POLICY BRIEF

12/01/2014

Should HPV Vaccinations

be Mandatory?
This policy brief creates awareness of Human Papillomavirus [HPV]
and discusses the long term effects of the infection. It advocates for
childhood vaccination against 4 strains of HPV that are known to
cause cancer and genital warts.
There are approximately 40 known strains of
Human Papillomavirus [HPV] that are
transmitted through sexual contact and
considered a sexually transmitted infection
[STI]. HPV is the most common STI in the
United States and affects both males and
females. There are many different strains of
HPV. Most strains of HPV do not cause
harm and people never even know they are
infected. Others may develop warts on the
skin and mucus membranes, which may or
may not develop into cancerous lesions.
HPV the STI is spread through vaginal, anal
or oral sex with an infected person. It can be
spread regardless of signs and symptoms
and is so common that the majority of
sexually active people will contract at least
one strain at some point in their lives
(typically harmless and resolves on its own).
Signs and symptoms of HPV can occur
years after contracting the STI, which makes
it difficult to pinpoint the introducing person
(CDC, 2014).

Why is this important?

HPV is a viral infection that affects
squamous epithelial cells. Signs of HPV can
be noted with the development of warts on
the skin or in the mucus membranes and
with an abnormal Pap smear exam. The
POLICY BRIEF: HPV Vaccination

American Cancer Society [ACS] (2014)

states that there are more than 150 known
strains of HPV viruses. Common warts that
appear on the hands, chest and feet comprise
about 75% of HPV strains and are
considered harmless. These strains of HPV
are not an STI. Warts that appear in the
mucus membranes comprise about 25% of
HPV strains. These warts may increase the
risk for developing certain types of cancer
(most commonly the cervix) and are
considered STIs (ACS, 2014).

What types of cancer?

HPV
related
cancers
include:
cancer of
the cervix,
vagina,
vulva,
penis, anus and the oropharyngeal area. The
CDC (2014) estimates that 20,000 cases of
female cancer are associated with HPV
virus.

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12/01/2014

Cancer of
the Cervix
is the most
common
HPV
related
cancer for
women.
An
estimated
12,000
cases of
HPV
related
cancer
affect men and oropharyngeal cancer is the
most common in this group (CDC, 2014).

Early prevention is the key

Abstinence is the only way to completely
protect against HPV, but vaccination can
help reduce the risk of developing certain
types of cancer associated with high risk
strains of HPV (CDC, 2014). The focus is to
vaccinate children early, before sexual
interactions occur (AAP, 2012). Vaccinating
children against high risk HPV strains,
before they become sexually active affords
the most protection from cancers related to
HPV infections (AAP, 2012).

Recommendations
Vaccination against HPV can reduce the risk
of certain types of cancer. Herd immunity
will protect people from contracting the STI
and from spreading it to others (AAP, 2012).
Vaccination will increase the longevity and
quality of life for those who are protected
from certain types of cancer related to HPV.
Mandatory HPV vaccinations for all
children age 11-12 and all others who meet
POLICY BRIEF: HPV Vaccination

the criteria for vaccination should be

implemented. Education should be provided
to all health care workers, parents and
children to ensure that ethical considerations
are met and compliance is achieved. In
addition, education should be provided on
safe sexual practices, annual screenings and
exams.

There are two types of vaccines currently

approved for use in the United States.
Gardasil is the most recommended vaccine,
because it protects against 4 strains of HPV
that are known to cause cancer and genital
warts (AAP, 2012). Gardasil is approved for
use in both males and females and should be
administered in 3 doses, starting at age 1112 (Gardasil, 2014). Cervarix is only
approved for use in females and only
protects against strains 16 and 18 (CDC,
2014).

Financial Considerations
Financial considerations to support HPV
vaccine implementation include: reduced
costs associated with HPV related cancer,
fewer cases of cervical or other HPV related
cancers, herd immunity helps to reduce
overall costs and most insurance plans cover
vaccinations. Help is available for those who
are uninsured through federal programs such
as: Medicaid and VFC (CDC, 2014).

POLICY BRIEF

Political Considerations
A total of 42 states and territories have
introduced mandatory vaccinations in the
Senate. Michigan was the first state to
introduce mandatory HPV vaccination to the
senate in 2006. It was not enacted at that
time, but 25 states have enacted mandatory
HPV vaccinations since then and many more
are attempting to pass the bill into law.

Health Considerations
Allergies and adverse reactions should be
considered before vaccinations are given or
made mandatory. According to NCSL,
2014), making HPV vaccinations mandatory
would allow for exemptions to be made.
According to Gardasil (2014), possible side
effects of the vaccine include: pain,
swelling, itching, bruising, and redness at
the injection site, headache, fever, and
nausea, dizziness, vomiting, and fainting.
People who have an allergy to yeast or other
vaccine ingredients should not receive the
vaccine (Gardasil, 2014). Gardasil and
Cervarix are considered safe vaccinations
that have been through extensive testing
from the Food and Drug Administration
[FDA] (CDC, 2014).

12/01/2014

2014). This amendment protects those who

claim exemption from mandatory
vaccinations based on religious or cultural
beliefs and practices.

Conclusion
There are more than 100 strains of HPV.
Approximately 40 strains of HPV can cause
genital warts and may lead to cancer.
Abstinence is the single most effective way
to prevent HPV infection and vaccination is
the second. Almost every sexually active
person will be infected with at least one
strain of HPV at some point in their lives.
Most cases of HPV will clear on their own,
but others will develop into genital warts
and certain types of cancer and can be
transmitted to others. Preventing HPV
infection before sexual activity occurs is
best achieved through vaccinations that
protect against the high risk strains of HPV.
Vaccination against HPV and herd
immunity will reduce the morbidity and
mortality associated with cancers caused
from HPV infection (CDC, 2014).

Cultural/Religious
Considerations
Exceptions to mandatory vaccinations
include cultural and religious considerations.
Some cultures and religions do not believe
in vaccination and are protected under the
First Amendment of the United States
Constitution. The First Amendment
guarantees freedoms concerning religion,
expression, assembly and the right to
petition (Cornell University Law School,
POLICY BRIEF: HPV Vaccination

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12/01/2014

References
ACS: What is HPV? (2014). American
Cancer Society. Retrieved November
11, 2014,
fromhttp://www.cancer.org/cancer/ca
ncercauses/othercarcinogens/infectio
usagents/hpv/humanpapillomavirusa
ndhpvvaccinesfaq/hpv-faq-what-ishpv
American Academy of Pediatrics (2012).
HPV vaccine recommendations.
American Academy of Pediatrics,
602-606. Retrieved November 14,
2014, from
http://pediatrics.aappublications.org/
content/129/3/602.full.pdf+html

content=sSNf9wecb|dc_pcrid_29171
116483&gclid=CO3G_svNgMICFad
aMgod9j8A0Q

Photos courtesy of:

http://www.medicinenet.com/cervical_cance
r_pictures_slideshow/article.htm
http://www.webmd.com/sexualconditions/ss/slideshow-std-pictures-andfacts
http://www.medicinenet.com/cervical_cance
r_pictures_slideshow/article.htm
http://www.cdc.gov/cancer/hpv/basic_info/c
ancers.htm

CDC: Human Papillomavirus (HPV).

(2014). Centers for Disease Control
and Prevention. Retrieved November
11, 2014,
fromhttp://www.cdc.gov/std/hpv/stdf
act-hpv.htm
Cervarix. (2012). GlaxoSmithKline.
Retrieved November 16, 2014, from
http://www.cervarix.ca/
Cornell University Law School: First
Amendment (2014). Legal
Information Institute. Retrieved
November 16, 2014,
fromhttp://www.law.cornell.edu/con
stitution/first_amendment
Gardasil. (2014). Merck Sharp & Dohme
Corp. Retrieved November 16, 2014,
fromhttp://www.gardasil.com/aboutgardasil/aboutgardasil/?MTD=2CPN=1&ENG=1&
ADG=1&utm_source=google&utm_
medium=cpc&utm_term=gardasil&u
tm_campaign=Branded+2013&utm_
POLICY BRIEF: HPV Vaccination