Young women can receive reproductive health care, birth control, abortions and other services at Planned Parenthood clinics - all without parental consent. But if they are under 18 and want a vaccine against the human papillomavirus, which can cause cervical cancer, they need family permission.
That leads to a lot of missed opportunities to protect women's health because teens may be reluctant to take up the matter with parents, said Assemblywoman Amy Paulin, D-Scarsdale, Westchester County. She is sponsoring legislation that would waive the consent requirement for minors. The vaccine is most effective when given to girls before they are sexually active, she said.
"They're in a Catch-22. They want the vaccine. They're sexually active. Planned Parenthood wants to be able to give it to them," she said on Monday.
In 2006, the U.S. Food and Drug Administration approved Gardasil, the first vaccine for cervical cancer, and the federal Centers for Disease Control's Advisory Committee on Immunization Practices recommended the vaccine be given routinely to girls 11 and 12. (It can be given to girls as young as nine and to females between 13 and 26.) The vaccine, manufactured by Merck & Co. Inc., prevents four types of cancer that cause about 70 percent of cervical cancer and 90 percent of genital warts cases.
The age group the FDA suggests should get the shots and the fact that it is most effective when given before the start of sexual activity make it controversial. Some believe that giving the immunization to children will encourage them to have sex earlier.
Paulin's bill is one of several HPV measures under consideration by the Legislature, including a separate proposal by Paulin to mandate the HPV vaccine be administered for all children born after Jan. 1, 1996. There are a few other bills on HPV, including one that would require the HPV immunization but permit parents to withhold consent for the vaccine.
Paulin does not have a sponsor in the Republican-led Senate for either one of her bills.
The state Department of Health is reviewing the specifics of Paulin's bill to waiver parental consent, said Beth Goldberg, a spokeswoman for the agency. "DOH welcomes working with the Legislature to remove the many obstacles which prevent timely access to this life-saving vaccine," she said.
As for mandating that HPV immunizations, "DOH does not believe there is sufficient evidence supporting the ability to appropriately implement an HPV vaccine school requirement at this time," Goldberg said.
Implementing such a requirement would be a "vast undertaking" and would be contingent on the ability of schools to manage the mandate, the availability of sufficient vaccine supplies, assurance of adequate insurance coverage and other factors, she said.
Sen. James Alesi, R-Perinton, Monroe County, said he has had discussions with Paulin about requiring the immunization. He said he is in the process of talking with the medical community and other groups to decide if he thinks the Senate should take up the issue.
States around the country are grappling with how to promote the cancer-fighting immunization and handle the controversy it brings about because it is caused by sexual contact. Besides moral objections, the cost of the drug and parents' right of refusal are other issues that come into play about the vaccine, according to the National Conference of State Legislatures.
As of last month, lawmakers in at least 41 states had proposed legislation that would mandate, fund or provide public education about the HPV vaccine, and at least 17 states had enacted legislation, the group said. Last year, a bill to set aside $5 million to promote the vaccine was signed into law in New York.
The state Health Department distributed 20,510 doses of the vaccine during the last two months of 2006 and 129,760 in 2007. They were given out through the Vaccines for Children Program, which receives most of its funding from the federal government and some from the state. Those shots mainly go to children who receive Medicaid or who are uninsured or inadequate insurance.
The vaccine is a covered benefit for women under 19 who have commercial insurance, Goldberg said. The state money approved for this fiscal year has gone toward promoting and expanding access to the vaccine for uninsured women 19 to 26, and additional funding is in the pending 2008-09 state budget, she said.
Six out of 13 Planned Parenthood centers in the Hudson Peconic region -- Westchester, Putnam, Rockland and Suffolk counties -- stock Gardasil, said Reina Schiffrin, president/CEO of the four-county Planned Parenthood. Four more will start giving it out this year, she said.
"New York State has really committed to fund us to do more, really help us with the education outreach and the funding," she said.
Most of the demand for the shots is for women between 18 and 26, since that is a large part of Planned Parenthood's client base, Schiffrin said. Because of that, parental consent hasn't been a big issue in the region, she said.
Source: Garnett News Service in PUSH Journal, 27 March 2008