February 21, 2007

Texas Lawmakers Send Letter Asking Gov. Perry To Rescind Executive Order Mandating HPV Vaccination For Girls Entering Sixth Grade

Thirty-two Texas lawmakers on Thursday sent a letter to Gov. Rick Perry (R) reiterating their plea for him to rescind an executive order that would mandate vaccination against human papillomavirus for girls entering the sixth grade, the AP/Dallas Morning News reports (AP/Dallas Morning News, 2/9). 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. Perry on Feb. 2 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 Gardasil at no cost beginning immediately. 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 (Kaiser Daily Women's Health Policy Report, 2/6).

Letter, Bills, Reaction
Perry's order "usurped the legislative process," the letter -- signed by 31 Republican representatives and one Democratic representative -- said, adding, "While philosophic differences will dictate where our beliefs fall, no Texan would willfully abdicate their voice in the Legislature to a single office of their government" (AP/Dallas Morning News, 2/9). According to the Dallas Morning News, at least 26 of the 31 Texas senators also have signed a letter to Perry asking him to withdraw the order. The governor as chief executive officer of the state has constitutional ability to issue directives, Perry spokesperson Robert Black said. He added that lawmakers have the right to modify or rescind an executive order through legislation (Hoppe, Dallas Morning News, 2/8). Several bills have been filed this week to overturn Perry's order and to prevent the vaccine from being required for a student's admission to school, the San Antonio Express-News reports. Rep. Charlie Howard (R) has introduced a bill (HB 1115) that would block Perry's order (Elliot, San Antonio Express-News, 2/7). Rep. Dennis Bonnen (R) has introduced a duplicate bill (HB 1098) that would overturn the order, and state Sen. Jane Nelson (R) on Wednesday asked Texas Attorney General Greg Abbott (R) to issue an opinion on the legality of Perry's order (Kaiser Daily Women's Health Policy Report, 2/8).

"Gardasil may well be the huge medical breakthrough it appears to be," but "a rush to make it mandatory, less than eight months after FDA approval, could have detrimental consequences," a USA Today editorial says. The "[s]cientific uncertainty" of Gardasil, the lack of public education about the vaccine and HPV being a sexually transmitted infection can "spark an anti-vaccine backlash that would result in fewer girls getting immunized against cervical cancer and other diseases," according to USA Today. "With more public education and real-life experience, these qualms may soon be overcome, and the vaccine may well deserve to be included on lists of required immunizations," the editorial says, adding, "For now, however, making [the vaccine] mandatory is premature." Sometimes, "promotion of a medical advance can move too fast for its own good," the editorial says, adding that the HPV vaccine "ought to be available at an affordable price to everyone who wants it after consulting with a doctor" (USA Today, 2/9).

Opinion Piece
"The executive order ... will help stop the spread of [HPV] and prevent cervical cancer in young women" and as "governor of Texas, I will do everything in my power to protect public health," Perry writes in a USA Today opinion piece. "Though some might argue that we should wait several years before requiring the vaccine, I believe such a delay unnecessarily risks the lives of young women," he writes. According to Perry, parents and guardians still will have the "final word" in deciding whether to vaccinate their children, and a "full debate will take place" before implementation rules are adopted in 19 months. If "Texas legislators want to debate and pass a different vaccine law, there is nothing standing in their way," Perry writes, concluding, "This is a rare opportunity to act, and as a pro-life governor, I will always take the side of protecting life" (Perry, USA Today, 2/9).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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