Texas Gov. Perry Signs Executive Order Mandating Girls Entering Sixth Grade Receive HPV Vaccine

Texas Gov. Rick Perry (R) on Friday signed an executive order mandating that girls entering the sixth grade receive a human papillomavirus vaccine beginning in September 2008, the Los Angeles Times reports (Bustillo, Los Angeles Times, 2/3). Merck's HPV vaccine 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, 2/1). The Texas mandate would affect approximately 365,000 girls annually, according to the Times. Perry on Friday in a statement said, "The HPV vaccine provides us with an incredible opportunity to effectively target and prevent cervical cancer," adding, "Requiring young girls to get vaccinated before they come into contact with HPV is responsible health and fiscal policy" (Los Angeles Times, 2/3). According to the New York Times, 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 no-cost Gardasil beginning immediately, the New York Times reports. Perry did not say how much the mandate would cost the state, although it is estimated to be about $60 million. According to CDC spokesperson Curtis Allen, the vaccine is given in three shots over eight months and costs $360 (Blumenthal, New York Times, 2/3). 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 (Los Angeles Times, 2/3). Perry in a statement said that Texas has the second-highest cervical cancer incidence in the nation (New York Times, 2/3). Last year, 1,169 new cervical cancer cases were reported and about 400 women in Texas died from the disease (Hoppe, Dallas Morning News, 2/3).

Reaction
By issuing the executive order, Perry "sidestepp[ed]" the state Legislature and "avoided a showdown with GOP lawmakers and Christian organizations that oppose mandatory HPV vaccinations," the Los Angeles Times reports. Some conservative groups criticized Perry's mandate and said that Perry has received campaign contributions from Merck, the Los Angeles Times reports (Los Angeles Times, 2/3). "Follow the money," Cathie Adams, president of the Texas Eagle Forum, said, adding, "It leads to Merck." Merck in 2006 contributed $5,000 to Perry's campaign and has paid three lobbyists up to $250,000 this year, according to the Morning News. 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 (Dallas Morning News, 2/3). Some public health advocates welcomed the executive order, according to the Los Angeles Times. "I'm surprised he took this step," Kathy Miller, president of the Texas Freedom Network, said, adding that "it breaks with his (political) base" (Los Angeles Times, 2/3).

Newspapers Examine Issues Surrounding HPV Vaccination
The Los Angeles Times on Monday examined whether HPV vaccination should be mandatory and who should decide whether women and girls receive the vaccine. According to the Times, the debate "highlights the balance between government's obligation to safeguard the health of its people and the rights of individuals to make their own decisions about matters affecting their health and their children's health" (Hendricks, Los Angeles Times, 2/5). In addition, the AP/Arizona Daily Star on Saturday examined how some physicians are not offering Gardasil because of "inadequate" reimbursements from insurers that do not cover administrative costs associated with the vaccine (AP/Arizona Daily Star, 2/3).

Two broadcast programs reported on the executive order:

• NBC's "Nightly News": The segment includes comments from Maurie Markman, vice president for clinical research at the Gynecologic Oncology Center at M.D. Anderson Cancer Center; parents who oppose the vaccination requirement; and a girl who received the vaccine (Okwu, "Nightly News," NBC, 2/2). Video of the segment is available online.
  

• ABC's "World News with Charles Gibson": The segment includes comments from David Stevens, CEO of the Christian Medical and Dental Associations, and parents who oppose the vaccination requirement (McKenzie, "World News with Charles Gibson," 2/2). Video of the segment is available online.
  

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