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The question of guarding girls.

Byline: Tim Christie The Register-Guard

It's not quite the Holy Grail of medicine - a cure for cancer - but it's not that far off: a vaccine that can prevent 70 percent of cervical cancers, which kill about 3,700 American women each year.

Federal drug regulators approved Gardasil last summer, and already it is catching on in a big way in Lane County and across the country, despite its hefty cost and opposition from some religious conservatives.

The catch is, to be most effective, the vaccine should be administered to girls before their first sexual experience, which is why a national immunization advisory committee recommended that Gardasil be given to all girls ages 11 and 12. The vaccine can be administered to girls as young as 9 and women as old as 26.

The looming public policy question is whether Gardasil should be a mandated vaccine, just as shots for measles, chicken pox and tetanus are required for school-age children.

To date, 18 state legislatures are considering bills to mandate Gardasil vaccinations for school-age girls. On Friday, Texas became the first state to mandate Gardasil immunization when GOP Gov. Rick Perry signed an executive order mandating Gardasil immunization for Texas schoolgirls.

Some conservative groups such as Focus on the Family oppose mandatory immunization with Gardasil, saying it interferes with parents' rights to make medical decisions for their children. Some parents who promote abstinence fear that the HPV vaccine will encourage promiscuity.

To date, no legislation has surfaced in the Oregon Legislature that would require Gardasil immunization, said Rep. Carolyn Tomei, D-Milwaukie, chairwoman of the House Human Services and Women's Wellness Committee.

And at least one strong proponent of Gardasil said Oregon may not be ready for such a mandate.

"Vaccination has been a particularly touchy subject in Oregon," said Dr. Audrey Garrett, a gynecological oncologist with Women's Care in Eugene. "I don't think it would go over so well."

Garrett, who also has a master's degree in a public health, is a staunch supporter of Gardasil, and, since last fall, Merck & Co. has paid her to be part of its speakers bureau, traveling around the Northwest talking to medical professionals about the vaccine.

"There's a large contingent in Oregon that refuses vaccines for routine childhood diseases," she said.

Many medical professionals fear that if Gardasil is mandated, "it would be another thing for people to refuse," she said.

Oregon's school immunization law, which requires school children to be vaccinated for various childhood diseases, allows parents to exempt their children based on their personal beliefs.

Exemption rates have been creeping up in recent years, from 2.51 percent in 2001-02 to 2.87 percent in 2002-03 to 2.99 percent in 2003-04 to 3.18 percent in 2004-05, said Martha Skiles, research and survey manager for the state immunization program. In Lane County, the exemption rate was 4.28 percent in 2004-05.

Nationally, 1 percent to 3 percent of students are exempted from vaccine requirements, according to the New England Journal of Medicine.

Katherine Bradley, administrator of the state Office of Family Health, said state officials are focusing on expanding access to the HPV vaccine using federal dollars, rather than pushing for a mandate.

"That tends to work better with Oregonians," she said.

Oregon was the third state to tap into money from the federal Vaccines for Children program to promote HPV immunization, she said. And it is seeking federal money to make the vaccine available at county health departments and federally qualified health centers. They also are working on projects that target Latina and American Indian youths because they're at higher risk for HPV, she said.

Even without a mandate, Gardasil is in demand at local clinics, doctors say. Strong word-of-mouth, public controversy over the vaccine and a powerful advertising campaign by Merck appear to be driving interest in the drug, they say.

The TV ads, often broadcast during programs popular with women, depict young girls skateboarding, dancing and playing the drums, and drive home the message of "one less."

"I want to be one less woman battling cervical cancer," the girls say. "I want to be one less - one less family turned upside down."

When adult women with young daughters come in for their regular gynecological exams, doctors are talking to them about the vaccine, Garrett said.

"It's the talk of the high schools," she said, as teen girls ask their friends, "Have you got your shot yet?"

Local pediatricians and family doctors say they're talking to their patients and parents about Gardasil, but parents frequently beat them to the punch.

"I'm not having to initiate the conversation very often," Springfield pediatrician Todd Huffman said. When mothers bring their pre-teen daughters in for a wellness check, "Usually before I have to bring it up, parents are asking if we have it available."

Likewise, Dr. Karen Weiner said she's fielding calls from mothers about Gardasil at her Eugene pediatric practice.

"Maybe some of the moms have had experiences with abnormal Pap smears and would like to avoid that kind of experience for their daughters," she said.

"We talk about it quite a bit," Eugene pediatrician Kevin Marks said. "We have not had many people who have not wanted to do it."

Dr. Doug Bailey, a family physician in Junction City, said most of his patients and parents understand what the vaccine is about: drastically reducing the risk of a disease that could sicken or kill them.

"If we could get everyone in the world to take this particular immunization, we would almost wipe out cervical cancer from the face of the Earth," Bailey said. "Wouldn't that be cool?"

GARDASIL

The vaccine made by Merck & Co. protects against four strains of human papillomavirus (HPV), including two of the strains that cause most cases of cervical cancer.

The vaccine is delivered in three doses over six months

and costs $360. The Oregon Health Plan covers immunization, as does Regence BlueCross BlueShield of Oregon and PacificSource Health Plans in Springfield.

Lane County Public Health offers Gardasil vaccinations at its weekly public immunization clinics, from 8 a.m. to 11:30 a.m. Wednesdays at 135 E. Sixth Ave., Eugene. Low-income patients may qualify for free or reduced vaccinations.

In Oregon, about 200,000 people are infected with HPV, including 15 percent in the 15- to 19-year-old age group.
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Title Annotation:Health; The looming public policy issue over a cervical cancer vaccine, Gardasil, heats up as states consider mandatory immunization
Publication:The Register-Guard (Eugene, OR)
Date:Feb 5, 2007
Words:1054
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