On February 2, Texas governor Rick Perry signed an executive order requiring all eleven- and twelve-year-old girls to be vaccinated against the human papillomavirus (HPV), the sexually transmitted virus that causes cervical cancer. At least twenty other states have similar legislation pending.

The campaign to make the new vaccine compulsory has sparked a polarized debate, prompting unfamiliar allies. The New York Times has sided with Big Pharma, congratulating Texas on its decision. Consumer advocacy groups, skeptical of government mandates and big corporations, are aligned with conservatives who fear the vaccine will encourage girls to become sexually active earlier. Framing the debate this way—saving lives vs. promoting promiscuity, Big Pharma vs. those who speak truth to power—obscures the facts.  

The Food and Drug Administration approved Merck’s Gardasil last June to protect against strains of HPV believed to be responsible for the vast majority of cervical cancer cases. The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices subsequently voted, unanimously, to recommend giving the vaccine to all eleven- and twelve-year-old girls (the vaccine is safe for girls as young as nine, and the ACIP encourages women as old as twenty-six to get it). The vaccine is given in three doses within a six-month period, at a total cost of $360. Merck says that most private health plans cover the vaccine.

The case for compulsory vaccination seems clear: Cervical cancer is caused by HPV, HPV is wide-spread and easily transmitted, and we now have a vaccine that can safely protect against HPV.

But there are over forty types of HPV, and not all types of HPV are the same. High-risk types of HPV are associated with 99 percent of cervical cancers. Gardasil protects against HPV 16 and 18, the two most common high-risk strains. A CDC study published last week in the Journal of the American Medical Association attributed 70 percent of all cervical cancer cases to these two strains. Low-risk types of HPV cause genital warts, which are relatively benign, and respiratory tract warts in children (an infrequent occurrence). Gardasil protects against the two most common low-risk types as well, types 6 and 11.

The JAMA study suggests that about 25 million American women are currently infected with HPV (as opposed to the number that have ever been). But only about 3 percent tested positive for the HPV strains Gardasil protects against.

Framing the debate this way—saving lives vs. promoting promiscuity—obscures the facts.

The American Cancer Society (ACS) estimates that only 11,150 women will be diagnosed with, and 3,670 will die from, cervical cancer this year. By way of comparison, ACS expects 178,480 new diagnoses of breast cancer this year, with an estimated 40,460 female deaths—and 450 male deaths.

Vaccines are normally made compulsory on the basis of public risk, for diseases that are extremely contagious and have the potential to cause great morbidity and mortality. Massachusetts began the modern trend in 1809, when it made smallpox immunization mandatory for everyone. The Supreme Court has twice upheld states’ rights to pass such laws, in 1905 and 1922. Today, all states mandate childhood vaccination against rubella and polio—both devastating and highly contagious. HPV spreads and kills less easily.

There’s also a more obvious step that now seems to be ignored: Of those now diagnosed with cervical cancer, approximately half have never received a Pap smear; 10 percent have not received one in the past five years. In fact, between 1955 and 1992, deaths due to cervical cancer in the United States dropped by 74 percent—a drop the American Cancer Society attributes to an increased use of the Pap test. The test can detect changes in the cervix before cancer develops, as well as detect cancer in its early stages, when it is easy to treat.

And who are the women not receiving yearly Paps? Overwhelmingly, they are the poor and uneducated. It is this same demographic group that is disproportionately suffering and dying from cervical cancer.

It is on this group, then—for reasons of morality, not public risk—society should push the vaccine. As the risk of the disease is personal, and because it can so easily be prevented, compulsory vaccination is not necessary, and in fact infringes on the rights of parents.

The federal government has already agreed to pick up the tab for vaccinating poor girls, ages nine through eighteen, through its Vaccines for Children program, which is run by the CDC. In the spirit of individual liberty and responsibility, the best next step would not be compulsion, but rather for private charities to educate the poor about the risks of HPV and cervical cancer and the available methods of protection. Parents and young women could then decide for themselves what risks they are willing to face.

Yael Levin is a research assistant at the American Enterprise Institute.

Image credit: Photo by Flickr user multi_everything