Despite Mandate Flap, State Has Offered HPV Vaccine for Years

Gov. Rick Perry's failed 2007 effort to mandate that girls in Texas be inoculated against a cancer-causing, sexually transmitted disease may have haunted him on the presidential campaign trail, but health providers say the state and federal governments' ongoing efforts to keep the HPV vaccine available to poor children for free is preventing thousands statewide from suffering the long-term effects of the STD. 

Though the Legislature shot down Perry’s executive order requiring 12-year-old girls to be vaccinated with Gardasil to prevent the transmission of human papillomavirus (HPV), the Department of State Health Services' Texas Vaccines for Children Program began offering the vaccination in February 2007. Over the last five years, parents have been able to have their children vaccinated for free if they qualify for Medicaid or are uninsured or underinsured.

State health officials do not track how many girls between ages 11 and 18 have received the trio of shots required for the vaccine to be considered effective, but they report that in 2011, the state ordered more than 308,680 doses at a cost of about $33.4 million — all but 1 percent of it paid for by federal funds. Those figures indicate an increase in usage from 2007. That year, when the program started, the state reported paying $22 million for 225,360 doses. In January 2010, it expanded the program to include boys.

In an e-mail to the Tribune, DSHS spokeswoman Carrie Williams wrote that her agency "added the HPV vaccine to the list of available vaccines because we follow the federal guidance, and the [Centers for Disease Control] added it to its recommendations [for girls in 2007 and for boys in 2010]."

It's not clear what role — if any — the governor may have played in getting the vaccine covered by the Texas Vaccines for Children Program, but DSHS is controlled by his appointees. In recent months, the governor has not shied away from criticizing the use of federal funds for initiatives like the Women's Health Program. (Perry and other GOP lawmakers are rejecting $35 million in Medicaid funds to prevent Planned Parenthood clinics from participating in the program.)

Still, some credit Perry with making HPV awareness a priority issue before August, when he backtracked while campaigning for the GOP presidential nomination. At the time, Perry called the way he tried to pass the mandate by executive order a "mistake."

Regardless, Dr. Javier Saenz, a family physician in the South Texas town of La Joya who treats mostly Medicaid and Medicare patients, credited Perry's early advocacy efforts. He also emphasized that parents and children have a choice whether to participate.

"HPV causes cervical cancer, and this is a good chance to prevent the younger generation from suffering," Saenz said.

Health experts say inoculation is important for children because HPV is a common STD that can lead to genital warts and life-threatening illnesses, including cervical cancer in women and penile cancer in men. Texas has one of the highest rates of cervical cancer in the country. The National Campaign to Prevent Teen and Unplanned Pregnancy estimates that about half of the state’s teenagers were sexually active in 2009.

Saenz said his clinic administers HPV shots to nearly 500 minors every year who would otherwise be unable to afford the vaccine.

“It’s preventive medicine down the road,” Saenz said. “It’s going to save tens of thousands of dollars. Can you imagine how much cervical cancer would cost the state for treatment? Surgery? Chemotherapy? Radiation? And the potential to spread [HPV] is incredible.”

When the state began offering HPV shots in February 2007, Gardasil was the only FDA-approved vaccine on the market. Since then, the state has added Cervarix, which is only available to females. So far, DSHS says, Gardasil makes up 97 percent of the vaccines it pays for; 3 percent are Cervarix. Both options are available through 6,800 providers in Texas, according to DSHS.

The vaccine isn’t cheap. DSHS officials say each dose of Cervarix costs $96.08, while the federal pediatric rate for Gardasil is $111.96 per shot. Multiply that figure by three shots, and the cost of getting fully vaccinated can exceed $300 per person.

Perry’s support for Gardasil was viewed with skepticism from the beginning by those who pointed out that the drug’s maker, Merck, had hired Perry’s chief of staff, Mike Toomey, to be its lobbyist around the same time.

When Perry proposed the mandate, he found himself at odds with his core base of social conservatives, who detested the notion of taking choice away from parents and said that making the shot available to minors would encourage them to have sex.

State Sen. Bob Deuell, R-Greenville, opposed Perry’s mandate but supports the vaccine as a prescription for a public health problem. As a family physician, he has given the shot to young patients, despite the awkward conversations that come up with parents.

“I lay out the pros and cons to the parents, and they make a decision,” he said. “In the long term, it’s going to reduce cervical cancer. By giving it to boys, it prevents them from infecting women.”

Deuell said he does not buy into any claims that Perry supported the vaccine to help a well-connected colleague in the drug industry.

“His heart was in the right place," he said. "We disagreed about the mandate, but he was just so wrapped up in eliminating this, I couldn’t criticize him for doing it that way."

Despite the vaccine being readily available and having Perry’s support, health providers offering the vaccine struggle to break through cultural barriers. Deuell and other health providers say discussing teen behavior with parents is a sensitive topic, with many parents still fearing the vaccine might encourage their children to be sexually active. 

At Nuestra Clinica del Valle, a federally qualified health center in Hidalgo County that serves mostly Hispanic and low-income clients, director Lucy Ramirez said the facility has long offered the vaccines to its clients, to no avail.

“We have a big problem,” she said. “A lot of our parents are not receptive and choose not to have their children immunized.”