Panel recommends vaccinating preteen girls against cervical cancer

ATLANTA -- Taking up a sensitive issue among religious conservatives, an influential government advisory panel Thursday recommended that 11- and 12-year-old girls be routinely vaccinated against the sexually transmitted virus that causes cervical cancer.

The Advisory Committee on Immunization Practices also said the shots can be started for girls as young as 9, at the discretion of their doctors.

The committee's recommendations usually are accepted by federal health officials, and influence insurance coverage for vaccinations.

The recommendation involves Gardasil, which is made by Merck & Co. and is the first vaccine specifically designed to prevent cancer. Approved earlier this month by the Food and Drug Administration for females ages 9 to 26, it protects against strains of the human papilloma virus, or HPV, which causes cervical, vulvar and vaginal cancers and genital warts.

Health officials estimate that more than 50 percent of sexually active women and men will be infected with one or more types of HPV in their lifetimes. Vaccine proponents say it could dramatically reduce the nearly 4,000 cervical cancer deaths in the United States each year.

The vaccine is considered most effective when given to girls before they become sexually active. About 7 percent of children have had sexual intercourse before age 13, and about a quarter of boys and girls have had sex by age 15, according to government surveys.

The committee's vote was unanimous, with two of the 15 members abstaining because of they have worked on Merck-funded studies.

The committee also voted to add the HPV vaccine to the coverage list for the federal Vaccines for Children program, which pays for immunizations for the poor. That could mean $50 million to $100 million in additional spending in the first year, government officials said.

Some health officials had girded themselves for arguments from religious conservatives and others that vaccinating youngsters against the sexually transmitted virus might make them more likely to have sex. But the controversy never materialized in the panel's public meetings.

Merck officials said that in the past 18 months they met with several conservative and religious groups to educate them about the vaccine and the illnesses it is designed to prevent.

Earlier this year, the Family Research Council, a conservative group, did not speak out against giving the HPV shot to young girls. The organization mainly opposes making it one of the vaccines required before youngsters can enroll in school, said the group's policy analyst, Moira Gaul.

Another organization, Colorado-based Focus on the Family, was even stronger in voicing fears that states would require schoolchildren to get HPV shots.

"By giving its highest level of recommendation, the panel has placed strong pressure on state governments to make HPV vaccinations mandatory," Linda Klepacki, a Focus on the Family analyst for sexual health, said in a statement.

"If that happens, state officials, not parents, would become the primary sexual-health decision makers for America's children. That's the way things are done in dictatorships, not democracies."

The government advisory panel did not recommend that the vaccine be required by schools, though some organizations -- including Planned Parenthood -- have advocated such a step.

Surveys suggest the shots will have little effect on youngsters' sexual behavior, said Nicole Liddon, a behavioral scientist with the Centers for Disease Control and Prevention. In a recent survey of virgins 15 to 19, only 10 percent of boys and 7 percent of girls cited fear of disease as a reason not to have sex, Liddon said.

The vaccine comes as a $360 series of three shots, and in tests has been highly effective against HPV. The vaccine is formulated to address the subtypes of HPV responsible for 70 percent of cervical cancer cases and 90 percent of genital warts.

In a public comment session at Thursday's meeting, all nine speakers supported recommending the vaccine to females 9 to 26, the broadest possible group under FDA license. The speakers included a state senator from Maryland and the chief medical officer of AmeriChoice, a UnitedHealth Group company that manages state Medicaid programs.

The panel focused on 11- to 12-year-olds in part because children that age already routinely get two other shots.

Several speakers also called for the immunization of boys, as soon as studies are completed on the vaccine's safety and effectiveness for males. HPV has been linked to penile, anal, and head and neck cancers and a tumor-like condition of the respiratory tract.

Merck officials said clinical effectiveness studies in males should be completed by 2008.

Merck officials also said they can provide the more than 19 million doses that health officials expect would be used in the next year.

Also on Thursday, the committee voted to recommend that children get two doses of the vaccine against chickenpox. The first dose would be given at 12 to 15 months of age, and the second at 4 to 6 years. The previous recommendation was for just one shot, but outbreaks have continued to occur among schoolchildren.

The committee also recommended a second dose for children and adults who have had only one shot.