Perry's Vaccination Order Raises Questions

Some state lawmakers and Capitol observers are questioning Gov. Rick Perry’s surprise mandate requiring young girls to receive a vaccine against human papillomavirus, a sexually transmitted disease that causes cervical cancer. At a hastily called press conference Monday morning, Lewisville Republican Sen. Jane Nelson, who chairs the Senate Health and Human Services Committee, asked Perry to rescind his executive order so legislators can weigh the pros and cons of a vaccine that has been on the market for only six months.

Nelson said her three primary concerns about the drug are costs ($360 for a three-shot regimen), safety, and parental rights. Nelson was joined at the press briefing by two GOP House members, Jim Keffer of Eastland and Dan Flynn of Van. Keffer, who chairs the House Ways and Means Committee, said Perry’s mandate caught him off guard because he and Nelson are working with Perry on a $3 billion cancer research initiative. “I don’t understand the thought process here,” he said.

The vaccine - manufactured by Merck & Co. and sold under the name Gardasil - prevents cervical cancer and genital warts caused by four unique strains (including the two most common) of HPV. Merck is aggressively marketing the vaccine to state governments before another pharmaceutical giant, GlaxoSmithKline, wins approval for a similar vaccine, Cervarix. Until then, Merck has the luxury of a competitive-free environment.
Perry's order, which mirrors a bill filed by Rep. Jessica Farrar, D-Houston, calls on the Health and Human Services Commission to adopt rules for vaccinating against HPV and to develop a public education campaign regarding the virus and vaccine. With the issuing of the executive order, Texas has become the first state in the nation to mandate HPV vaccinations.

The HPV vaccine was approved by the U.S. Food and Drug Administration last summer and recommended for use as a routine vaccination by the national Advisory Committee on Immunization Practices on June 29. The vaccine prevents cervical cancer and genital warts caused by four unique strains (including the two most common) of HPV. Worldwide, cervical cancer is the second leading cause of death in women, killing more than 200,000 each year. According to the FDA, there are nearly 10,000 new cases of cervical cancer diagnosed each year in the U.S., many of them caused by HPV, Perry noted in his executive order. The Texas Cancer Registry estimates that 1,169 new cases of cervical cancer were diagnosed last year and 391 women in Texas died from the disease.

Perry has ordered the Department of State Health Services to make HPV vaccine available to low-income children through the Texas Vaccines for Children program and has ordered the DSHS and Health and Human Services Commission to “move expeditiously to make the vaccine available as soon as possible.” Perry's order notwithstanding, Farrar will move forward with her bill, HB 215, which seeks to codify many of the same provisions included in Perry's order, said assistant Lillian Ortiz. The difference between an executive order and a law, Ortiz said, is that an order "could be revoked."

Although immunizing all of Texas' sixth-grade girls (typically, 11- and 12-year-olds), as well as all uninsured girls ages 9 to 18, as Perry also called for, would reportedly cost about $50 million in the first year alone (half of which would come from federal tax money), HPV vaccine supporters - including Farrar and Sen. Leticia Van de Putte, who has filed companion legislation (SB 110) - say it is a small price to pay in order to, literally, eradicate an entire strain of cancer. Nonetheless, several opponents have cropped up - including social conservatives who have said the HPV vaccine would somehow encourage sexual promiscuity (although others, including the Family Research Council, which initially opposed the vaccine have since changed their tune - reportedly after meeting with Merck officials last year), and the Texas group Parents Requesting Open Vaccination Education, whose executive director, Dawn Richardson, in an appearance on the Today Show on Feb. 5, said Perry's order circumvents the legislative process and that state law does not provide adequate protection for parents who want to opt out from the vaccination requirements. For sure, Merck has bankrolled a contingent of lobbyists – including, in Texas, former Perry Chief-of-Staff Mike Toomey – to push for Gardasil's inclusion on state vaccination lists, which would ultimately mean seriously hefty profits for Merck. (To read Perry's order, click here.)