The CDC first recommended the widespread use of the human papillomavirus (HPV) vaccine in 2007. Eight years later, only Virginia and Rhode Island have mandated that middle and secondary school students get it. Compared to the way other vaccines have been incorporated into state public health efforts, this is remarkably slow.

If you’re sexually active, you’ll probably get infected with HPV at some point in your life. In most cases, your body will fight off the infection. But in some people some strains of the virus can linger, causing genital warts or more serious problems like cervical or penile cancer later in life.

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Those are the strains the vaccine targets. And because no one can predict the future, there’s no way of knowing in advance whether a person is going to be exposed to one of the nastier strains of the virus. There’s also no way to tell whether they’re one of the unlucky people whose body can’t kill that virus. That’s why the CDC recommends that kids get the HPV vaccine when they’re 11 or 12: it’s not that they think those kids are having sex, it’s to make sure they’re protected from the virus before they start having sex.

But a research article by Princeton bioethicist Jason Schwartz and his undergraduate research assistant Laurel Easterling in today’s issue of the Journal of the American Medical Association points out that states seem to be squeamish about requiring HPV vaccinations in a way that has not been true for other preventable diseases. For example, take a look at the current list of states requiring childhood vaccines for hepatitis B, another disease that’s often transmitted sexually.

States Requiring Childhood Vaccination for Hepatitis B in 2015

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Impressive, eh? Forty-seven states in 2015 require vaccination against hepatitis B. But that vaccine’s been around a lot longer than the HPV vaccine–maybe the eight years since the CDC’s HPV recommendation is too short a time for most states to enact the relevant laws? Not so, say Schwartz and Easterling: eight years after the CDC first recommended widespread vaccination for hepatitis B, thirty-six states had mandated its use.

Hepatitis B vaccine is usually given to infants. Maybe it’s more difficult to mandate vaccines for older children and adolescents?

Schwartz and Easterling also checked state vaccination requirements for meningococcal meningitis, a potentially fatal brain-swelling disease whose vaccine (like the HPV vaccine) is recommended for 11 to 12 year olds. They found a lot more variation in the the way those vaccine mandates were implemented. Still, twenty-one states had relevant legislation in the same eight-years-after-CDC-recommendation window, and twenty-nine states currently require the shots for either public school or university students.

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States Requiring Childhood or Adolescent Vaccination for Meningococcal Meningitis in 2015

Maybe a lot of parents think that the HPV vaccine is unnecessary and is being pushed on the public by the company that makes it? I remember another vaccine that was accused of just that when it was first introduced: the vaccine for the virus that causes chicken pox. Want to see how states responded?

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States Requiring Childhood Vaccination for Chicken Pox in 2015

That’s right. If your kid is going to attend daycare or a public school, EVERY STATE NOW REQUIRES A CHICKEN POX VACCINE. It’s really not a bad idea: chicken pox is insanely infectious, can make a kid miserable for a couple of weeks, and sets you up for totally no fun cases of shingles in later life.

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Schwartz and Easterling’s analysis shows us that state legislatures are perfectly capable of drafting laws that require children to be vaccinated against a sexually transmitted disease, or that require vaccines in later childhood, or that require vaccines for diseases that some of their constituents think aren’t a big deal. But the fractious political debate that surrounded the introduction of the HPV vaccine and its manufacturer-backed lobbying campaign in 2006 may have turned this particular vaccine into a political land mine.

[CDC | Immunize Action Coalition | JAMA]

Charts by D. Kelly via amcharts


Contact the author at diane@io9.com.

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