Texas Gov. Perry Asked To Rescind Executive Order Mandating HPV Vaccination For Girls Entering Sixth Grade

A group of Texas lawmakers on Monday asked Gov. Rick Perry (R) to rescind an executive order that would mandate vaccination against human papillomavirus for girls entering the sixth grade, the Houston Chronicle reports (Elliott, Houston Chronicle, 2/6). Perry on Friday signed the executive order, which will affect approximately 365,000 girls annually. Perry said that parents who do not want their daughters to receive an HPV vaccine "for reasons of conscience, including religious beliefs," will be able to opt out of the requirement. Under the executive order, girls and women ages nine to 21 who are eligible for public assistance will be able to receive Merck's HPV vaccine Gardasil at no cost beginning immediately. Perry did not say how much the mandate would cost the state, although it is estimated to be about $60 million. Perry spokesperson Krista Moody said the state would increase funding for existing health programs by $29.4 million annually to help cover the cost of the vaccine for low-income women and girls. Gardasil and GlaxoSmithKline's HPV vaccine Cervarix in clinical trials have been shown to be 100% effective in preventing infection with HPV strains 16 and 18, which together cause about 70% of cervical cancer cases. FDA in July 2006 approved Gardasil for sale and marketing to girls and women ages nine to 26, and CDC's Advisory Committee on Immunization Practices later that month voted unanimously to recommend that girls ages 11 and 12 receive the vaccine. GSK in April plans to file for FDA approval of Cervarix, and it expects approval by the end of this year (Kaiser Daily Women's Health Policy Report, 2/5).

Reaction
State Sen. Jane Nelson (R) on Monday asked Perry to reverse the order and said she would ask Texas Attorney General Greg Abbott (R) about the mandate's legality and whether the Legislature has any recourse (Houston Chronicle, 2/6). Nelson also said that the Legislature should hear testimony from doctors, scientists and patients before mandating the vaccine. "This is not an emergency," Nelson said, adding, "It needs to be discussed and debated" (Dallas Morning News, 2/5). Sen. Glenn Hegar (R) said he would introduce a bill to reverse the mandate (Houston Chronicle, 2/6). Reps. Dennis Bonnen (R) and Charlie Howard (R) filed a bill (HB 1098) that would prohibit requiring students to receive an HPV vaccination to attend public schools (Dallas Morning News, 2/5). Critics said mandating the vaccine would send a message to girls that sex is permissible. Perry in a statement said the vaccine does not "promote sexual promiscuity any more than providing the hepatitis B vaccine promotes drug use," adding, "If the medical community developed a vaccine for lung cancer, would the same critics oppose it claiming it would encourage smoking?" Other opponents of the mandate said that Perry issued the order in return for campaign contributions from Merck (Houston Chronicle, 2/6). Merck in 2006 contributed $5,000 to Perry's campaign and has paid three lobbyists up to $250,000 this year. One lobbyist, Mike Toomey, formerly served as Perry's chief of staff. Perry's press secretary, Robert Black, said that the governor has not spoken to anyone from Merck or to Toomey about the executive order (Kaiser Daily Women's Health Policy Report, 2/5). Black said, "The governor is very pro-life, and he views [HPV vaccination] as protecting life," adding, "Not to pursue that opportunity, the governor believes that would be morally reprehensible" (Houston Chronicle, 2/6).

Related Editorials, Opinion Piece
Several newspapers have published editorials and opinion pieces in response to the executive order. Summaries appear below.

Editorials

• Austin American-Statesman: Perry' executive order was a "bold move ... on an issue where Texas usually lags -- health care," an American-Statesman editorial says. However, Perry's mandate "carries political, as well as medical, social and religious baggage," with his connection to Merck, the editorial says. It "could turn out that Perry's executive order is the perfect marriage of profit and health care," but no matter the outcome, "parents should have their girls vaccinated to guard against cervical cancer. And the government should make those vaccinations available to families who are uninsured or can't afford it," the American-Statesman concludes (Austin American-Statesman, 2/6).
  

• New York Times: "Other states would be wise to follow" Texas in requiring HPV vaccines, a Times editorial says. Some people fear that HPV vaccination might encourage teenagers "to engage in risky behavior" and some "complain that there are already a slew of required vaccinations," the editorial says, adding that none "of these objections seem strong enough to forgo the protection against a devastating disease." The editorial concludes, "All students deserve protection against HPV infection, and the presumption should be that they will get it" (New York Times, 2/6).
  

Opinion Piece

• Rep. Eddie Johnson (D-Texas), Austin American-Statesman: "Though parents can opt out of the vaccination requirement on religious or philosophical grounds, I would hope they would want to spare their daughters such trauma and stigma" of cervical cancer, Johnson writes in an American-Statesman opinion piece. "What strides could we make if we embraced the concept of prevention, regardless of our feelings on premarital sex?" Johnson asks, adding that "providing the vaccine does no harm and can potentially do plenty of good" and that it might be "unethical to not ... use a scientific development to eliminate a disease." Johnson writes that the mandate is a "pro-woman policy," concluding that Texas parents "should join with state officials to make this vaccine as affordable and accessible as the other vaccines that have revolutionized our public health system" (Johnson, Austin American-Statesman, 2/6).
  

NPR's "All Things Considered" reported on states that are considering vaccine mandates and Merck's efforts to market Gardasil. The segment includes comments from David Catania, a member of the Washington, D.C, City Council; Richard Haupt, a medical director at Merck; and Neal Halsey, a pediatrician and vaccine expert in the Department of International Health at the Bloomberg School of Public Health at Johns Hopkins University (Wilson, "All Things Considered," NPR, 2/6). Audio of the segment is available online. In addition, "All Things Considered" included an interview with the mother of a 3-year-old girl about whether she would vaccinate her daughter against HPV (Norris, "All Things Considered," NPR, 2/6). Audio of the segment is available online.

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