Actions taken on HPV vaccine proposals in Kentucky, Massachusetts, New Mexico, Ohio, South Dakota and Virginia

The following highlights recent news of state actions on human papillomavirus vaccine proposals. Merck's HPV vaccine Gardasil and GlaxoSmithKline's HPV vaccine Cervarix in clinical trials have been shown to be 100% effective in preventing infection with HPV strains 16 and 18, which together cause about 70% of cervical cancer cases.

FDA in July 2006 approved Gardasil for sale and marketing to girls and women ages nine to 26, and CDC's Advisory Committee on Immunization Practices later that month voted unanimously to recommend that girls ages 11 and 12 receive the vaccine. GSK in April plans to file for FDA approval of Cervarix, and it expects approval by the end of this year. CDC has added Gardasil to its Vaccines for Children Program, which provides no-cost immunizations to children ages nine to 18 covered by Medicaid, Alaska Native and American Indian children, and some uninsured and underinsured children (Kaiser Daily Women's Health Policy Report, 2/12). Summaries appear below.

• Kentucky: The House last week voted 59-39 to approve a bill (HB 345) that would require all middle school girls in the state to receive an HPV vaccine unless their parents sign an exemption form, the AP/Lexington Herald-Leader reports. Gov. Ernie Fletcher (R) in a statement said he does support the legislation, adding, "Without funding for uninsured and low-income women, this is no option" (Alford, AP/Lexington Herald-Leader, 2/22). Fletcher earlier this month in his State of the Commonwealth address called for more than $4 million for the vaccine to be administered on a voluntary basis, the Grayson County News-Gazette reports. The legislation now moves to the Senate (Whitlock, Grayson County News-Gazette, 2/26).
• Massachusetts: Gov. Deval Patrick (D) on Sunday announced that his budget for fiscal year 2007 includes a $24.8 million increase in public health spending to provide universal state coverage for three new immunizations for children, including an HPV vaccine for 72,126 girls and women ages 9 to 18, the Boston Globe reports (Wangsness, Boston Globe, 2/26). Patrick's plan would make HPV vaccination optional, MetroWest Daily News reports. Sen. Richard Moore (D) has proposed a bill that would require girls to receive the HPV vaccine before entering sixth grade (Rutherford, MetroWest Daily News, 2/28). Patrick in a statement released on Sunday said, "These investments not only save lives but also reduce treatment costs in the future" (AP/Forbes, 2/26).
• New Mexico: Sen. Steve Komadina (R) recently introduced a bill (SB 1174) that would require girls ages nine to 14 to receive an HPV vaccine to attend public and private schools, the AP/Santa Fe New Mexican reports. Under the legislation, parents would be permitted to opt out of the requirement. Another bill (SB 407), sponsored by Sen. Dede Feldman (D), would require insurance companies to cover HPV vaccines for girls who do not receive it through CDC's Vaccines for Children Program. The New Mexico Department of Health is developing a plan that would make HPV vaccines available beginning in 2008 to fifth-grade girls attending public schools. School districts in the state could decide whether to participate in the program, according to Jane McGrath, school health officer for the health department. The health department is asking state lawmakers for $1 million to purchase the vaccine. Steve Jenison, medical director for infectious diseases at the health department, said the "best way" to vaccinate the population is to "target one grade and offer all three doses [of the vaccine] in the same school year" (AP/Santa Fe New Mexican, 2/26).
• Ohio: Rep. Edna Brown (D) plans to introduce a bill that would require that all girls receive an HPV vaccine before entering the sixth grade, the Dayton Daily News reports. According to the Daily News, it would cost $56 million annually to vaccinate the state's 156,000 sixth-grade girls. Brown aide Mercy Sutyak said private insurers, Medicaid and federal immunization plans would probably pay for the vaccinations (Bischoff, Dayton Daily News, 2/26). Brown said the measure also would include a provision to educate children and parents about the vaccine. Gov. Ted Strickland (D) said although the vaccine is a "major medical breakthrough," he is not in favor of making it mandatory, the Toledo Blade reports. "I think there are problems in trying to make it mandatory, and so that's not where I'm going," Strickland said, adding that "there are legitimate questions about when it should be administered." Anne Harnish, acting director of the state Department of Health, has not taken a position on making immunization mandatory, Harnish spokesperson Jay Carey said (Provance, Toledo Blade, 2/27).
• South Dakota: The Senate on Tuesday voted 33-2 to approve a measure (HB 1061) that would authorize $9.2 million in funding to provide HPV vaccines at no cost to females ages 11 to 18, the AP/Rapid City Journal reports (AP/Rapid City Journal, 2/27). Gov. Mike Rounds (R) last month announced the voluntary program, and Health Secretary Doneen Hollingsworth said that it likely will focus on girls ages 11 and 12 in future years. The House last week voted 61-9 to approve the measure (Kaiser Daily Women's Health Policy Report, 2/22). However, the legislation must be returned to the House because of a Senate amendment (AP/Rapid City Journal, 2/27).
• Virginia: Gov. Tim Kaine (D) on Tuesday said he has "some qualms" about recently approved legislation that would require girls entering the sixth grade beginning Oct. 1, 2008, to receive an HPV vaccine, the Washington Post reports. The legislation, which was approved by the General Assembly earlier in the month, would require parents to be given information about the vaccine, after which they could request their daughter not receive it. Speaking on WTOP radio, Kaine said he might try to amend the legislation to include "a generous opt-out" provision so parents or guardians have more authority to decide whether their child receives the vaccination. Delegate Phillip Hamilton (R), sponsor of the legislation, said parents only have to sign a form so the Department of Health "knows they opted out." Kaine has until March 26 to decide whether he will sign, veto or amend the legislation (Craig, Washington Post, 2/28). The General Assembly is the first state legislature in the country to pass an HPV vaccination mandate (Kaiser Daily Women's Health Policy Report, 2/22).

WTOP's "Ask the Governor" program included comments from Kaine about the HPV vaccine legislation and other issues (Moss, "Ask the Governor," WTOP, 2/27). Audio of the program is available online.

NPR's "Day to Day" on Tuesday included a discussion with Sydney Spiesel, a medical columnist for Slate, about HPV and the effectiveness of the vaccine (Chadwick, "Day to Day," NPR, 2/27). Audio of the segment is available online.

WBUR's "On Point" on Wednesday included a discussion about the vaccine and state mandate proposals. Guests on the program include Arlene Weintraub, associate editor of science and technology for BusinessWeek; California Assembly member Edward Hernandez (D); Lois Ramondetta, associate professor of gynecologic oncology at the University of Texas M.D. Anderson Cancer Center; and Louis Cooper, professor emeritus of pediatrics at Columbia University and a member of the steering committee of the National Network for Immunization Information (Ashbrook, "On Point," WBUR, 2/28). Audio of the segment is available online.