My friend Sandy is confused and concerned. The Centers for Disease Control (CDC) and her family's pediatrician recommend that her 9-year-old daughter be immunized against HPV (human papillomavirus) this year. But Sandy has legitimate and serious questions about having her daughter vaccinated and her concerns may be well founded. Her predicament could soon be further complicated by the Ohio state legislature.

In February Edna Brown (D-48) introduced House bill 81. The proposal would make the series of three HPV inoculations part of the vaccination schedule required for public school attendance for girls entering the 6th grade.

I applaud the measure for its option to forego the vaccine if parents choose based on medical, religious or philosophical reasons. And the passage of this bill may encourage coverage by Medicaid and private health insurance to help provide those with and without healthcare coverage equal access to the costly vaccine.

However, I believe there should be more research done on the effects and efficacy of the vaccine before including it on the list of mandatory inoculations. It appears that testing was only performed on females age 16--23. Additionally, Merck, the maker of Gardasil, admits that it does not know if the vaccine effectively protects against HPV infection for longer than five years.

Our legislators' excitement over a vaccine against cervical cancer is understandable. But what motivations have spurred the accelerated progress of this legislation? We would like to think that the bill's sponsors are anxious to wipe out a form of women's cancer. But could their race to enact the legislation be linked to other issues?

While three co-sponsors of the bill received campaign contributions from Merck totaling less than $1000, it is interesting to note that Brown is a member of the bi-partisan non-profit organization Women in Government (WIG).

In February WIG launched a bi-partisan initiative called the Challenge to Eliminate Cervical Cancer. It is unclear if Brown received contributions from Merck through WIG, but Janet Skidmore, a Merck spokeswoman, and Susan Crosby, president of Women in Government, admit that the pharmaceutical company has donated to the organization, but would not disclose the amount. Merck is also not willing to divulge how much it has spent lobbying for the vaccine.

Given the recent history of other pharmaceuticals recalled by the FDA that may have been approved on the fast track--like Gardasil--I think it would be prudent to wait until further testing can be completed. Perhaps, then, Sandy's concerns would be assuaged if some of the safety questions could be answered.

Whatever the reasons for the legislation's introduction, we should encourage our lawmakers to take a closer look at the issues surrounding possible serious health repercussions. It would be terrible to find out in a few years that in our rush to protect our daughters we may have caused them irreparable harm.

Amy Moore

Canfield, OH

I am trying very hard not to take the well-intentioned comments of the other readers personally.

I was first diagnosed with HPV in the spring 2000. I had a hysterectomy during Hurricane Katrina (at the ripe old age of 33).

I went through years & years of biopsies, surgeries & phone calls to my office that started, 'Well, we've determined that you don't have cervical cancer, now we think that you might have.... Come in for the test tomorrow.'

Did you see the woman on NOW discussing how she & her husbands were virgins when they got married? Then she was raped in the grocery store parking lot. Now she is fighting for her life.

Parents can opt out. Mandates force insurance companies to cover the bill. And Medicaid to cover girls that are going to have enough problems. I had a hard time covering co-pays for the years I was averaging a test or biopsy every 3 weeks.

If I was uninsured and/ or still in school, I would have been even less equipped.

Honestly. Tell me why I am supposed to be grateful? Or why I should ask my niece to forgo the vaccine? (Since I will certainly never have my own child.)

Why do you people think that we deserve the lot we have been dealt?

Meg Warren

Little Rock, Arkansas

In early March the Journal of the American Medical Association (JAMA) estimated the population prevalence of HPV infection in American women aged 14 to 59 years old. What the CDC study authors found was an overall prevalence of HPV (any type) infection in 26.8 percent of the American females studied, with 3.4 percent infected with one of the four HPV types in Merck's quadrivalent vaccine and 2 percent infected with one of the two vaccine types (HPV 16 and 18) associated with cervical cancer.

The study noted that 90 percent of all HPV infections are cleared from the body and do not become chronic. This means that less than one quarter of one percent of all American women are at risk for chronic infection with one of the two HPV types associated with cervical cancer which are contained in Merck's Gardasil vaccine.

These new HPV prevalence data seriously call into question the cost benefit ratio for Gardasil, particularly when taking into account short- and long-term serious vaccine reactions being reported to the Vaccine Adverse Event Reporting System (VAERS), such as five cases of Guillain Barre Syndrome (GBS) and cases of syncope with seizures, facial paralysis and other signs of brain and immune system dysfunction. The editorial in JAMA also questioned whether the two HPV types in the vaccine would be replaced by the other HPV types associated with cervical cancer, limiting the vaccine's effectiveness. On May 18, 2006, the FDA staff questioned this possibility.

The Washington Times reports that ACIP chairman Jon Abramson and other committee members did not want Gardasil mandated. If this is true, then ACIP should have stated that fact clearly when they made their recommendation in the summer of 2006 that all eleven-year-old girls get the vaccine. In light of newly published HPV prevalence data and the fact that Merck only studied Gardasil in a few hundred eleven-year-old girls for a few years, together with reports of serious adverse events such as GBS coming into VAERS, the CDC's ACIP members should be more worried about unanimously recommending GARDASIL for routine use with inadequate supporting evidence.

This is worth repeating...there have already been five cases of GBS, and the vaccine was only tested on a few hundred girls.

Despite the growing list of outstanding scientific questions about the vaccine's necessity, safety and effectiveness. All we see is knee-jerk endorsements of school mandates for this vaccine. American children should not be viewed as guinea pigs by drug companies, health officials, doctors, or politicians.

Kenneth Stoller, MD, FAAP

Santa Fe, New Mexico

I am neither a "conservative, a "consumer advocate," or "anti-vaccine" organization. I am proud liberal and I object to any kind of government mandate of the Gardasil vaccine for a number of reasons. I don't believe the government has the right mandate any kind of medical treatment or procedure. In much the same way that I am Pro-Choice with regard the legality of abortion, I am Pro-Choice with regard to any kind of vaccination. Citizens of this country have a constitutional right to privacy and any kind of mandated medical procedure is a clear violation of that right.

I also think the medical value of Gardisal is questionable at best. According to CDC, only 2% of HPV infections are type 16 and 18, which are the only high risk HPV types associated with cervical cancer included in Merck's GARDASIL. Those aren't very impressive numbers for a vaccine with little to no safety record. One thing that is quite clear is that Gardasil's greatest value will be its ability to line the pockets of both Merck's stakeholders and that of the politicians they give money to. For example, it is well known that Merck campaign contributions coincided with a Feb. 2, 2007 Executive Order by the Governor of Texas that mandated the vaccine and that on Dec. 14, 2006, Merck announced a $57 million dollar expansion of its plant in Elkton, Virginia (with an annual payroll of $60 million) to produce GARDASIL. Gov. Kaine approved a $700,000 performance-based grant from the Virginia Investment Partnership (VIP) program for Merck to improve the Elkton plant to make it ready to produce Gardasil.

Very little is known about the short or long term safety of this vaccine; my opposition to Gardasil this has nothing to do with "family values," sex and or religion - it has only to do with actual public health (as opposed to profit-driven "public health" as promoted by Big Pharma and the FDA) as well as the right to personal choices when it comes to my own health and that of my child.

Give me liberty or give me death,

Chris Bousquet

Chris Bousquet

New Haven, CT

The role of marketing of an intervention to a public health risk, and lobbying of government officials in particular is what so offends. I do not see this vaccination program as a priority of organizations of public health professionals. The article does not take up alternative expenditures on public health measures. Gardasil is so interesting not because it may prevent a sexually transmitted disease, but because the vaccination program, aimed as it is to those who are not at much risk of contracting the HPV, has small short-term benefits, compared to public health measures which would immunize against diseases that are likely to be contracted by the individual in the near future. Delaying this immunization program until competing products and competing claims on public funding have a chance to appear and be considered will result in very little additional lifetime morbidity or mortality. What such delays will do to the bottom line of the manufacturer are something else again.

Harry Travis

Washington, DC

Can you imagine a vaccine to prevent prostate cancer? That would be a welcome scientific breakthrough. But what if it were determined that prostate cancer was caused by a sexually transmitted virus? Would we be engaging in a national debate about the promiscuity of men and whether or not they "deserve" prostate cancer? Would Bob Dole or Rudy Guiliani become the "poster children" for men who deserve what they got because of their past behavior?

For critics of Gardasil who cite "lifestyle choice" as a reason to oppose the cervical cancer vaccine (which immunizes the recipient against four strains of the sexually-transmitted Human Papilloma Virus that can cause cervical cancer), I would suggest there is a long list of illnesses that we treat at taxpayer expense related to lifestyle choice.

In fact, the list is virtually endless. Heart disease and high cholesterol can be caused by poor diet. A choice. Skin cancer can be caused by overexposure to the sun and failure to wear sunscreen. A choice. Lung cancer, emphysema, complications from obesity or diabetes...linked to personal choices.

Men carry the Human Papilloma Virus at the same rate as women. Most men will never know they carry it and will never develop a single symptom. Women however can develop cervical cancer from the virus and a number of other complications which can be painful, life-altering or fatal. Women, therefore, need to speak out to protect their health and their lives. This is about health, not sex.

The same cultural conservatives who oppose abortion claim they are only trying to "save lives" not "control women." Here is their opportunity to save lives. Support Gardasil. Unless, of course, it's all really about controlling women.

Kim Stanley

South Riding, Virginia

I am puzzled by the author's obvious support for this untested (except by the Merck Corporation) vaccine.

While The Nation has traditionally taken what coporate America has to say with an enormous grain of salt, somehow vaccines are treated as a sacred cow when it comes to ignoring the plethora of reliable opposing research which has been available for decades that puts the lie to the vaccine manufacturer's claims about their products.

By the government's own accounting, most of the diseases which past vaccines were supposedly designed to fight were statistically dead in the United States before the corresponding vaccine was created to "cure" it. While it is obvious that this virus does not fall into this category, everyone, especially writers for your publication, should be very wary of any claims these manufacturers make, especially in light of the fact that there is no public or private agency which does any testing or verification of these grand claims.

In the past Merck has been guilty of excluding unfavorable data and hand-picking favorable results from their studies on vaccines. This from former members of the FDA as well as former employees involved with the development of them--not crazed libertarian-style or fundamentalist Christian critics.

William Berkemeyer

Richmond, VA

Does this vaccine come with the preservative thimerisolm which contains mercury... or any other mercury-containing preservative commonly used in vaccines.?

Jack Doan

New York, NY

While the idea of an HPV vaccine is wonderful news for women, I would be a lot more comfortable with it if there were more control tests being done.

In the last ten years or so we've seen promising medicines turn out to be horrific nightmares. The vaccines of today are not thoroughly tested like the ones 50 years ago.

I say the federal government, along with the FDA and Deptartment of Health and Human Services, should take this approach very slowly.

I'd hate to hear 15 months down the line our young girls and young women have been afflicted and possibly die from this vaccine because the research was rushed through.

A Cook

Atlanta, GA