School Mandates for HPV Vaccination: Public Health Law Making Amid Political and Scientific Controversy

Background: After the licensing in June 2006 of a vaccine against human papillomavirus, state legislators and policy makers considered a variety of measures to increase uptake of the vaccine. Bills to make the vaccine compulsory for school attendance were introduced in forty-one states. These proposals prompted contentious debates over issues such as immunization safety, adolescent sexuality, and the use of public health law.

Objectives: We sought to identify the most important factors influencing whether or not states adopted a law requiring girls to be vaccinated against HPV.

Methods: We conducted semi-structured interviews with 71 key informants, including legislators, public health officials, and stakeholder groups, in 6 states and at the national level.

Results: Respondents identified 8 factors that impeded the adoption of mandates or, in one case, led to the adoption of a weak mandate. Five of the factors were specific to the HPV vaccine itself: the newness of the vaccine, the sexually transmitted nature of HPV, the fact that HPV is not casually transmissible, the price of the vaccine, and discomfort with the manufacturer’s involvement in policy making. Three of the factors were related to the vaccine policy making process more generally: antipathy toward government coercion, anti-vaccination activism, and aspects of the policy making process itself.

Conclusions: Although points of consensus emerged among stakeholders, there remain fundamental disagreements about when vaccine mandates are appropriate. The legislative process, though it may contribute to transparency, may be a suboptimal venue for making immunization policy.