One of the co-authors of this article is the editor-in-chief of
The Journal of the American Medical Association.
http://jama.ama-assn.org/cgi/content/full/297/17/1921... The ACIP recommendation supports making quadrivalent vaccination the standard of clinical care.
However, it is important to emphasize that the vaccine is supported by limited efficacy and safety data. Clinical trials have thus far involved a relatively small population (<12 000 participants) for a limited period of follow-up (5 years). The vaccine has not been evaluated for efficacy among younger girls (aged 9 to 15 years). Yet, if the vaccine were required nationwide, it would be administered to some 2 million girls and young women, most of them between 11 and 12 years old and some as young as 9 years old.
The longer-term effectiveness and safety of the vaccine still need to be evaluated among a large population, and particularly among younger girls. Given that the overall prevalence of HPV types associated with cervical cancer is relatively low (3.4%)4 and that the long-term effects are unknown, it is unwise to require a young girl with a very low lifetime risk of cervical cancer to be vaccinated without her assent and her parent's consent. Consider the information a clinician can honestly provide to a 12-year-old girl to obtain her assent:
"The 3 injections will probably protect you from an infection that you can only get from sexual contact, but research has not shown how long the protection will last or whether it might have rare bad effects on your health." ...
Public health authorities, pediatricians, and infectious disease specialists, rather than political bodies, should drive mandatory vaccination decisions and policies. The Centers for Disease Control and Prevention recommend routine use of HPV vaccinations, but that is not equivalent to mandatory use. Merck, the manufacturer of the HPV quadrivalent vaccine, lobbied legislatures to make the vaccine mandatory17 before withdrawing its campaign when it became controversial.18 Since the manufacturer stands to profit from widespread vaccine administration, it is inappropriate for the company to finance efforts to persuade states and public officials to make HPV vaccinations mandatory, particularly so soon after the product was licensed.
Private wealth should never trump public health. ...
Years from now, when additional data and experience better inform clinicians and policy makers about the risks and benefits, states might consider requiring HPV vaccination as a condition of school entry. But for now, it is preferable to take a deliberative approach and view routine, voluntary HPV vaccination as part of a comprehensive package for preventing sexually transmitted infections and cervical cancer. A systematic approach to prevention would include promoting reduced sexual activity and safer forms of sex, cervical cancer screening (eg, Papanicolaou tests and HPV testing), and education about HPV and cervical cancer among schoolchildren, health care professionals, and the general public. Interventions are particularly important among African American and Hispanic women, who have disproportionate burdens of cervical cancer.23
These important concerns about mandatory HPV vaccination are not motivated by morals, as there are no data to suggest that an appropriately conducted public health program encourages sexual activity. Rather, maintaining the public's trust is vital—both for HPV vaccination in particular and for school-based vaccination programs more generally.24 Legislation to make HPV vaccine mandatory has undermined public confidence and created a backlash among parents. There is nothing more important to the success of public health policies than to ensure community acceptability. In the absence of an immediate risk of serious harm, it is preferable to adopt voluntary measures, making state compulsion a last resort.25
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