Gail Javitt, JD, MPH, is a Research Scholar at the Johns Hopkins Berman Institute of Bioethics and the Law and Policy Director at the Institute s Genetics and Public Policy Center. In a recently published paper in the Summer 2008 issue of the Journal of Law, Medicine & Ethics , Javitt and her co-authors argue state-mandates requiring girls to be vaccinated for HPV as a condition for school attendance would not currently be supported by legal and ethical justifications.

The HPV vaccine, sold as Gardasil in the U.S., is intended to prevent 4 strains of the human papillomavirus. HPV is the most common sexually transmitted infection in the world. Two strains are known to cause 70% of cervical cancer cases and two other strains are associated with 90% of genital warts cases.

While the HPV vaccine represents a significant public health advance, the article argues it is inappropriate at this time to mandate the vaccine for the following reasons: the vaccine is relatively new, and long-term safety and effectiveness in the general population is unknown; outcomes of those voluntarily vaccinated should be followed for several years before mandates are imposed; the HPV vaccine does not represent a public health necessity of the type that has justified previous vaccine mandates; the economic consequences of mandating HPV are significant and could have a negative impact on financial support for other vaccines as well as other public health programs.

Javitt and her colleagues argue that during the current climate regarding vaccines and their effects on children, state-mandated vaccinations are under a higher degree of scrutiny from parents, especially the HPV vaccine.

The paper argues that state lawmakers' push to mandate HPV has led to significant concern that the government is overreaching its police powers and authority, and unduly interfering with parental rights to make health care decisions for their children. At this time, Javitt warns a mandate could actually do more harm than good, "It could not only pose Constitutional concerns, but could also lead to public backlash, undermining both HPV vaccines and existing vaccine programs."

Gardasil is the first vaccine developed for a disease that is not easily communicable (i.e. airborne) or immediately life-threatening. "There will likely be other vaccines available in the future that don't fit the traditional conditions that have justified state mandates," says Javitt, "and we need to figure out a legally and ethically appropriate way to provide such vaccines to the public."

Other authors of this paper include:

Deena Berkowitz, MD, MPH, Asst. Professor of Pediatrics, George Washington University School of Medicine and Health Sciences

Lawrence O. Gostin, JD, LLD, (Hon.) Associate Dean (Research and Academic Programs), Linda D. and Timothy J. O Neill Professor of Global Health Law, Faculty Director of the O Neill Institute for National and Global Health Law, and Director of the Center for Law and the Public s Health, Georgetown University Law Center

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