Posted 01/17/2007

Proposed law would require middle-school age
 girls to be vaccinated against HPV

Arnold School researcher says new drug very effective against disease
 that strikes 200 S.C. women each year

South Carolina is among a growing number of states seeking to require all middle school-aged girls to get a new vaccine that can prevent cervical cancer.

“I think we’ve been given a miracle and I would like to see us take advantage of it,” said Rep. Joan Brady, R-Richland.

Brady and nine co-sponsors have introduced a bill to require the human papillomavirus (HPV) cervical cancer vaccination for all 11-year-old female students before they can enroll in the seventh grade in any South Carolina school, public or private.

HPV is the cause of genital warts and can cause cervical cancer which afflicts some 10,000 American women and kills 3,700 annually.

South Carolina ranks third in the country in the incidence of cervical cancer, with approximately 200 new cases annually, according to the S.C. Department of Health and Environmental Control.  The state ranks eights in cervical cancer deaths.  DHEC reported that 55 S.C. women died from the disease in 2004.

DHEC also calculates an annual cost of some $25 million to treat HPV-related conditions in South Carolina.

Brady’s vaccination requirement would become effective for the 2009-2010 school year and would be contingent on adequate state and federal funding to pay for the vaccinations.  Parents whose religious beliefs conflict with vaccinations could opt out of the requirement.

Meantime, the S.C. Department of Health and Environmental Control is asking the General Assembly to add $2 million to its budget to begin a vaccination program for uninsured and underinsured young girls, Brady said.

The vaccine, which became available last fall, is called Gardasil.  It was approved in June by the Food and Drug Administration. Soon after, the Centers for Disease Control and Prevention advised women and girls 9 to 26 to get inoculated.

Merck, Gardasil’s maker, said the vaccine costs $360 for a full, three-shot course. That makes it among the most expensive vaccines ever made. 

Gardasil prevents lasting infections from two HPV strains that cause 70 percent of cancers and another two strains that cause 90 percent of genital warts.

Many, but not all, private insurance plans cover the vaccine. “That’s why we encourage people to check with their insurance providers,” said Dr. Heather Brandt, research faculty member in the Department of Health Promotion, Education, and Behavior at the Arnold School of Public Health. 

Brandt also is a full-time researcher in the Cancer Prevention and Control Program which is affiliated with the Arnold School.

Blue Cross Blue Shield, the state's largest private insurance provider, covers Gardasil for clients who have preventive vaccination coverage as a part of their insurance plan.

Brandt has spent most of the past eight years working in prevention and control of cervical cancer and HPV, particularly among disadvantaged women many of whom will have to rely on public assistance to vaccinate their daughters.

Brandt describes the vaccine as “amazing because it produces such a robust response to our immune system,” while providing lifelong protection against cervical cancer caused by these two types of HPV.

Brandt and Brady agree both the public and members of the General Assembly need to be educated about HPV, a belief substantiated by research showing public awareness and knowledge about HPV are still very limited.

Only 40 percent of women ages 18 to 75 have heard of HPV and of that group, less than half know that it is associated with cervical cancer, a 2006 research paper indicated.

Brady says she intends to be vigilant in support of the bill, but she also concedes that it may take two legislative sessions to get it passed.

Merck, which stands to make a lot of money on Gardasil, also is engaged in a national print, television and online advertising campaign to increase awareness of the vaccine. The campaign is entitled “One Less” -- as in 'one less life affected by cervical cancer'.  The TV ads can be viewed on the Gardasil website

Brady says her legislation has an ally in the S.C. Commission for Women, which advises the governor on matters related to the needs of women.  Led by Dr. Lilly S. Filler, a Columbia obstetrician/gynecologist, the commission has identified the HPV vaccine as its No. 1 women’s health initiative for 2007.

Vaccination also is supported by American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians and the American Medical Association.

But Brady adds that to her surprise the bill has some strong opposition. "My naiveté was in assuming that everyone would embrace and support this cure for cancer. After all, who would be against a cure for cancer?"

The high cost of the vaccine and religious objections are the main concern of many opponents, said Brady.  Others argue that the vaccine would encourage promiscuity.

But Brady said the vaccination program would help open a healthy dialog between parents and the child before she becomes sexually active. “I just don’t buy the argument that it would encourage or increase promiscuity,” she said.

In other states considering vaccination programs, conservative Christian groups such as Focus on the Family, have praised the development of “safe, effective, and ethical vaccines against HPV and other viruses.”

But these same groups say no to making the vaccine mandatory because it would interfere with the parents’ rights to make key health decisions for their children.

Preliminary research conducted by Brandt and colleagues at USC has shown high levels of support for an HPV vaccine among a sample of women living in the Pee Dee Region.  Further, members of the Community Advisory Group of the USC-Claflin EXPORT Center presented similar support from members of their community at the South Carolina HIV/STD Conference in October.  This is promising; however, Brandt cautions that high levels of support do not always lead to uptake.

Besides South Carolina, efforts to encourage or require HPV vaccinations are under way in California, Colorado, Kentucky, Maryland, South Dakota, Texas, Virginia and the District of Columbia.

New Hampshire has established a program that allows girls 18 and younger to get the vaccine for free through a pool that is financed by the federal government and private insurers.

The Senate in Michigan passed a vaccination bill last fall, but the initiative died in the House.

Besides Brady, nine other House members are co-sponsors of the Cervical Cancer Prevention Act (H. 3136). They include Republicans Wallace Scarborough of Charleston, Nikki Haley of Lexington and Catherine Ceips of Beaufort.  Democrats include Gilda Cobb-Hunter of Orangeburg, Laurie Funderburk of Kershaw, Vida Miller of Georgetown, Cathy Harvin of Clarendon, Anne Parks of Greenwood and Denny Neilson of Darlington.

For more information:

Genital HPV Infection - CDC Fact Sheet

Cancer Risk – Understanding the Puzzle

1-800-4-CANCER (National Cancer Institute Cancer Information Service)