Case Study of the Human Papillomavirus Vaccine Controversy: When Should Vaccines Be Mandatory?

Background:
The dramatic decrease in vaccine-preventable diseases is largely attributable to state laws that mandate vaccination as a condition of school attendance. Traditionally, mandated vaccines related to the safety of the school environment, targeting diseases easily transmitted in school settings. The Human Papillomavirus vaccine departs from that standard because HPV is sexually transmitted, not transmitted by routine school activity.

Setting:
The AAP issued provisional recommendations for use of the HPV vaccine calling for routine immunization, but did not recommend it be mandatory. Several states considered whether to mandate the vaccine, but most chose not to do so. The Washington, DC Council requested an opinion from Children's National Medical Center (CNMC) before making its decision.

Population:
Washington, DC has some of the highest rates of sexually-transmitted infections and cervical cancer in the nation.

Project Description:
CNMC responded to the Council's request primarily through its Child Health Advocacy Institute (CHAI), which considered arguments for and against mandatory vaccination generally and for and against the HPV vaccine specifically. The CNMC Board of Directors, based on the CHAI's recommendation, adopted a policy calling for mandatory HPV vaccination following a waiting period of up to two years to conduct public education, ensure funding and develop an opt-out provision.

Results/Lessons Learned:
The policy became the basis for the law in Washington, DC when the Council voted to make the vaccine mandatory.