Keeping choice on the Gardasil vaccine

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If some state lawmakers around the country prevail, girls as young as 10 could soon face a mandatory medical appointment: They would need to be vaccinated against a sexually transmitted virus said to cause cancer – or risk being denied entrance to school.

Already 20 states are considering making the vaccine mandatory for preteen girls. In Texas, Gov. Rick Perry avoided a legislative debate with an executive order requiring all girls who will be sixth-graders in September 2008 to be vaccinated.

In most states, including Texas, parents who object on religious or medical grounds would be able to opt out. But why can't lawmakers reverse the process, letting those who want it "opt in" voluntarily?

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Doctors say the human papillomavirus is the leading cause of cervical cancer. Drug manufacturer Merck claims that the vaccine, called Gardasil, could eliminate 70 percent of cases of the disease if girls are vaccinated before becoming sexually active. The Food and Drug Administration approved the vaccine in June for females between the ages of 9 and 26. Supporters are hailing the vaccine as a sure way to reduce deaths. But some doctors are urging caution.

Besides the estimated $360 cost for a series of three shots, the most pressing questions are moral and ethical, beginning with: Why the rush? And why the medical coercion?

If successful, these efforts would mark a shift in public-health policy. Until now, mandatory inoculations have been reserved for diseases regarded as communicable, representing a public health risk. Gardasil is designed to protect against a virus whose transmission can be prevented through individual behavior.

In addition, Merck is playing multiple roles. As the sole manufacturer of the vaccine, the pharmaceutical giant is waging an aggressive campaign to make its use mandatory. It is helping states such as Florida draft legislation. It is also giving money to Women in Government, a group working to require vaccinations. These efforts hardly represent altruism on the drugmaker's part. Merck stands to make billions of dollars if inoculations become mandatory.

The vaccine also is said to produce minor, temporary side effects. Since the FDA approved Gardasil last summer, 82 girls and women have reported adverse reactions. Although Merck calls that number "small," no one knows the long-term effects. Among the 25,000 patients who took part in early tests, only 1,194 – less than 5 percent – were preteen girls. That is hardly a reason to turn girls into medical guinea pigs.

One hopeful sign comes from Michigan, the first state to introduce such legislation. Lawmakers defeated the bill last month, saying the bill would interfere with family privacy.

If this vaccine becomes mandatory, where will such government intrusion stop? If other vaccines become available, promising to prevent or cure noncommunicable diseases, might they, too, be required by law?

Caring parents everywhere want to do what they believe is best for their children. For some in this case, that will mean choosing to have their daughters vaccinated. For others, it will mean declining to do so. Either way, families deserve options, not coercion, in private health matters.

The decision belongs to parents, not state governments.

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