Mandating HPV vaccination--private rights, public good.

To the Editor: Those who oppose mandating vaccination against human papillomavirus (HPV) as a condition for school entry generally open the debate with two fundamental questions. First, how can the government interfere in the medical decisions parents make for their children by compelling immunizations for school entry? Second, how can the HPV vaccine be a good candidate for school mandates when HPV infection is transmitted only through intimate contact, not through casual encounters, as with other diseases that are preventable with vaccines? In fact, requiring vaccination against HPV for school entry is firmly rooted in American jurisprudence. The Supreme Court, when first adjudicating compelled vaccination, recognized that the “police power” granted to states under the Constitution’s 10th Amendment permits all jurisdictions to legislate to “protect the public health and the public safety.”1 Thus, the Court said, Massachusetts was acting within its appropriate authority when requiring persons to submit to vaccination against smallpox and when imposing sanctions for noncompliance. Seventeen years later, the Court affirmed a Texas mandate that required documentation of the receipt of certain vaccinations before children could enter school.2 Today, all states and the District of Columbia have instituted immunization requirements for school entry and all jurisdictions provide a procedure for parents to opt out of the requirements. These mandates have proved to be the most effective tool ever devised for increasing access to recommended vaccines for our children. Indeed, the national coverage rate for most childhood vaccines is 95%.3 Another argument against compulsory HPV vaccination contends that because the infection is not casually communicable, the traditional justifications outlined in previous judicial decisions do not apply. However, the mode of transmission is a distinction without meaningful difference, and the result is the same. Twenty million persons are currently infected with HPV; 6 million more become infected each year. The threat to the public’s health, at least with respect to vaccinerelated strains, is preventable with the vaccine. Legal precedent, although established before the introduction of the new vaccine against a virus that is transmitted through intimate contact, will nevertheless serve as the nexus for decisions about the future. If courts are ever called on to review the appropriateness of mandating vaccination against HPV, the traditional underlying this week’s letters