New product, old problems: The debate over HPV vaccine mandates

In June 2006, Gardasil, manufactured by the pharmaceutical company Merck, became the first FDA-licensed vaccine against strains of human papillomavirus (HPV). Initially, the vaccine was widely hailed as a boon to women's health. But as states began considering legislation to make HPV vaccination mandatory for schoolchildren, a vociferous public debate erupted. Those opposed to HPV vaccine mandates argued that they undermined Christian values, infringed on parental rights, and put the health of young girls at risk in order to serve corporate interests. Proponents asserted that mandates were the best way to ensure universal coverage with an unprecedented cancer-preventive and the best way to target racial disparities in cervical cancer rates. The debate over compulsory vaccination is not new; arguments that vaccines are harmful, or are used to unfairly target certain members of society, or should be administered to children solely at their parents discretion, are centuries old. But the debate over HPV vaccine mandates drew in new constituents: namely, teenagers, who have voiced their opinions on social networking and video sharing websites. The debate also elicited, from more familiar constituents, new arguments: namely, that proposed mandates are the result of government collusion with corporate interests, specifically, those of the vaccine's sole manufacturer to date, Merck. Nonetheless, studying the debate within a historical context reveals that the HPV vaccine is the latest object of two historically contentious areas of public health regulation: how to best manage sexually-transmitted infections, and the limits of the state's role in safeguarding the health of its members. This research places the current HPV vaccine mandate debates within the context of the two-hundred-year-old history of immunization laws in the U.S. , as well as the history of debate about how the transmission of sexually transmitted infections should be curtailed. Research to develop a vaccine against HPV may have been motivated by the best of intentions, but the vaccine's forceful entry into the healthcare marketplace, and the fact that it targeted a little-known STI, put many members of the American public on guard and unwilling to embrace compulsory immunization.