For a time, Georgia was poised become the latest state to require preteen girls to be vaccinated against a virus that causes cervical cancer.
A powerful state Republican lawmaker proposed making the vaccine mandatory for girls entering sixth grade, and the governor included $4.3 million in his budget to make it available to some 13,000 girls whose family's insurance policies wouldn't cover it.
But state lawmakers nixed the plans after aggressive lobbying by religious conservatives, who argued that vaccinating young girls could promote promiscuity. The human papillomavirus that causes cervical cancer is transmitted through sexual contact.
Similar proposals were introduced in 23 other states and the District of Columbia, but only Virginia has signed such a mandate into law.
Proposals in many states died or were watered down to only provide parents with educational materials instead of requiring the vaccine. In Texas, Gov. Rick Perry signed an executive order requiring vaccinations for sixth-grade girls, but the Legislature then passed a bill blocking the order.
Over the past several months, a vaccine that once was hailed as a breakthrough to prevent cancer deaths has become embroiled in some of the nation's most politically-charged issues: teen sex, parental control, state mandates, a backlash against vaccines, and a suspicion of drug companies.
"It encapsulates so many issues that are at the core of politics and health policy right now," said Alina Salganicoff, director of women's health policy at the Kaiser Family Foundation.
The vaccine Gardasil was approved by the Food and Drug Administration in June 2006. The federal Advisory Committee on Immunization Practices followed with a recommendation that all girls be vaccinated at age 11 or 12. The three-dose treatment costs $360.
Cervical cancer kills 10 women a day in the U.S. and one in four U.S. women ages 14 to 59 is infected with HPV, according to a recent report from the federal Centers for Disease Control and Prevention. While Gardasil is not a magic bullet, it protects against the strains of HPV that cause 70 percent of cervical cancers cases.
With the vaccine potentially saving many lives, cervical cancer survivor Lori Grice said, she was "completely dumbfounded" that it had become fodder for the culture wars.
"If this were a vaccine for prostate cancer they would have to call in the National Guard to keep the men from storming the place," said Grice, of Statesboro, Ga.
Grice said she plans to have her 6-year-old daughter vaccinated when she's old enough. She said her daughter can "make every right choice," avoiding IV drug use and premarital sex, "but she can marry someone who's a carrier of HPV, develop cervical cancer and die."
The sponsor of the Georgia bill, state Sen. Don Balfour, has said it is a great thing for the health of women in the state.
"It's good for your daughters," he said in a February hearing.
Others saw the vaccine mandate proposals differently.
The religious conservatives did not want the government to mandate a vaccine for "something that is only contracted through sexual activity," said Sadie Fields, executive director of the Georgia Christian Alliance.
Some parents insist that they should decide when their preteen daughter should be offered a vaccine that involved a discussion about sex.
Moira Gaul, director of women's and reproductive health at the conservative Family Research Council, said her group doesn't oppose the vaccine, but doesn't want it required.
"We think parents ought to be given a choice about what is best for their children," she said.
Others were turned off by what they saw as heavy-handed lobbying by the drug's maker, Merck and Co. Critics saw a drug company trying to get rich.
And there were worries that not enough was known about the drug's long-term health effects. As ammunition, critics pointed to Merck's recall of its popular arthritis drug Vioxx because of increased heart risks. Merck has since said it will not lobby states for mandate bills.
Others argue politics is winning out over public health.
"It's really a shame that politics and ideology are getting in the way of saving lives," said Cantu Hinojosa, assistant director of government relations for the Planned Parenthood Federation of America. Hinojosa noted that the mandate bills — including the new law in Virginia — have opt-out provisions for parents who don't want their daughters vaccinated.
Still, Hinojosa said five states — Indiana, New York, North Dakota, Utah and Washington — have agreed to fund public education campaigns, which she said is a positive first step.
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