[Home]  [N Y State Programs]        [Communities]        [State  Page]

 

HPV Vaccine (Gardasil)


 A Research Note
 

Updated April 18, 2007

NCSL Resources  -  HPV Vaccine Legislation 2007

also see the comprehensive article in the Wall Street Journal
on April 16, 2007 (subscription required) entitled "Questions on Efficacy
Cloud a Cancer Vaccine" (link here with subscription)

Debate is heating up about whether or not to require girls to be vaccinated against Human Papillomavirus (HPV), which causes virtually all cases of cervical cancer and genital warts.  This flurry of state activity stems from the June 2006 recommendation by the national Advisory Committee on Immunization Practices (ACIP) that routine vaccination is recommended for girls between ages 11 and 12.  

According to the Centers for Disease Control and Prevention (CDC), HPV infects approximately 20 million people in the United States with 6.2 million new cases each year.  There is no treatment for HPV, only treatment for related health problems.  There are more than 30 strains of HPV that affect at least half of sexually active people in their lifetime.  Most strains of HPV do not produce any symptoms and disappear on their own.

Cervical cancer is the second leading cancer killer of women worldwide.  In the United States, nearly 10,000 women are diagnosed with cervical cancer each year and 3,700 women die.  This number is much smaller than in other countries largely because of the Papanicolaou (Pap) test, a screening tool for cervical cancer. The American Cancer Society reports that, with early detection, cervical cancer is usually treatable.  

Currently, the only HPV vaccine approved by the federal Food and Drug Administration (FDA) is Merck's Gardasil, which protects against HPV strains 6, 11, 16 and 18.  Almost 70 percent of cervical cancer cases and 90 percent of genital warts cases are linked to these four strains of HPV.  The Advisory Committee on Immunization Practices (ACIP) recommends administering the vaccine to girls between 11 and 12 years of age, before they become sexually active.  GlaxoSmithKline also has developed a vaccine (Cervarix) to target HPV strains 16 and 18 and is awaiting FDA approval.

Even after recommendations by the ACIP, school vaccination requirements are decided mostly by state legislatures.  Some state legislatures have granted regulatory bodies such as the Health Department the power to require vaccines, but they still need the legislature to provide funding. 

The debate in states has centered--in part--around school vaccine requirements, which are determined by individual states.  Some states grant regulatory bodies, like the Board of Health, the power to require vaccines, but the legislature must still provide funding.  Some people who support availability of the vaccine do not support a school mandate, citing concerns about the drug's cost, safety, and parents' rights to refuse.  Still others may have moral objections related to a vaccine mandate for a sexually transmitted disease.  Financing is another concern: if states make the vaccine mandatory, they must also address funding issues, including for Medicaid and SCHIP coverage and youth who are uninsured, and whether to require coverage by insurance plans.  This has caused some to push for further discussion and debate about whether or not to require the vaccine.

State Action
The Michigan Senate was the first to introduce legislation (S.B. 1416) in September of 2006 to require the HPV vaccine for girls entering sixth grade, but the bill was not enacted. Ohio also considered legislation in late 2006 to require the vaccine (H.B. 703), which also failed.  Legislators in at least 37 states and D.C. have introduced legislation to require, fund or educate the public about the HPV Vaccine.  The sponsor of Maryland's senate bill requiring the HPV vaccine withdrew it citing poor timing, while the house introduced a bill to establish a task force on the HPV vaccine.  The New Hampshire Health Department announced in 2006 that it will provide the vaccine at no cost to girls under age 18.  South Dakota's governor also announced a similar plan in January 2007 that combines $7.5 million in federal vaccine funds and $1.7 million from the state's general fund.  On February 2, 2007, Texas became the first state to enact a mandate--by executive order from the governor--that all females entering the sixth grade receive the vaccine, with some exceptions.  Legislators in Texas introduced H.B. 1098 to override the executive order. Virginia became the first state legislature to pass a school vaccine requirement (SB 1230), followed by New Mexico (SB 1174). Both bills need governor approval to become laws. At least 21 states have introduced legislation to specifically mandate the HPV vaccine for school. See the bills marked under the school mandate column in the table below for more information.

 

NCSL Resources
Web-buzzHPV PodcastNew item
Jody Hatz, February 2007.

Preventing Cervical Cancer
Jody Hatz and Leah Oliver, NCSL Legisbrief, November/December 2006.

Specific Cancer Types: Information on Risk Factors, Prevention, Screening, Treatment and Policy

2002 SNAPSHOT: A Summary of State Actions Relating to the Federal Breast and Cervical Cancer Prevention and Treatment Act of 2000

Other Resources
Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices
CDC: Morbidity and Mortality Weekly Report, March 2007.

Prevalence of HPV Infection Among Females in the United States
Journal of the American Medical Association, February 28 2007.

HPV Vaccine Implementation and Financing Policy Fact Sheet
Kaiser Family Foundation, January 2007.

 


HPV Vaccine: Introduced Legislation 2007
 

 

 

 

 State  Summary

 School Mandate

 Arizona S.B. 1385 Would allocate $2.6 million from the 2007-2008 state general fund to pay for the HPV vaccine for women 21 to 26 years of age. Also reports a federal funding match of $5.6 million. 

S.B. 1437 Would appropriate $200,000 for outreach and education on numerous vaccines including the HPV vaccine.

S.B. 1502 Would require insurance providers to cover the cost of the HPV vaccine.

 
 Arkansas S.B. 954  Would require the Department of Health and Human Services to provide HPV vaccinations to every girl 12 years and older.
 
 
 California* A.B. 16 Would require all girls entering sixth grade to be vaccinated with the HPV Vaccine.

 X

 Colorado* S.B. 80 Would require information be given to parents about the HPV vaccine and requires the vaccine be given to girls before the age of 12 in order to attend school. Allows exemption if parent or guardian objects. Also requires the Executive Director of the Department of Public Health and Environment to decide the content of information given to parents.

H.B. 1016 Would request a Medicaid waiver from the federal government to provide the HPV vaccine for girls 12 to 18 with parental consent.

S.B. 97 Would allocate four percent of state tobacco settlement money to the cervical cancer immunization fund.

H.B. 1292 Would include information on HPV, the link to cervical cancer and the vaccine in human sexuality education in schools.

 X

 

 

 Connecticut* S.B. 86 Would require the Department of Health to develop standards for giving the vaccine.

H.B. 5485 Would provide coverage of the HPV vaccine through the state's insurance plan (HUSKY).

H.B. 6085 Would create an awareness campaign on cervical cancer and HPV.

H.B. 6977 Would require the first dose of the HPV vaccine for girls before entering sixth grade.

 

 

 

X

 District of Columbia* B.17-0030 Would mandate the HPV vaccine for girls before the age of 13 and gives parent's the right to opt-out their daughter. 

X

 Florida* S.B. 86 Would allow the Board of Medicine and Board of Osteopathic Medicine to establish guidelines concerning information given to parents on HPV and also requires insurance policies to cover the HPV vaccine.  

S.B. 660 Would prohibit certain students from entering school without the HPV vaccine and would require public and private schools to provide information on HPV and the HPV vaccine to parents of certain children.  (H.B. 561 is identical) 

 

 

X

 Georgia* H.B. 11 Would mandate insurance coverage for the vaccine.

S.B. 155 Would require the HPV vaccine for sixth grade girls unless parents provide a written statement that they cannot afford the vaccine.

 

X

 Hawaii H.B. 590 Would require health insurance providers to cover the HPV vaccine and adds the vaccine to the teen vax program.  This would allow the department of health to decide if the vaccine should be a school requirement.

H.B 1000 Would add the HPV vaccine to the teen vax program.

 
 Illinois* H.B. 115 Would create an awareness campaign on HPV and cervical cancer; provide parents with information; and require the HPV vaccine for girls entering sixth grade unless their parents choose to exempt them.

S.B. 10 Would require the HPV vaccine for girls ages 11-12, but allows parents to opt-out. Also requires the school to track the number of immunized children attending the school.

H.B. 2033 Would require the department of health to provide and promote information on the HPV vaccine.

X


X

 Indiana S.B. 0327  Requires the parents of girls entering the sixth grade to receive information about the link between HPV and cervical cancer and the availability of an HPV vaccine.  Within 30 days, the parent of the sixth grader must sign a statement notifying the school of their decision to vaccinate or not vaccinate their child.  The school must provide the information to the state Health Department.  This bill does not mandate the vaccine for school attendance.  
 Iowa S.F. 43 Would include HPV as a sexually transmitted disease, its link to cervical cancer and availability of the HPV vaccine in human sexuality education in schools. (Companion H.B. 87

H.F. 661 Would require insurance providers to cover the cost of the HPV vaccine for females nine to 26 years of age.

S.F. 326 Makes an appropriation to the Department of Health to provide HPV vaccinations to uninsured females between the ages of 19 and 26 with incomes below 250 percent of federal poverty guidelines at no charge.  Also funds a public awareness campaign about HPV and cervical cancer, including identifying medically accurate information, making that information available on the Department's Web site, notifying school districts of the information, and educating the public and health professionals.  

 
 Kansas* H.B. 2227 Would require vaccination against HPV for girls before entering sixth grade. Also requires that parents receive information on the link between HPV and cervical cancer before the vaccination of their child.

X

 Kentucky* H.B. 143 Would require all girls entering middle school to be vaccinated against HPV.

H.B. 345 Would require the HPV vaccine for girls entering middle school, but allows parents the right to exempt their child for any reason.

H.B. 327 Would appropriate $4,116,000 from the general fund to provide the HPV vaccine on a voluntary basis to uninsured females ages nine to 26. 

X

X

 Maine L.D. 137 Would establish financial coverage for the HPV vaccine through the MaineCare program.  
 Maryland S.B. 54 Would require all girls entering sixth grade to be vaccinated against cervical cancer starting in 2008. Bill Withdrawn.

H.B. 1049 Would establish a task force for the HPV vaccine. Duties would be to make recommendations for a state plan for the vaccine including possible requirements, cost and education efforts.

 
 Massachusetts* Docket # 604 Would require all girls entering sixth grade to receive the HPV vaccine.  Allows parents to opt-out of the requirement if the vaccine contradicts religious beliefs.  Promises state financing of the vaccine for any girl in a family with income below 300 percent of federal poverty guidelines.

 X

 Michigan* H.B. 4164 Would require the HPV vaccine. Provides information to parents and allows exemptions.

H.B. 4104 Would require the HPV vaccine for girls entering sixth grade. Allows exemptions.

S.B. 133 Would require parents to recieve information on the HPV vaccine and sign a form saying their child has had the vaccine for entry into sixth grade, or that the parent has opted their child out of the vaccine.

S.B. 132 Would require the HPV vaccine for girls entering sixth grade, requires parents recieve information on the vaccine and allows exemptions.

X

X

X


X

 Missouri* H.B. 802  Mandates that girls entering the sixth grade prove that they have had the HPV vaccine or begun the immunization series (with intent to complete the 3-dose vaccination). Allows parents to decline the vaccine for their daughters on medical or religious grounds, but they must sign an informed consent and receive information on the relationship between HPV and cervical cancer.

S.B. 514 Would provide parents with information on HPV, cervical cancer and the HPV vaccine. Would require all sixth grade girls to be vaccinated against HPV. Allows religious and medical exemptions.

X

 

X

 Minnesota* S.B. 243 Would require the HPV vaccine for girls entering school at the age of 12. Provides parents with information and allows exemptions. (Companion: H.B. 530) 

X

 Mississippi* H.B. 895 Would require all girls entering sixth grade to be vaccinated against HPV. Also relates to financing and Medicaid coverage of the vaccine. Died.

X

 New Jersey* A. 3659 Would mandate insurance coverage of the HPV vaccine.

S. 2286 Would require distributing information about HPV to parents and guardians and requires vaccination of seventh to 12th graders. Also proposes a public awareness campaign. (Identical Bill: A.B. 3920)

S. 2284 Would mandate insurance and state health program coverage of the HPV vaccine.

A. 4050 Would mandate insurance and state health program coverage of the HPV vaccine.

 

X

 New Mexico* S.B. 407  Requires insurance plans in the state to cover the FDA-approved HPV vaccine for girls age 9 to 14. Existing deductibles and coinsurance may apply. 

H.J.M. 39 Would create the human papilloma virus- papanicolaou advisory panel to study cervical cancer disparities and find cost-effective strategies for primary and secondary cervical cancer interventions, inlcuding the HPV vaccine.

H.B. 965 Would allocate funds from an increased cigarette tax to the department of health to increase cervical cancer vaccination outreach.

S.B. 1174 Would require the HPV vaccine for girls between nine and 14 years of age. Allows parents to elect not to have their child vaccinated. Also provides information to parents. Passed legislature, sent to governor 

 

 

 

 



X

 New York A.B. 2856 Would include information on the HPV vaccine and its relation to cervical cancer in sexual education. (Companion S.B. 1342)  
 North Carolina A.B. 260 Would require the department of health to distribute information on the HPV and the vaccine through schools to all parents of children in grades five through 12.  
 North Dakota H.B. 1471 Would establish educational materials on HPV and the HPV vaccine.  
 Ohio* H.B. 81 Requires all female students entering the sixth grade to receive the HPV vaccine.  The student may not attend school for more than 14 days without providing documentation that they have received the vaccine or are in the process of receiving it.  Allows parents to opt out after they are given information on the link between HPV and cervical cancer. Also creates an HPV Immunization Advisory Committee within the Department of Health. 

 X

 Oklahoma* S.B. 487 Would require the HPV vaccine for all girls before entering the sixth grade.

 X

 Oregon H.B. 3253 Would require health benefit plans to cover the HPV vaccine for girls 11 years and older.  
 Pennsylvania H.B. 352 Would ammend the Insurance Company Act of 1921 to require insurance providers to cover the cost of the HPV vaccine.

H.R. 21 Would create a cervical cancer awareness week to promote awareness of cervical cancer's relation to HPV and the availability of the HPV vaccine.

H.R. 42 Would designate January as cervical cancer awareness month and includes the HPV vaccine in the campaign. 

 
 Rhode Island H.B. 5061 Would require providers to cover the cost of the HPV vaccine.

 

 South Carolina* H.B. 3136 Would enact the "Cervical Cancer Prevention Act" to require the HPV vaccine for girls before entering sixth grade or after their 11th birthday. Allows for religious exemptions.

X

 Texas* S.B. 110 Would provide information for parents and guardians on HPV and requires the HPV vaccine for girls entering the sixth grade.

H.B. 215 Would provide information for parents and guardians on HPV and requires the HPV vaccine for girls entering the sixth grade. (Companion to above Bill)

H.B. 146 Would require the Department of Health to educate the public about HPV and cervical cancer and promote immunization against HPV.

H.B. 1098 Would prohibit any elementary or secondary school requirement for the HPV vaccine. If enacted, this would override the executive order listed below.  (S.B. 438 is identical. H.B.1115 is duplcate)

H.B. 1215 Would prohibit the HPV vaccine from being added to the immunization schedule and does not allow the executive commissioner of the Health and Human Services Commission to require the vaccine for school entry.  

S.B. 815 Would require health benefit plans to cover the cost of the HPV vaccine.

Executive Order 4 signed by Governor Rick Perry February 2, 2007 - Mandates that all females entering the sixth grade must receive the HPV vaccine.  Orders the Vaccines for Children program to make the vaccine available to eligible children up to age 18 and the state Medicaid program to finance the vaccine for eligible females age 19-21.  Allows parents to refuse the vaccine for their daughters. Enacted

X

 

X

 

 

 

 

 

 

X

  Utah  H.B. 358 Would establish $25,000 for an awareness campaign on the causes, prevention, and risks of cervical cancer.  
 Vermont* H.B. 256  Requires all females entering sixth grade to receive the HPV vaccine.  Allows exemptions for medical, moral or religious beliefs.  If the parent refuses the HPV vaccine, they must sign a "refusal to vaccinate" statement that they understand the link between HPV and cervical cancer.  Appropriates nearly $8 million dollars to the health department to pay for and administrate the vaccine to all 11-year-old girls and 25 percent of the population age 10, or 12-26.   

S.B. 139 Would require all girls to be vaccinated against HPV before entering sixth grade. Allows exemptions for medical, moral or religious beliefs.  If the parent refuses the HPV vaccine, they must sign a "refusal to vaccinate" statement that they understand the link between HPV and cervical cancer.  Appropriates nearly $8 million dollars to the health department to pay for and administrate the vaccine to all 11-year-old girls and 25 percent of the population age 10, or 12-26.

X

 

 

X

 Virginia* S.B. 1230 Would require the HPV vaccine for girls entering sixth grade. Passed legislature; sent to governor

H.B. 1914 Would add the HPV Vaccine to the required vaccination schedule for girls, 11 years of age.

H.B. 2035 Would require the HPV vaccine for girls on or after their 11th birthday and allows parents to exempt their child.

X

X

X

 Washington H.B. 1802 Would provide every parent of sixth grade girls with information on HPV and where they can get the vaccine. Does not require the vaccine.  
 West Virginia* H.B. 2835 Would require the HPV vaccine for girls entering sixth grade. Allows medical exemptions.

X

 

*Represents a state with at least one bill introduced to mandate the HPV vaccine as a school requirement.

Souce:  National Conference of State Legislatures, 2007.

 

      

 

[Home]  [N Y State Programs]        [Communities]        [State  Page]
 
Revised: April 18, 2007 .