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Why is HPV vaccine not mandatory?

The human papillomavirus (HPV) vaccine protects against HPV infections that can cause cancers and genital warts. While the vaccine is recommended for preteens aged 11-12 years by major medical organizations like the Centers for Disease Control and Prevention (CDC), it is not yet mandatory for school attendance in most places.

Is the HPV vaccine effective?

Yes, the HPV vaccine is very effective. Studies have shown the vaccine provides near 100% protection against the HPV types covered when given at the recommended ages. The vaccine protects against HPV types 16 and 18, which cause 70% of cervical cancers and precancerous cervical lesions, and types 6 and 11, which cause 90% of genital warts.

Clinical trials found the HPV vaccine was close to 100% effective in preventing precancerous cervical, vaginal and vulvar lesions, as well as genital warts, in women who received the recommended doses and had no prior HPV infection. Real-world monitoring data has also shown impressive impact – countries like Australia that have implemented HPV vaccination programs have seen cervical abnormalities decrease by over 50% in young women.

Is the HPV vaccine safe?

Yes, the HPV vaccine has a very good safety record. More than 270 million doses have been distributed worldwide over 13 years of use. No serious safety concerns have been identified.

The most common side effects are mild, including pain/redness/swelling at the injection site, headache, fever and nausea. Severe allergic reaction can occur but is very rare, estimated at around 1 in a million doses. Cases of rare neurological conditions like Guillain-Barré syndrome have been reported but have not been proven to be caused by the vaccine.

Large studies monitoring the safety of HPV vaccines continue to show they do not cause serious side effects or long-term health problems. Leading health agencies like the CDC and World Health Organization agree the benefits of HPV vaccination far outweigh any potential risks.

Why is the HPV vaccine not mandatory for school attendance?

There are several reasons why HPV vaccine is not yet mandatory for school attendance in most places:

  • It is a relatively new vaccine – first recommended for girls in 2006 and boys more recently in 2011. Newer vaccines tend to take more time to become universally mandated compared to older ones.
  • There was initial controversy and skepticism about the vaccine’s safety, morality and necessity. Some groups claimed it would promote sexual promiscuity.
  • It is mainly targeted at preteens (ages 11-12), an age group that has lower vaccine uptake compared to younger kids. Many parents hesitate to vaccinate children at this age.
  • HPV is not transmitted casually like measles or chickenpox. It requires sexual contact to spread, so some view HPV as less of an infectious disease threat.
  • The vaccine is expensive, especially when considering the 3-dose schedule required for full protection. This can be a barrier for universal mandates.

However, school entry mandates for HPV vaccine are becoming more common over time as evidence of the vaccine’s safety and efficacy accumulates and resistance declines. A growing number of locations now require HPV vaccination for middle school entry, including Virginia, Washington D.C., Puerto Rico and the Canadian provinces of British Columbia, Nova Scotia and Prince Edward Island.

What are the main arguments in favor of mandatory HPV vaccination?

There are several compelling arguments in favor of making HPV vaccine mandatory for school attendance:

  • Effectiveness – Mandating vaccination is highly effective at achieving high, sustained vaccine coverage compared to simply recommending it.
  • Health benefit – Widespread vaccination provides both individual protection and herd immunity against cancer-causing HPV infections that spread through sexual contact.
  • Equality – Mandates prevent disparities, ensuring all socioeconomic groups benefit from the vaccine’s cancer prevention effects.
  • Savings – HPV vaccination is cost-effective, saving money by preventing thousands of cancer cases. Mandated programs amplify these cost savings.

According to models, achieving 80% HPV vaccine coverage in 12-year-olds could prevent over 53,000 cervical cancer cases over 50 years. Targeted vaccination programs alone cannot reach such high, sustained coverage levels quickly without mandates.

Table 1: Projected Health and Economic Impact of 80% vs. 50% HPV Vaccine Coverage in 12-Year-Olds Over 50 Years

Outcome 80% Coverage 50% Coverage
Cervical cancer cases prevented 53,000 30,000
Cervical cancer deaths prevented 17,000 9,700
Genital warts cases prevented 508,000 287,000
Direct medical costs saved (millions) $8,000 $4,300

Sources: Chesson et al. Vaccine 2011; Jit et al. BMJ 2008

What are the main concerns about mandatory HPV vaccination?

There are some common concerns expressed about making HPV vaccination mandatory for school entry:

  • Safety – Despite extensive monitoring and safety data, some parents still worry that mass vaccination might uncover rare side effects not seen in clinical trials.
  • Necessity – Some argue HPV vaccine is unnecessary to mandate since it prevents an infection not easily spread in schools, unlike airborne diseases like measles.
  • Sexual morality – Socially conservative groups claim the vaccine may encourage premarital sex, sending the message that teens are expected to be sexually active.
  • Overreach – Some view mandated HPV vaccination as government overreach, infringing on parental rights to control their children’s healthcare.
  • Cost – The vaccine’s 3-dose schedule makes it more expensive than other mandated childhood vaccines. Cost can be a barrier for schools.

However, leading public health authorities point out there is strong evidence of HPV vaccine safety and effectiveness. They emphasize that vaccination provides protection long before sexual activity begins, does not change sexual behavior, and is a prudent public health measure against cancer-causing infections.

What are other key factors influencing HPV vaccine mandate policies?

Some other important factors impact whether jurisdictions impose school entry mandates for HPV vaccine:

  • Vaccine uptake – Places with higher voluntary acceptance of HPV vaccine are more likely to consider mandates. Under 50% of teens are up to date on HPV vaccination in the U.S.
  • Cancer burden – Areas with higher cervical cancer rates tend to prioritize HPV vaccination mandates.
  • Funding – Government funding to cover vaccine costs for the uninsured facilitates implementation of mandates.
  • Exemptions – Flexibility with non-medical exemption policies makes mandates more politically acceptable in some areas.
  • Recommendations – Consistent recommendations from major health authorities provide momentum for mandates.

National medical groups like the American Cancer Society and American Academy of Pediatrics now endorse mandatory HPV vaccination. However, some argue boys should also be included in mandates to prevent other HPV-related cancers and protect girls through herd immunity.


In summary, the main reasons HPV vaccine is not yet mandatory for school attendance include its relatively recent introduction, initial controversy, target preteen age group, prevention of a sexually transmitted rather than casually contagious infection, and high cost. However, arguments in favor of mandatory HPV vaccination are gaining momentum as evidence of the vaccine’s significant health impact and cost-effectiveness continues growing. While concerns persist around parental rights and government overreach, the precedent of mandating other newer vaccines like hepatitis B bodes well for wide acceptance of mandated HPV vaccination over time.