1. Cruise, Erin MSN, RN, NCSN

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From a public health perspective, my opinion is that it is important to mandate the human papillomavirus (HPV) vaccine for young girls. This stirs debate, despite the fact that there has been a real decline in many serious communicable diseases because of mass immunization. These are the facts: Research conducted on more than 11,000 female patients between the ages of 16 and 26 demonstrated nearly 100% efficacy of the newly approved HPV vaccine without serious side effects (CDC, 2006). This fact alone should convince skeptics of mandatory vaccination, because this vaccine has the potential to eradicate a disease that disproportionately burdens women. There are many other reasons to support adding HPV to the list of mandatory immunizations for school-aged girls, however.


More than 6 million people in the United States are newly infected with HPV each year, making it the most common sexually transmitted infection (STI). Estimates are that 50% to 80% of people who are sexually active will contract at least one of the more than 100 types of HPV during their lives. Although HPV is most frequently transmitted by vaginal or anal sex, other nonpenetrative sexual activities also may result in infection (CDC, 2006). Approximately 47% of teens in 9th through 12th grades are already sexually active, with 14% indicating that they have had at least four sexual partners (CDC, 2006). These rates have remained fairly constant for the past 10 years. Many adolescents experiment with alcohol and drugs, which are associated with risky sexual behaviors, increasing the risk of contracting HPV (CDC, 2006). Immunizing girls at the age of 11 or 12 years old, before they become sexually active, could significantly reduce the rates of HPV infection and prevent cervical cancer.


Two types of HPV cause nearly 70% of all cases of cervical cancer, which affected approximately 10,000 women in 2006 and resulted in nearly 4,000 deaths. The newly approved HPV vaccine targets these viruses and viruses that cause 90% of genital warts. Opponents cite the estimated $900 million annual cost of immunizing 11- to 12-year-old girls (Borgmeyer, 2004). However, these costs could be appreciably offset by decreasing the more than $2 billion expended for cervical cancer treatment each year, not to mention reducing time lost from work by women enduring illness and avoiding associated loss of life.


Some of the controversy surrounding the HPV vaccine seems to be related to the sexual nature of the infection. However, the hepatitis B virus is also primarily sexually transmitted, and a vaccine was made mandatory for infants in most states a decade ago with far less outcry. Surveys indicate that parents are generally supportive of the HPV vaccine and many religious groups support its use, provided that administration is accompanied by education promoting premarital abstinence and monogamy within marriage (Zimmerman, 2006). Healthcare providers also must continue to provide education about the continued risks of contracting other types of HPV or STI and the need for ongoing routine Pap tests. The fact that the vaccine is currently recommended only for girls also seems to stimulate significant debate. Vaccine efficacy studies have not supported the introduction of immunization for males, however, and life-threatening health effects for males with HPV are rare (CDC, 2006).


Finally, mandating immunizations for school attendance has been shown to increase immunization rates, thus protecting everyone, particularly individuals who cannot receive vaccines because of contraindications (Zimmerman, 2006). This protection against the disease is the most compelling reason for mandatory vaccination. Girls usually receive other immunizations, such as the combined DPT and the meningococcal vaccine, between the ages of 11 and 12, so adding the HPV vaccine should not result in significant inconvenience to families. Mandatory vaccines are more likely to be covered by private insurance and state immunization programs, which removes cost as a barrier to compliance and acceptance.




Borgmeyer, C. (2004). Many states are moving to require HPV vaccination for school entry: AAFP calls such mandates "premature." Retrieved February 24, 2007, from[Context Link]


Centers for Disease Control and Prevention (CDC). (2006). Human papillomavirus: HPV information for clinicians. Retrieved February 25, 2007, from[Context Link]


Zimmerman, R. K. (2006). Ethical analysis of HPV vaccine policy options [Electronic version]. Vaccine, 24, 4812-4820. [Context Link]