The
panel, whose decisions carry great weight with government health departments and
private health insurers, said girls as young as 9 and women up to age 26 could
be given the vaccine if doctors approve.
Anne
Schuchat, an official at the federal Centers for Disease Control and Prevention,
hailed the move as a huge breakthrough for women's health and said
11- and 12-year-olds were targeted to gain the maximum preventative
impact.
People
in the room in
Atlanta
where the recommendations were announced burst into applause after the
unanimous votes, said a member of the panel, the Advisory Committee on
Immunization Practices.
The
new vaccine, Gardasil, protects against strains of a sexually transmitted human
papillomavirus that cause 7 0 percent of cervical cancer cases. The disease is
expected to strike about 9,700 women and kill 3,700 in the
United States
this year.
Doctors
and scientists say the vaccine works best when administered before a female
becomes sexually active. It is given in three doses, for which its manufacturer,
Merck & Co., is charging 120 each.
Recommendations
of the panel, which urged the government to make the vaccine available free to
children of low-income families, are subject to approval by federal health
officials. And states and communities must decide whether to promote and
administer the vaccine.
The
decisions could raise budgetary concerns in cash-strapped health departments.
And some conservatives who support abstinence might apply pressure to resist the
recommendations.
Linda
Klepacki, a sexual health analyst for the group Focus on the Family, said states
should not treat the vaccine like those for mumps and measles, because it guards
against a disease contracted through sexual activity. She said its use should be
left up to parents and not be required by the states.
It's
parents who should be in charge of their children, not the government,
Klepacki said. Parents should have a right to determine whether their
child is vaccinated or not, especially when it involves a sexually transmitted
disease.
Dr.
William Schaffner, a liaison to the advisory panel from the Infectious Diseases
Society of America and the National Foundation for Infectious Diseases, said the
panel's recommendation was not intended to pressure states into requiring that
girls receive the vaccines. He said he sees no sign that states are considering
making the immunizations mandatory.
Instead,
the committee wanted to encourage parents and their children to consult with
doctors about the vaccinations, said Schaffner, chairman of the department of
preventive medicine at
Vanderbilt
University
medical school. That is exactly where it is being left, he said.
Greg
Reed, who runs
Maryland
's immunization programs, said the state health department has not reviewed the
advisory panel's recommendations but usually follows such advice.
There
are currently no plans to make this a school requirement, said Reed,
program manager for the
Maryland
Center
for Immunization.
A
preliminary study that gauged attitudes among 30 parents and 15 teenage girls in
the
Rochester
,
N.Y.
, area found them receptive to the vaccine if their doctors recommended it and
if they were assured that there were no side effects.
Most
parents said they would like to vaccinate their sons as well as their
daughters, said Dr. Cynthia Rand, an associate professor of pediatrics at
the
University
of
Rochester
's medical school who conducted the study for the CDC.
Gardasil
also protects against genital warts, and Merck is studying the impact of the
vaccine when it is administered to males. But the company has not asked federal
drug regulators to approve such use.
This
month, federal drug regulators approved sales of Gardasil, which studies found
to be safe and nearly 100 percent effective. Merck, the manufacturer, said it
has already shipped tens of thousands of doses across the country.
Cervical
cancer deaths in the
United States
occur far less frequently than in the past because of widespread Pap screening.
But most health experts have expressed enthusiasm about the vaccine's potential
to virtually eradicate the disease.
Liberal
advocates and government health officials have expressed concern that the
vaccine's price - 360 for the three-shot series - is far higher than that of
traditional vaccines and might be too costly for low-income women.
Mary
Mincer Hansen,
Iowa
's public health director and president-elect of the Association of State and
Territorial Health Officials, said states are being squeezed by the rising costs
of new vaccines with promising public health benefits. Her department plans to
ask the federal government for more money to cover the cost of vaccinating poor
and low-income residents.
We
need funding to support this new recommendation, she said.
Dr.
Joshua Sharfstein,
Baltimore
's health commissioner, said the city will try to get money from the federal
government to provide the vaccine for low-income females not covered by federal
subsidies.
That's
a major financing gap, he said.
The
federal Vaccines for Children program, which insures low-income children, is set
to begin negotiating with Merck for a discount on the price of immunizations for
9- to 18-year-old girls.
Private
health insurers had been awaiting the recommendations before deciding whether
and how to incorporate the vaccinations into their coverage. Similar reviews of
coverage for other vaccines have taken three months to a year.
If
it's a recommended vaccination that the medical community agrees with, chances
are it will have coverage upon review, said Mohit Ghose, a spokesman for
America's Health Insurance Plans, an industry group whose 1,300 members cover
200 million Americans.
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