Mandatory Vaccinations

Yesterday Texas Governor Rick Perry issued an executive order that mandates a new 3-step vaccination for pre-teen girls. One would assume that there is a medical crisis either in play or in the making for Perry to do an end-run around public debate in the Texas legislature, right? So what is it that’s such a pressing emergency that every parent of a 12 year old girl in Texas must submit to the governor’s whim?

A sexually transmitted disease. Where’s the fire, Rick? There’s no epidemic. No contagions. No second hand communications of any kind. And we’re supposed to support a mandatory innoculation of all 6th grade girls with Gardasil, a drug that’s only been on the market for 7 months? This is not right.

“Requiring young girls to get vaccinated before they come into contact with HPV [human papilloma virus] is responsible health and fiscal policy that has the potential to significantly reduce cases of cervical cancer and mitigate future medical costs,” Perry said in a press release.

This may very well be true. I won’t dispute the governor’s point, for it’s not possible to do so absent information about what future costs might be or what new treatments might be forthcoming). It is, in fact, probably a good idea for girls to be vaccinated against HPV.

But government-mandated medical procedures such as Perry’s are appropriate only when there is a demonstrable risk to a significant portion of the population, as in the case of polio, etc., and those at risk cannot easily avoid contracting the disease. Neither is true in this case – HPV can be avoided simply by not engaging in risky behavior.

There is also the question of cost. CNN reports that insurance companies are reluctant to reimburse parents for their daughters’ vaccinations – they pay only a small fraction of the cost – and that doctors offices are reluctant to buy stocks of the medicine when there is a good chance that they may never be able to use it. Those that do carry it charge a premium for injections to guard against future losses.

The problem is that parents are looking at the $360-600 cost of the drug and have doubts about whether or not it is worth the money. Many would opt for it if insurance companies would pay for it, but since they may not, parents are saying “no” or at least “not right now”.

Then there is the entitlement crowd, as represented in the referenced articles in the person of Julie Falco, a New Yorker who, after struggling to find a cheap way to give the shots to her daughters, said:

“I still don’t have the shot, and now I have to decide whether I want to make a $1,200 investment to get them vaccinated,” she said. “I really don’t want to deny them what I think is right.”

I would suggest that if it were necessary and what she truly thinks is right that she would find a way for her 13 and 15 year old to be protected against this STD. But it isn’t medically necessary and she knows that, hence their lack of vaccination.

Back in Texas there was contention in the legislature:

A plan requiring sixth-grade girls to be vaccinated against a sexually transmitted virus that causes cervical cancer can expect a flurry of opposition in the Texas Legislature.

Critics contend that bills already filed in both houses would take away parents’ rights, send the wrong message to impressionable young girls and cost more than many parents can afford.

“Don’t we put seat belts on our kids, helmets on bike riders?” asked state Sen. Leticia Van De Putte, D-San Antonio, sponsor of the Senate bill. “This is one more thing we can do to protect our daughters.”

State Rep. Jessica Farrar, D-Houston, the sponsor of the bill in the House of Representatives, said she is hopeful about its chances but not quite optimistic. She said “ideology has prevailed over science” lately.

Ms. Farrar, I couldn’t agree more – if science were to prevail over ideology I’m fairly certain that scientists would say that 12 year old girls should not be having sex. The law agrees, what with the age of consent being significantly higher than that.

Enter Governor Perry, who charged in from left field on his white horse to save the day for all of the pre-teen girls at risk of contracting an STD. Cost is evidentally no object for Perry, especially now that he’s sitting on top of a fat budget surplus – of our money – in Austin.

It’s estimated that 162,000 girls would be eligible for the shot, making the total gross cost of the mandate a minimum of $58 million dollars for the vaccine alone. That’s at the MSRP price – the street price is 25-50% higher. One must also add in the cost of 3 office visits
to arrive at the true cost of the plan.

For those whose medical expenses are paid for by the state the inconvenience of 3 doctors visits is a minimal price to pay for what is almost surely a positive health benefit. But for those of us who pay for that entitlement and then have to pay again for our children to be in compliance with immunization laws this plan is a very bad investment.

None of this considers the moral implications of making pre-teen and early teen sex “safer”. Questions abound.

“These young girls are being given a hope that they will be protected from cervical cancer,” said Cathie Adams, president of Texas Eagle Forum. “What about sexual activity that gives them AIDS?”

And Susie Moore, a retired woman, said she’s sympathetic to the argument that the shot could give young girls implicit permission to have sex.

“I’m old enough to remember when the Pill was introduced,” Moore said. “People raised the issue that it would cause promiscuity and advocates denied it, but promiscuity definitely followed.”

Free love, anyone? Well, not free, exactly. Not if you’re a Texas taxpayer.

Update – 2/6/2006

Governor Perry’s office said yesterday:

it would cost the state $29 million for its share of inoculating students who are uninsured or on government programs.

Federal funds will be available for girls on Medicaid or the Children’s Health Insurance Program. Private insurers are expected to pick up most of the $360 cost of the three-shot series.

Perry also said this:

“Providing the HPV vaccine doesn’t promote sexual promiscuity any more than providing the Hepatitis B vaccine promotes drug use,” the governor said. “If the medical community developed a vaccine for lung cancer, would the same critics oppose it claiming it would encourage smoking?”

The last line tells the truth. If we could cure lung cancer, smoking rates would soar. To think otherwise is to be a fool.

Update – 2/7/2006

The plan is coming under fire from an unexpected source – Texas doctors:

the Texas Medical Association and the American Academy of Pediatrics, many doctors are saying it’s too early to mandate the vaccine, which was approved for use last June. It protects against four strains of the human papillomavirus that cause 70 percent of cervical cancers.

“We support physicians being able to provide the vaccine, but we don’t support a state mandate at this time,” said Dr. Bill Hinchey, a San Antonio pathologist and president-elect of the TMA, which represents 41,000 physicians. “There are issues, such as liability and cost, that need to be vetted first.”

…

“Perry gave a classic public-health-ethics rationale for the program,” said Laurence McCullough, a professor in Baylor College of Medicine’s Center for Ethics and Health Policy. “But he needs to present to the legislature a cost analysis and funding source so other priorities are not displaced.”

Update – 3/14/2007
The Texas House agrees.

The Texas House sent a veto-proof message to Gov. Rick Perry on Tuesday that schoolgirls will not be required to be vaccinated against a sexually transmitted virus linked to cervical cancer.

…

The House vote of 119-21 to tentatively approve the bill demonstrated a comfortable margin…

“Let’s continue to allow only parents and children and doctors to decide if this is right for you,” said Rep. Dennis Bonnen, the Angleton Republican who sponsored the bill.

As I wrote before, this is the correct decision. Even so, it’s may prove to be unfortunate for any number of young ladies. Let’s hope that the cost of the vaccine comes down as it becomes more well-known and demand, in theory, increases.

Of course, there is an even easier way to prevent HPV in teenage girls. Mom and dad, do you know that that is?