Gail Javitt, J.D., M.P.H., Deena Berkowitz, M.D., M.P.H., and Lawrence O. Gostin, J.D., LL.D., review the scientific evidence supporting Gardasil's approval and the legislative actions in the states that followed and raise several concerns about state mandates for HPV vaccination.
To begin with, they assert that Gardasil is relatively new and long-term safety and effectiveness in the general population is unknown. Outcomes of those voluntarily vaccinated should be followed for several years before mandates are imposed.
Additionally, they argue that the HPV vaccine does not represent a public health necessity of the type that has justified previous vaccine mandates, so Constitutional concerns are raised. It is possible that state mandates could lead to a public backlash that will undermine both HPV vaccination efforts and existing vaccination programs.
Finally, they note that the economic consequences of mandating HPV are significant and could have a negative impact on financial support for other vaccines as well as other public health programs. Such consequences should be evaluated before the vaccine is mandated.
"HPV will not be the last disease that state legislatures will attempt to prevent through mandatory vaccination," the authors conclude. "This is a good time to reevaluate the criteria that should be used to mandate vaccination of children as a condition of school attendance."