The Republican governor of Texas, Rick Perry, has signed an executive order requiring girls aged about 11 or 12 to be vaccinated with Gardasil, Merck's vaccine against the sexually transmitted human papillomavirus (HPV). Girls who haven't been vaccinated will not be allowed to enter the sixth grade of school, unless their parents say that they object to vaccination on the grounds of religion or conscience.
By issuing an executive order Governor Perry avoided the usual approval process through the Texas state legislature. He said, “The HPV vaccine provides us with an incredible opportunity to effectively target and prevent cervical cancer.” He said that it was no different from vaccinating children against polio. His supporters also point out that vaccinations against childhood diseases are often required by school districts in the United States.
Merck's vaccine protects against HPV types 6, 11, 16, and 18. In clinical trials it provided five years of protection, but only about 1200 of those participating in trials were pre-teen girls.
The vaccine was unanimously recommended by the US Centers for Disease Control and Prevention last July. It costs about $360 (£185; €280) for three required injections, considerably more than vaccines against other childhood diseases, most of which are spread by close social contact, not by sexual activity.
The vaccine will be available free of charge to Texan girls who do not have health insurance or whose health insurance does not cover the vaccine.
Parents have criticised the governor's decision, and some state legislators have called for it to be amended. They said that providing the vaccine was giving tacit approval to premarital sex, when Texas endorses a programme of abstinence until marriage in school sex education courses.
Parents and other groups have complained that the vaccine's long term effectiveness is not known. They are also worried about the effects many years later of injecting chemicals into children's bodies.
Focus on the Family (www.family.org), a conservative group, issued a position statement saying, “Focus on the Family supports widespread (universal) availability of HPV vaccines but opposes mandatory HPV vaccinations for entry to public school. The decision to vaccinate a minor against this or other sexually transmitted infections should remain with the child's parents or guardians.”
Thirty two of the 37 members of the Texas state House of Representatives sent Governor Perry a letter asking him to rescind his order because it intruded into families' lives, the Dallas Morning News reported (www.dallasnews.com, 9 Feb, “More lawmakers ask Perry to rescind order”).
The Wall Street Journal and the Associated Press news agency reported that Merck has been lobbying state legislators to gain approval of the Gardasil vaccinations. The Associated Press said that Merck had “funneled money through Women in Government, an advocacy group made up of female state legislators around the country” (http://news.yahoo.com, 30 Jan, “Merck lobbies states over cancer vaccine”). Women in Government, a non-profit, bipartisan group of women legislators in state governments, began its campaign to eliminate cervical cancer in 2004 (www.womeningovernment.org).
The Associated Press and the Wall Street Journal reported that Governor Perry received $6000 as a campaign donation from Merck. Mike Toomey, the governor's former chief of staff, is now a leading lobbyist for Merck in Texas. Moreover, Dianne Delisi, the mother in law of Governor Perry's current chief of staff, Deirdre Delisi, is a state director of Women in Government, a group that the Wall Street Journal said received funding from Merck. An executive from Merck's vaccine division was also on the board of Women in Government. The newspaper said that many of the bills relating to Gardasil had been introduced into several state legislatures by members of the group.
A statement from the organisation's president, Sarah Crosby, said, “Women in Government receives unrestricted educational grants from numerous corporate, governmental, individual, and foundation sources, including from Merck. This means that our bipartisan Board of Directors, in conjunction with our policy staff, determines the content of our programs. We leave it up to our supporters if they wish to share specific funding information.” Ms Morris was unable to say how much funding Women in Government had received from Merck.
A spokeswoman in Governor Perry's office, Krista Moody, said that it was “absolutely absurd” that the governor had been influenced by a campaign donation. “This is not a political issue. It's a public health issue, an opportunity to prevent cancer,” she said. She also said that it was absurd that he had been influenced by the relationship between his chief of staff and her mother in law.
If other states make vaccination with Gardasil a requirement for remaining in school—and about 20 states are considering bills to do so—Merck would get billions of dollars in annual revenue, the Wall Street Journal reported (www.wsj.com, 7 Feb, “Moves to vaccinate girls for cervical cancer draw fire”).
The American Cancer Society estimates that about 11 200 new cases of cervical cancer will be diagnosed in 2007 and that about 3700 women will die from the disease. Only lung cancer and breast cancer kill more American women.