When a Republican governor makes a shockingly progressive push that combines a moral dilemma with medical issues, people are bound to speak out.
"It's a very smart move," said Nicholas Chu, a government junior and University Democrats president.
"It's a dangerous precedent," said Elizabeth Young, government sophomore and member of the Young Conservatives of Texas.
Marv Shepherd, a pharmacy professor and Director of the Center for Pharmacoeconomic Studies, folded his hands and smiled as he said, "It's got a lot of people really upset."
Last Friday, Gov. Rick Perry issued an executive order stating that all girls entering sixth grade in Texas as of September 2008 must receive a vaccine against a sexually transmitted disease that causes cervical cancer. Texas is the first state to mandate that young girls get vaccinated against the human papillomavirus, or HPV, the country's most common sexually transmitted disease.
Cervical cancer accounts for 3,700 deaths a year in the U.S., nearly 400 of which are in Texas. Gardasil, the vaccine, protects against four strains of HPV, two of which are responsible for 70 percent of cervical cancer cases and two of which cause 90 percent of genital warts.
"Cervical cancer is a killer," said social work professor Cynthia Franklin. "If this vaccine provides safety to young women from this killer, cancer, then I think it certainly would be an real advantage."
Sex, legislation and medical tests
Since his executive order, Perry has been criticized on a variety of issues pertaining to the HPV vaccine. Arguably, the most controversial one is the issue of sexual morality: the idea that getting the vaccine will encourage young girls to be more sexually promiscuous, because they believe they are safe from disease.
"The morality implications can't be separated here," Young insisted.
Chu pointed out that Texas parents are allowed to say no to the vaccine. Parents can opt out of inoculations by filing an affidavit that objects to the vaccine on religious or political reasons.
"Why be concerned?" Chu asked with a casual flick of his fingers. "This is just another shot."
Cynthia Franklin, a social work professor, has done research on adolescents and pregnancy issues. She said the idea of a safety precaution like this vaccine will not affect teenagers' views on sex.
"That's the fear, that it will be sending a message that it will give a license to young women to have sex," Franklin said. "But putting safety precautions and choices before people does not make people make those kinds of choices."
She cited the woman's relationship with "her family, her community and her God" as factors that would influence her decision to have sex at an early age.
"Those are the kinds of things that make a difference, not whether you're gonna give them a vaccine," she said.
Because Perry issued an executive order, the Legislature has no authority to repeal it. Young insisted that Perry went about the mandate the wrong way, overstepping the legislature to avoid dissent. Critics of the executive order have also pointed out that by mandating the vaccine, Perry is interfering with parental rights.
"It's socially dangerous. How much power does the government have? What else can they mandate in addition to this?" Young asked, lifting her hands in a questioning gesture. "The government is basically stepping in as a parent."
Some argue that the vaccine has not been tested widely enough. Gardasil was approved by the Federal Drug Administration in June 2006, for girls and women ages 9 to 26.
"This vaccine is so new. We don't know what the long-term benefits from having it might be, much less long-term risks," Young said.
Chu disagreed, pointing out a similar occurrence in U.S. history.
"This is just another part of the history of all mandated vaccines, like the polio vaccine," he said. "There just comes a time when people should realize that curing a disease outweighs any minor concern these people have."
Big publicity, bigger costs
In the wake of nationally televised Gardasil commercials, public demonstrations and widespread criticism from Perry's political peers, officials at University Health Services say awareness about HPV and cervical cancer is growing. UHS Health Coordinator Shannon Rauh said she has seen a rise in presentations for her and her staff to discuss both the virus and the vaccine.
"I have a lot of sororities on my schedule that I'll be visiting and giving presentations to," Rauh said. "Dorms, RAs, student organizations. But this was all on my schedule before the mandate went through."
UHS spokeswoman Sherry Bell said the Gardasil vaccine was made available to UHS in October 2006, roughly four months after the drug was approved nationally for production in June. From Oct. 2 through Feb. 5, UHS administered 333 vaccines to 258 different patients. Each dose of the vaccine can range from $120 to $200. UT students, faculty and staff can receive the vaccine at UHS for $159 per dose.
Most private insurers are expected to pay for "a good chunk" of the total vaccine cost, said Shepherd, which could mean anywhere from $85 to $100 depending on the insurance plan.
Perry directed state health authorities to make the vaccine available for no cost to girls aged 9 to 18 who are either uninsured or whose insurance does not cover vaccinations. He also ordered Medicaid to offer Gardasil to women from 19 to 21. According to the spending plan Perry issued Tuesday, $72 million will be applied to cover costs of administering the vaccine to uninsured children and those in government health care programs like Medicaid or the Children's Health Insurance Program.
"Texas has a lot of children that live below the poverty line, especially young women," Franklin said. "I think one of the advantages of this being mandated is it becomes more available to people who wouldn't normally be able to afford it."
Young Conservatives of Texas President and government junior Tony McDonald said though he is pleased with the efforts to make the vaccine widely available, he has "strong reservations" about state funding.
"As I understand it, I believe that the state will be paying for all of the vaccines," McDonald said in an e-mail. "This seems a pointless expenditure when most parents would be able to afford it."
Franklin supported the idea of taxpayers' money going toward the costs of supplying the vaccine to uninsured girls.
"I think we shouldn't forget here that we're talking about children, about young girls," she said. "If we don't provide for them to prevent a disease - which we can with this vaccine - then we certainly will be paying and providing for them when they become ill, won't we?"
This is the first in a three part series.
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