SACRAMENTO - When authorities approved a vaccine last summer that prevents most cervical cancers, experts cheered it as a breakthrough in fighting a disease that kills 3,700 American women each year.
Now, a Bay Area lawmaker wants to make sure California girls get that vaccine, which guards against certain strains of human papilloma virus, known as HPV, that can cause cervical cancer. Assemblywoman Sally Lieber has introduced legislation that would require girls to be immunized against HPV before they enter the sixth grade.
The federal Centers for Disease Control and Prevention recommends that parents get the vaccine for their daughters, ideally when they're aged 11 and 12. But the proposal to mandate vaccination in California, AB 16, is causing quite a stir because HPV is transmitted only through sexual contact.
Mark Mangin of San Jose, Calif., saw his sister die, at age 32, from a different kind of cancer, ovarian, a decade ago. So when he saw a television ad for the new vaccine Gardasil, Mangin wrote his wife a Post-it note reminder to research it.
Mangin said they may talk to their family doctor about whether their three daughters, who attend Leland High and Castillero Middle schools, should get the shots. And he's generally OK with the state mandating the vaccine.
But the subject does give him pause. How much would he want to tell his daughters about Gardasil? Would kids chatter about their shots in homeroom or at lunch?
"It's very complicated," he said. "You don't explain anything to your kid when they get a measles shot. The thing that crossed my mind is, what will the kids think? Will they think it's OK to have sex if you get this vaccine?"
At least 10 states from Maine to Texas are considering HPV bills.
Lieber, who already stirred debate with her recent proposal to ban spanking young children, knows the issue is fraught for many families. But, she said, California requires vaccinations for Hepatitis B, which is transmitted through sexual contact and intravenous drug use.
"This is the first time we have a chance to prevent a virulent form of cancer," Lieber said, adding, "What we're trying to do is prevent disease, not mandate morality."
The state allows parents to decline any vaccination for their children for medical reasons or because of personal beliefs, Lieber stressed. But some bill critics say that option is little publicized.
"This, to me, is clearly an issue between a child and a parent, especially when we know that this vaccine is for a disease that is shown to only occur through sexual activity," said Republican state Sen. George Runner. "The point is that I have certain values and issues to which I deal with my daughter on. And it seems like it sends an inconsistent message about sexual activity."
Runner, a father of two, said he is all in favor of a public information campaign about the vaccine. But he would vote against mandating it.
Human papilloma virus is the most common sexually-transmitted disease in the United States, affecting about 20 million people at any time. Each year, there are about 6.2 million new infections, according to the Atlanta-based CDC.
People with HPV rarely exhibit any symptoms. However, some strains of the virus can carry serious consequences, causing cervical cancer and genital warts. Some 10,000 women in the U.S. are diagnosed with cervical cancer each year; about 3,700 die from it.
Gardasil is effective against the strains of HPV responsible for 70 percent of cervical cancers and 90 percent of genital warts. It does not protect against other sexually-transmitted diseases, AIDS or pregnancy.
Merck's Gardasil, given in three shots over six months, costs $360. It's covered by nearly all insurers. Other pharmaceutical companies are working on their own HPV vaccines.
The state's Medi-Cal program covers the shot for girls 18 and younger. The Schwarzenegger administration has proposed $11 million in additional funding to get the vaccine to 50,000 Medi-Cal recipients aged 19 to 26.
Republican Assemblywoman Bonnie Garcia, a mother of, is passionate that women learn about the vaccine.
"One thing I've told people with a religious objection is, `Your daughter could be a virgin on her wedding day, but you don't know where her partner has been,'" said Garcia. "Once you take off your clothes and get naked, you're at risk."
But she's also reluctant to mandate it. "I don't think that will get out of" the Assembly, she said. "It's really about having parents buy into it."
By late last year, all Kaiser Permanents facilities in Northern California had received the vaccine. It's free to Kaiser patients whose doctors prescribe the vaccine.
"There isn't resistance" to it, said Dr. Ruth Shaber, Kaiser's director of women's health for Northern California. But, "we're surprised. We had expected more women to come in on their own" requesting it, because of Merck's aggressive "One Less" series of television ads.
Shaber said her own 12-year-old daughter has gotten the first Gardasil shot. And she recommends it to her patients. But, "my push would be for more public information."
It's so new, she said, that no one knows how long the vaccine is effective for. Initial studies didn't find any serious side effects from the vaccine, but there's a "remote possibility" that new side effects could emerge as the vaccine is more widely used.
Parent Mia Burnham, who has a 12-year-old son and a 13-year-old daughter at Castillero Middle School in San Jose, leans in favor of a bill.
"I would tell my daughter, `This could protect against an STD,'" she said. "'And we would want it for you because we would hate for you to get cervical cancer if we could have prevented it.'"
AB 16 will get its first hearing sometime this spring. Gov. Arnold Schwarzenegger said he hasn't seen the bill yet and doesn't have a stance on it.
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HPV FACTS
The human papilloma virus, or HPV, is the most common sexually transmitted disease in the United States and it can lead to cervical cancer. A Bay Area lawmaker wants to require girls to get a vaccine against it before entering the sixth grade.
_Number of people affected by HPV: About 20 million in the U.S.
_New cases each year: 6.2 million
_Health effects: Usually causes no symptoms, but certain strains can lead to cervical cancer and genital warts.
_Cervical cancer data: 9,700 new U.S. cases a year. 3,700 deaths.
_New vaccine: Gardasil, which is effective against HPV strains causing 70 percent of cervical cancers and 90 percent of genital warts.
_Recommended recipients: Girls 11- to 12-years-old or before onset of sexual activity. Can be given to girls as young as 9. Also advised for 13- to 26-year-olds.
_Cost: $360 for a set of three shots over six months. Covered by vast majority of insurers.
_Side effects: No serious ones reported; some pain at injection site.
