When Rhode Island health officials rolled out a new immunization requirement for seventh graders this fall, they weren’t expecting controversy. The vaccine for HPV, or human papillomavirus, protects against a sexually transmitted infection that causes most cervical, anal, and throat cancers. But a small but vocal group of opponents say the state shouldn’t mandate the HPV vaccine, and they’re taking the fight to the statehouse.
Parents and activists confronted the health department director at one of several town hall meetings this summer. How can you mandate a vaccine, they ask, that isn’t safe or necessary? The exchanges grew heated.
At one point, state police were called in to investigate threats to the health department. And health officials canceled the remaining town hall meetings.
Now, a group called Rhode Islanders Against Mandated HPV Vaccinations carries the movement’s torch. Co-founder Aimee Gardiner says they want lawmakers to overturn the vaccine rule because it violates a parent’s right to choose.
“This is a personal family point," said Gardiner, "where the doctor and the parent should be discussing and making the decision for the child and it should have nothing to do with whether or not they attend school.”
Gardiner acknowledges that parents can opt out by submitting a religious exemption form. And Rhode Island health officials say no child will be turned away from school. It’s not really a mandate in that sense. But Gardiner feels the HPV vaccine shouldn’t even be on the list of requirements for school.
Why? HPV is sexually transmitted. It’s not passed around at school. And Gardiner points out that most HPV infections resolve on their own.
“Having regular checkups of pap smears and using condoms has an extremely high effectiveness rate of preventing this," Gardiner said. "So it’s not OK to mandate a preventative way when a parent has a right to educate their child in other ways and choose that this is the more effective way.”
“That’s kind of like putting your helmet on after you’ve had a bike crash. The infection has already happened," said pediatrician Dr. Elizabeth Lange, recalling a metaphor used by a colleague.
Dr. Elizabeth Lange has been practicing at Waterman Pediatrics in East Providence for 20 years. She says many parents say yes to a vaccine she believes is safe and effective. But it’s a sensitive conversation with a growing number of them. Lange says she empathizes with parents who struggle with the decision.
“If another mom says, ‘Well, I heard on the internet that this vaccine is bad and we need to avoid it at all costs.’ Then I reflect back and say, ‘OK. I appreciate you saying that up front. Tell me what you’ve learned, and let’s work together to help you to understand why I recommend this vaccine.’”
Lange says some parents are concerned about the vaccine’s safety. But she finds more often it’s about sex.
“People are more concerned that if we give a vaccine like this to an 11 or 12-year-old, we’ve now given them permission to be promiscuous," Lange said. "There are actually many studies that show that is not the case. We are actually giving a vaccine to 11 and 12-year-olds because it is actually this time of their life their immune system is most robust.”
She tries to refocus the conversation on what the vaccine prevents.
“Would we be having all these media discussions if this were a breast cancer vaccine or a colon cancer vaccine? I suspect not," said Lange. "That’s why I’m concerned as we focus on words like mandatory, as we focus on words like sexually transmitted, we lose the point that this vaccine protects against cancer.”
Rhode Islanders who oppose the vaccine requirement often dispute that point. But for Women and Infants Hospital oncologist Katina Robison, the science is settled.
“When I see these women come into my office with cancer that I can’t cure sometimes," said Robison, "it means a lot to me to know that we have a vaccine that can prevent that from ever happening again.”
Robison says friends ask her all the time about stories they’ve heard about the vaccine causing serious harm. They’re not true, she tells them.
“The hard thing is, when you give 67 million doses of a vaccine, there are going to be things that happen to people after that that aren’t related. And so all of those events have been studied very carefully. And there is not a causal relationship. Nobody’s been able to show that in fact the vaccine caused that serious effect.”
Robison says she’s proud Rhode Island is leading the way requiring that boys and girls get the HPV vaccine – a first in the nation. Massachusetts health officials say they’re watching the experiment closely.
Meanwhile, Rhode Islanders Against Mandated HPV Vaccinations is stepping up public outreach. The group launched an online fundraising campaign. A few state lawmakers have joined their cause. And several school committees have passed resolutions denouncing the vaccine requirement.
Are they having an impact on vaccination rates? It’s too soon to tell. School nurses are still combing through this year’s paperwork. But if you look at all the vaccines required for seventh graders last year, fewer than one percent opted out.