely no reason for the state to abridge it's citizens' rights to manage their own health care and that of their children. Cervical cancer is not an airborne contagion, nor can it be contracted from doorknobs or casual contact.

  • Amanda Fritz (unverified)

    As noted on my blog last night, The Oregonian's editorial missed half the problem. According to an AP report published Friday, the manufacturer and insurance companies are making the vaccine uneconomical for health care providers.

    There is already a huge ad campaign marketing the vaccine to teenage girls - I've seen commercials for it probably two dozen times or more while watching TV with my daughter. That's extraordinary, and laudable. But public education and state requirements must be accompanied by making the vaccine affordable for health care providers as well as for young women.

  • Betsy (unverified)

    Does anyone else find the sudden focus on cervical cancer unusual, given that heart disease is a much -- much -- bigger women's health issue than cancer of any kind?

    To quote one study: "Experts estimate that one in two women will die of heart disease or stroke, compared with one in 25 women who will die of breast cancer."

    And how about cervical cancer? About 3,670 women will die from cervical cancer in the United States during 2007, meaning that cervical cancer is the cause of death for about one in every 658 women!

    So why are we so preoccupied with breast and cervical cancer, when heart disease education and prevention measures are so much more important to women's health?

  • JHL (unverified)

    We need to do everything we can to make these vaccinations available through some form of universal coverage... especially for preventative medicine like this.

    But a mandate? Call me old-fashioned, but the government requiring citizens to inject themselves with anything kind of raises shades of 1984 for me.

    Maybe an education campaign explaining the facts to parents. Not enough people know about this.

  • Jessica (unverified)

    Of course it should be a requirement.

    The "sudden focus" is not on cervical cancer, it's on the vaccine.

  • Marty Wilde (unverified)

    Texas made it mandatory last week. Are you telling me that Texas is more progressive than Oregn. Of course it should be mandatory and there should be no religious opt out. We would not let parents opt their children out of surgery after an auto accident, why are vaccinations any different?

  • Guy G. (unverified)

    The primary difference between Cervical Cancer and the host of other potential health threats of which the government mandates we be immunized is the simple fact that you cannot catch Cervical Cancer by breathing the same air or being in close proximity of another person who has the disease.

    Clearly there is a big difference, and the individual should decide whether they want this vaccine or not.

    Call it funny, but I think people ought to have control of their own medical decisions when their body (and nobody else's be it the public at large or an unborn child) is the one on the line.

    I just do not see how a government mandated vaccine, at least in this instance, is progressive.

    -Guy G.

  • Michael M. (unverified)

    It's rather extraordinary that legislators who support a woman's right to choose vis-a-vis abortion would not support a woman's right to choose vis-a-vis a vaccine. It's anything but "progressive" -- it's authoritarian.

    And regarding Texas's allegedly progressive action, from the AP report:

    "Merck [which makes the vaccine] is bankrolling efforts to pass state laws across the country mandating Gardasil for girls as young as 11 or 12. It doubled its lobbying budget in Texas and has funneled money through Women in Government, an advocacy group made up of female state legislators around the country. [Gov. Rick] Perry has ties to Merck and Women in Government. One of the drug company's three lobbyists in Texas is Mike Toomey, Perry's former chief of staff. His current chief of staff's mother-in-law, Texas Republican state Rep. Dianne White Delisi, is a state director for Women in Government. The governor also received $6,000 from Merck's political action committee during his re-election campaign."

    Note that it was not the Texas legislature that mandated the vaccine, it was an executive order issued by Gov. Perry. It seems he was paid handsomely for his trouble.

  • Thomas Ware (unverified)

    I have a wife, a daughter, three step-daughters (one adolescent), a grand-daughter and a fifty percent chance on the way. I am not unconcerned with women's health issues (believe me, some times it's all I hear about for daaaayyyyyssss at a time). But I do have to ask "Just how much money will Big Pharma make off of this?

  • Brian Shaw (unverified)

    A cervical vaccine? Fantastic. Universal access. Wonderful. Through the roof price tag. Damn.

    Here's what surprises and concerns me - progressives around the country are demanding that a vaccine be available to all without a public dialog regarding the safety of the vaccine itself and the precedent for wide-spread or mandatory vaccination. What have been the thresholds for other universal vaccinations? Are we going to take an FDA approval as the final word? Do we face possible health problems from the vaccine or its preservatives (see themarosil)?

    In Texas, Governor Perry instituted the vaccinations as an executive order. His former chief of staff has connections to Merck, maker of Gardasil, and his campaign has recieved fund from the company. Meanwhile, Merck is pushing for fast adoption of similar policies around the country. I think if this provides a safe way to prevent cervical cancer, great news. But since when do we trust the pharmaceutical approval process so whole-heartedly?

  • TomCat (unverified)

    Make it mandatory, so that it is done automatically like other common vaccines, but leave a way for families who have objections to opt out.

  • Steve Bucknum (unverified)

    I've lived long enough to see all sorts of "safe" things turn out not to be so.

    I'd hate it if down the line 10 years we discovered that every woman who got these shots had the left foot fall off or some such crazy thing.

    I'd like to see this vaccine made available to any woman who wants it - but mandatory I have trouble with.

    My grandmother refused all medical services from 1938 to 1995. She lived to be 93 years old, in part due to not getting all these medications with side effects that her peers got, and possibly in part due to her fondness for a nip of whiskey now and then. I just don't think that the paradigm of the "magic cure" is all its cracked up to be.

    Mandatory no. Wait and see.

  • John Mulvey (unverified)

    But a mandate? Call me old-fashioned, but the government requiring citizens to inject themselves with anything kind of raises shades of 1984 for me.

    I'm not sure of the answer on this issue, but this comment strikes me as odd.

    To anyone with some awareness of history, the notion of individuals opting out of a vaccine is what is "new." Until very recently, mandatory vaccines against communicable deseases would have been expected of the government; indeed, leaders that didn't do so when they had the opportunity would have been considered neglectful and incompetent.

    What's changed? Well, in this instance it seems to me that it is less a newfound respect for individual rights and more a result of the same old anti-sex activism that has obsessed the right for two generations.


  • Jessica (unverified)

    It's a vaccine that prevents the spread of hpv, which can cause cervical cancer. This means they won't get certain kinds of genital warts if they have sex. That's what the right doesn't like about the vaccine because they don't want to think that teenage girls have sex. The vaccine is usually given to young women (think pre-teen to teen) so it's not like they're decing, their parents are deciding. Unfortunatley, all the info is not out there yet - women can have this vaccine after they have become sexually active, a concept that hasn't seemed to catch up with many doctors. Too bad. You do realize that the fda wouldn't release this vaccine without years of clinical trials, right? It's safe. A lot safer than contracting hpv which can lead to cancer. It should be required to protect those young women who's parent's don't want to think their angel would never let a boy do that to her. My prediction: In the year 2050 - 2060 we'll see the majority of cervical cancer cases in red states. Sad.

  • (Show?)

    What if it were an AIDS vaccine?

    Seriously, there's just not much difference here - except that AIDS can transmit sexually back to the men.

    What we have here, as Jessica points out, is a disease that is transmitted sexually. It's critical that the vaccine for that disease be administered prior to sexual activity. For some right-wing Neanderthals, that means we shouldn't have this conversation until the woman is about to get married - they can't imagine their daughters might be sexually active sometime between puberty and marriage.

    Now, is there a drug company trying to get rich here? Sure. Not really. Is overactive profiteering a problem? Youbetcha. Should we find a way to make this drug affordable to low-income folks without insurance? Of course.

    The bottom line is this: It's going to save lives. (And unlike heart disease prevention/education, which is a good thing to be sure, a vaccine - if it works - is a magic bullet.)

    I'd propose this: Let's make it mandatory for insurance companies to provide it. Let's make it mandatory to have it (with an opt-out, which pretty much makes it un-mandatory). Then, let's require the drug company to either release a generic version - or provide X amount free to low-income folks.

  • Marty Wilde (unverified)

    For those concerned about the private profit motive, why not just exercise eminent domain over the patent? Put another way, pay off the company for the reasonable market value of the patent, license production, and make it available at cost.

    Regarding the question of choice, remember that we are not talking about adults here. We are talking about children - people who we accept cannot make informed decisions in their own best interests.

    Regarding parental rights, as far as I'm concerned, a parent should not have the right to make medical decisions where the outcome for the child is unambiguously positive. We routinely override the authority of parents to refuse blood transfusions for a medically needy child for religious reasons. I don't see how this is any different.

  • Amanda Fritz (unverified)

    Kari, that's a very good thought, which stirred one in me:

    Why is this vaccine being marketed and given only to women? Men get HPV infections too, that's why women need the vaccine. Only women get cervical cancer, but if both teenage boys and girls were vaccinated, wouldn't that also reduce the likelihood that a woman who was a virgin on marriage might be infected by her new husband who wasn't? And reduce the number of infected people in the whole population? Why vaccinate only half the virus' host pool?

    As for the rest of your recommendation, I agree. Plus, in addition to requiring Merck to provide more free doses (they're donating some, but not enough), the insurance companies and Merck must fix the problem that health care providers aren't being reimbursed adequately to cover their costs.

  • Marty Wilde (unverified)

    Amanda -

    Slate has a good article on the issue. Basically, the vaccine might work to prevent anal cancer in men.

    Merck has no obligation (legally) to provide free doses, but health care entities that qualify as 501(c)(3) organizations do have a requirement to provide some free care (and not just write off bad debt). This has been underenforced, IMHO.

  • John Mulvey (unverified)

    Amanda: It should be given to boys as well. Note however that the drug is very new and has not yet been tested or approved for use on boys. Presumably that testing is underway.


  • (Show?)

    The resolution of the mystery of Texas Progressivism is easy enough to solve.

    The top Texas lobbyist for Merck is the governor's former chief-of-staff.

    God I love those Texas progressives!


    As for certification by the FDA, if you start thinking about mercury used in vaccination, and the whole tortured history of RU-486, you might conclude that there are some "invisible hands" on the scale.

    I'm going with the available but not mandatory crowd, even though I understand that this will shut out some minors who want it.

  • Mel Harmon (unverified)

    Make it available, but not mandatory. Everyone should be able to opt out if they so choose or choose for their child. Especially on non-transferrable illnesses/diseases.

    For those who say it should be mandatory, would you feel the same way if the government made it mandatory for everyone regardless of age or gender? If that's the case, why don't we have mandatory vaccines for everyone for communicable diseases like measles or chicken pox? We don't have that now and we never should. People have a right to make choices (even if some consider them poor choices)about their own health and bodies.

    As for Texas being progressive...hah! If you consider Texas progressive, I'll stay in backward Oregon, thank you. Besides, as an earlier poster Texas, everything and I mean EVERYTHING is all about the money. Follow the money, honey. Follow the money...

  • Shawn (unverified)

    Yes, please, give it to boys too. HPV is spread so easily, even condoms do not prevent it. Boys and men can be carriers without symptoms, and give it to any number of people without ever knowing it. Some men I have spoken to do not know what HPV is, let alone have a concern about spreading it.

    As to the mandatory part - probably a bad idea. Spend energy instead forcing insurance companies to cover the vaccine for those who want it, educating people on why it is needed, and providing it to those who are uninsured.

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