Vaccine mandate oversteps bounds of government

You have to give Texas Gov. Rick Perry credit for showing the gumption to step outside his conservative political reputation by initiating a policy that some circles might view as “progressive.”

But his execution of this new direction — mandating anti-cancer vaccines for all girls entering sixth grade — was clumsy and has made him a target of criticism by both his supporters and his opponents.

The vaccine the governor wants administered to Texas’ preteens is a remarkable innovation. Gardasil, developed by Merck & Co., protects women against four main types of the human papillomavirus that together cause 70 percent of cervical cancers and 90 percent of genital warts.

Cervical cancer is a serious problem — blamed for the deaths of about 3,700 women in the United States and about 233,000 worldwide annually. As the much higher international death total indicates, it is a highly detectable and treatable cancer.

While some people might want to characterize critics of the order as ultra-conservative or anti-technological, there are shortcomings involving political, familial, medical and financial components.

With regard to the political, Perry’s use of an executive order has been widely panned for bypassing the democratic process. There were no public hearings to gather input from Texans — medical experts or ordinary citizens — and the Texas Legislature was left out of the process altogether.

This prompted 26 of the state’s 31 senators, including the Democratic senator who filed a bill proposing a similar requirement, to send Perry a letter asking him to rescind the order.

On the familial side of the equation, Perry risks alienating the conservative base that has elected him to two terms as governor. Most parents want what is best for their children and are guided by that desire.

Having the state government intrude in this matter is particularly dicey since the vaccine guards against sexually transmitted diseases. The logic behind administering the vaccine to 11- and 12-year-olds is that it would be most effective if given prior to any sexual activity, but many parents are sensitive to guarding against those diseases at an age when such behavior should be years in the future.

Might the vaccine give young girls, as some have speculated, a green light to engage in sexual activity? It’s hard to say, but there is the possibility that underinformed teens and pre-teens could be confused about what the vaccine protects against — some strains of HPV — and what it does not guard against — other sexually transmitted diseases and pregnancy.

Informed parents are best equipped to evaluate the tradeoffs present with any vaccine, including the medical limitations. Gardasil is still a new vaccine, which means there hasn’t been time to inform the public about its benefits or to do long-term testing of its effectiveness and safety.

Doctors were surprised by Perry’s order; the Texas Medical Association and the American Academy of Pediatrics both say it’s too early to make the vaccine mandatory, according to a story last week by the Houston Chronicle.

“It’s such a new vaccine — they haven’t had time to explain it to patients,” Dr. Patricia Sulak, a professor of obstetrics-gynecology at the Texas A&M Health Science Center College of Medicine, told the Chronicle. “I think everybody was happy with the (Centers for Disease Control’s) … recommendation that it be routinely given. But this makes it seem like it’s being shoved down people’s throats.”

Critics speculate that the rush to require the vaccine is the product of heavy lobbying by Merck, which stands to make millions of dollars, particularly if it can get states to require the vaccine. An Associated Press story about the controversy noted that one of Merck’s three lobbyists in Texas, Mike Toomey, is Perry’s former chief of staff, leading to questions about conflicts of interest.

The vaccine isn’t cheap — $360 for the series of three shots. How much of that cost is going to fall on the state’s taxpayers? Would a mandate open the state to lawsuits in the case of adverse effects from the vaccine?

“There are issues, such as liability and cost, that need to be vetted first,” said Dr. Bill Hinchey, president-elect of the TMA.

Perry’s order would allow parents to “opt out” of the vaccine, but the method — a signed and notarized affidavit — is far too difficult. Some lawmakers wish to make it an “opt in” vaccine, which would be better. But the best idea of all would be to make this remarkable new vaccine completely voluntary.