Should Nurse Practitioners Support the Use of Gardasil as a Mandatory Vaccine?

Article Outline

• Support for Mandatory Vaccination
• Rationale Against Mandatory Vaccination

Deborah Carey, MN, APRN, completed her MSN as a family nurse practitioner at Louisiana State University. For 23 years she has been active in critical care, oncology, and mental health nursing caring for patients across the life span. She mentors students and employees at the bedside, in education, and in a supervisory role. She is an adjunct nursing instructor at Bossier Parrish Community College. Deborah is currently employed in education at Christus Schumpert and in palliative care at Grace Home, an acute care residential hospice in Shreveport, LA.

Jennifer Palermo, MN, APRN, completed her MSN as a family nurse practitioner at Louisiana State University. Prior to her nursing career, Jennifer earned her MS in sociology/gerontology at Indiana State University and worked as a Project Manager for RTI International, conducting health-related research studies supported by the NIH and CDC. In addition to working full-time in a family practice, Jennifer serves as a volunteer health care provider to underserved communities in Central America. She is currently assessing rural areas of Guatemala and Honduras with the hope of opening a needs-based clinic.

Human papillomavirus (HPV) is the most common sexually transmitted disease in the United States. There are 140 known genotypes of HPV, 40 genotypes are transmitted sexually, and 15 to 20 genotypes cause cancer. Each year as many as 3.1 million people, 15 to 24 years of age, are infected with HPV. The most common types of HPV in this population are HPV type 52, 16, 66, 6, 18, 31, 45, 11, and 33. Approved in 2006 for females aged 9 to 26, Gardasil works against strains 6, 11, 16, and 18, responsible for about 80% to 99.7% of cervical cancer. The debate regarding mandatory vaccines is not new. Some believe it violates an individual's freedom of choice, religious beliefs, or moral values. Recently, state representatives debated a bill that would require the HPV vaccine (for females aged 11 to 12) for school attendance. School and childcare entry laws for all immunizations are state laws and vary nationwide. Federal and state governments pay for every Medicare and Medicaid patient who develops cervical cancer, so should they have the right to insist on mandatory Gardasil vaccinations?

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Support for Mandatory Vaccination 

Deborah Carey

I believe APRNs should actively support the use of Gardasil vaccine as a mandated vaccine. As APRNs, we have an incredible opportunity to be part of a paradigm shift in thinking. For the first time, instead of being reactive to cancer, we can be part of the educational process that causes our patients to be proactive in preventing cervical cancer. The American Academy of Pediatrics, (AAP) President states, “prevention is always better than treatment.” The AAP and CDC recommend the use of HPV vaccine for females age 11 to 12. To the argument that a child does not understand what they are being vaccinated against, I would propose this same child does not understand what meningococcal is either, yet we give this vaccine with no moral outcry. Research has shown no increase in sexual promiscuity after HPV vaccination. HPV is spread by epithelial contact; it is essential to vaccinate before sexual experimentation for maximum benefit of the vaccine. Research has shown 100 times greater immune response in children ages 9 to 12 compared to age 20. Aluminum is included in the vaccine to induce a stronger antibody response; no adverse reactions are documented. The vaccine has a strong safety profile, with only local site redness and fever as adverse reactions. Mandatory vaccination at first seems a violation of rights, but when one realizes there is an “opt out” choice for parents who do not desire vaccination, now mandatory vaccination becomes the great “equalizer.” First, the working class has insurance for the vaccine that otherwise would not have been covered. Second, “mandatory” overcomes our hectic schedules by making it part of the system that says you've just got to make time for this. We know from research that vaccines do not work unless we overcome the inertia of society. Third, and most importantly, mandatory status means fairness to ensure that all female children have the opportunity to obtain the vaccine that prevents cervical cancer.

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Rationale Against Mandatory Vaccination 

Jennifer Palermo

I do not believe NPs should be promoting the new Gardasil vaccine as a mandatory immunization. Forcing someone to take a drug violates personal rights and may be dangerous as well. Merck proposed to inoculate girls beginning at age 9. Most girls aren't sexually active until well above this age. The Gardasil vaccination involves getting three separate injections within a 6-month period and costs from $300 to $500, with possible additional charges for office visits. Because Gardasil only lasts for 5 years, a booster would be required at age 14. Unlike other diseases that children are required to get vaccinated for, HPV is sexually transmitted, not an airborne virus that can be spread easily in a group setting. According to the Gardasil website, “The vaccine only decreases your chances of getting cancer, it doesn't eliminate the risks. It may not protect everyone and does not prevent all types of cervical cancer so it is important to continue regular cervical cancer screenings.” The American Cancer Society states that from 1955 to 1992, the rate of cervical cancer has dropped by 74% and continues to decline.

With all of that in mind, is it really necessary to expose young girls to potentially harmful long-term effects that may be unknown at the present? Scientists have found that exposure to heavy metals such as aluminum and mercury (found in Gardasil) may contribute to conditions such as ADHD, Autism, and Alzheimer's disease. Also, Gardasil may give teens a false sense of security as far as STD protection.

It seems that the costs of this vaccine clearly outweigh the benefits. Each case should be evaluated on an individual basis and the patient be made aware of both the risks and advantages of how Gardasil will affect her health.